Adventures in [Crunchy] Parenthood

Essay on "What You Think is the Most Troubling Aspect of the Current State of Affairs Concerning Birth in the US"

2011-03-31T20:27:00.004-06:00

I think the most troubling aspect of the current state of affairs concerning birth in the US is the total loss of a cultural memory or understanding of the normalcy of birth in the life of a human female. While increasing numbers of American women are seeking safer, more natural alternatives to the typical highly-medicalized and managed birth, it remains within the context of a medical procedure. Even those women who seek out midwives and home birth do so with the caveats of “safety,” “technology,” and “professionalism.” The end result is that the natural childbirth movement is making a lot of noise, but not a lot of progress.

In the 1970s, the natural childbirth movement first began to catch on. However, the focus of the movement was on the reduction of intervention and the humanizing of the birth management process. Having been removed from the natural biology of labor and childbirth by a couple of generations at that point, women were not able to conceive of labor and childbirth outside the scope of medicine. So, even though many women began advocating for home births and midwives, the movement was still very much dependent on the medical establishment for information, support, and legitimization. In her book, Spiritual Midwifery, Ina May Gaskin, perhaps the movement’s biggest and most successful midwife, describes how she began learning to attend women outside of the hospital setting by studying from an obstetrics manual. She heavily relied on the book and the advice and support she received from a close obstetrician friend, and throughout her own accounts, speaks of doing several procedures which we now know to be at best unreliable, and at worst, physically harmful (such as measuring dilation through the anus, and routine episiotomy for breech presentation). The result of this skewed paradigm was that the natural childbirth movement of the 1970s did not accomplish its intended goal of returning childbirth to the mother. Because the focus of the movement was so limited, childbirth remained within the bounds of medical knowledge, only succeeding in forcing the medical establishment to respond to women’s demands by changing medical protocols, and introducing more “humane” procedures and medicines. The majority of American women continued to flock to the hospital to give birth, now more than ever attracted by the “natural” focus, while the medical profession worked to eliminate midwifery as a profession, thereby eliminating any competition.

Thirty years later, the natural childbirth movement has regained some steam. After thirty years of advancement in medical technology, the medical profession continues to dominate in labor and delivery, under the guise of safety and the illusion of choice. With the advent of the information age and the internet, women are now able to network, research, and study, and are learning exactly what each procedure and medication means and what its risks are. Once again, women are clamoring for the reduction of intervention and the humanizing of the birth management process, and yet still, women are unable to conceive of childbirth outside of the medical model. The focus is still on medical management of birth, and the current midwifery licensure movement reflects this. Mothers, midwives, and doctors alike, rather than trying to re-examine the childbirth model as a natural process, are seeking to legitimize midwifery as a medical profession. Now, medical organizations are bowing to outside pressure to legitimize midwifery, but with the stipulation that they can state the terms of licensure. Midwives are now being allowed to practice, but only under such restriction that most women will still be subject to medical testing and interventions, both at home and in the hospital. In addition, the movement for licensure is reinforcing the cultural identification of birth as a medical process which requires a licensed medical professional. Ultimately, no real or lasting changes will be made in the natural childbirth movement following this model.

As long as American culture continues to view childbirth as a process which belongs within the scope of medicine, no meaningful changes will be made. Some small, piecemeal concessions may occur along the way, some new forms of technology or less-invasive procedures will be developed, but birth will still be firmly in the realm of pathology. Women must shift their paradigm, and come to an understanding of childbirth as a normal part of human biology. They must take their understanding of the physiology of childbirth and remove it from its medical setting, and place it back where it once was, as a rite of passage and social event for women. Medical professionals, including midwives, must be relegated to the position of consultant, and their role in childbirth should be considered as an adjunct to the natural process of labor. Once women can re-frame birth, and birth professionals, in this light, they can begin to heal from the loss of generations of valuable knowledge. Once our culture begins to remember the true, unhindered physiology of labor and birth, they can then regain their autonomy, and be able to take advantage of medical technology in its proper sphere, rather than the other way around.

Low amniotic fluid is NOT an emergency

2010-10-17T17:58:00.008-06:00

Hey, guess what time it is? It's been a good while since I busted my last OB myth, but I think it's time to get that ball rolling again.

This time I am tackling the myth of "low amniotic fluid." It seems that the more silly excuses OBs give for induction get shot down, the more they like to come up with. What baffles me is how they can justify doing so, knowing all the literature out there that does NOT support active management in most cases...but they do anyway. And since the average pregnant woman in America has neither the time nor the inclination to go read a bunch of research articles, I have dedicated my precious time to doing it for you. Let's look at the issue:

Disclaimer: This post is discussing the merits, or lack thereof, of inducing labor for low AFI levels, at term, and in the absence of any other risk factors. I do not address preterm labor, preterm premature rupture of membranes, or congenital defects. If any of these things apply to you, then this post does not.

This website describes the basics of low amniotic fluid (oligohydramnios), or low AFI. The level of amniotic fluid is determined by measuring, by ultrasound, an estimate of the various pockets of fluid around the baby. This is important because too much or too much fluid might indicate some sort of problem. A fluid level of between 5 and 18 cm. is considered normal. The level of fluid cycles, and so can fluctuate daily, or even hourly. You may begin to see for yourself the margins for error with this diagnostic tool.

First of all, what's the big deal with low AFI anyway? Extremely low, and/or persistent low AFI can be associated with various congenital defects, such as uteroplacental insufficiency, congenital anomalies, viral diseases, idiopathic fetal growth restriction (FGR), premature rupture of the fetal membranes, fetal hypoxia, meconium-stained fluid, and/ or postmaturity syndrome. It can also contribute to malpresentations, umbilical cord compression, and difficult or failed external cephalic version. (ref) For these reasons, doctors have typically associated low AFIs with poor fetal outcomes. However, as Leeman and Almond discuss, "A number of studies over the past 15 years have shown an association between oligohydramnios and poor fetal outcomes. These were predominantly retrospective studies, which failed to control for the presence of factors known to be associated with oligohydramnios such as intrauterine growth restriction (IUGR) and urogenital malformations."

In other words, though low AFI might be associated with some of these conditions, it doesn't necessarily mean the baby is in any immediate danger with a low AFI, with no other indicators. That is, low AFI by itself doesn't really mean much. In addition, there have been several studies which also show no correlation between low AFI and poor outcomes. (here, here, here, here, among others)

Knowing this, it would make sense if doctors chose not to actively manage low AFI in the absence of any other factors, as it doesn't usually mean negative outcomes, but this is not the case. According to this survey, submitted to perinatologists across the nation, ninety-two percent of respondents consider isolated low AFI (IO) to be a risk factor for various adverse outcomes. With a favourable cervix, 82% would consider inducing labour without documented lung maturity prior to 39 weeks. When asked whether induction of labour in cases of IO reduces perinatal morbidity, 45% were unsure and 21.4% thought it would not. Only 33% believe induction could decrease adverse outcomes. So most of the respondents considered low AFI to be a risk factor of some sort (it can be), and a full 78% either didn't know or thought induction would result in improved outcomes (it doesn't). This is pretty consistent with my own (anecdotal) experience with different mothers I have come in contact with in my own personal life. In every case of mothers that I have personally known being induced for low AFI, there was not a single other supporting factor. In both this and this blog post, I have mentioned before that I believe that low AFI is more likely to be used as a convenient "medical" reason to induce a woman who is postdates, especially if she refuses an induction for convenience.

Questionable motivations aside, let's assume for a moment that low AFI by itself can mean serious problems for the baby. How does one determine a dangerously low AFI? It is assessed by using ultrasound to measure the levels of fluid around the baby. Naturally, this is not an exact science. Gloria LeMay, in her article, "Low Amniotic Fluid....I don't think so," she describes the process like this:

What the ultrasound technician is doing could be compared to viewing an adult in a see-through plexiglass bathtub from below the tub. In such a scenario, it would be difficult to assess how much water is in the tub above the body that is resting on the bottom of the tub. You might be able to get an idea of the water volume by measuring how much water was showing below the elbows and around the knees, but if the elbows were down at the bottom of the tub, too, you might think there was very little water. This is what the technician is trying to do in late pregnancy—find pockets of amniotic fluid in little spaces around the relatively large body of an 8 lb. baby who is stuffed tightly into an organ that is about the size of a watermelon (the uterus). If most of the amniotic fluid is near the side of the uterus closest to the woman’s spine, it can not be seen or measured. This diagnosis of low amniotic fluid frightens the parents-to-be into acquiescing to an induction of labour.

That is to say, it can easily be inaccurate. In the above referenced article from gynob.com, it is even admitted that ultrasound measurements can be wrong:

If there were to turn out to be a normal amount of fluid with rupture of membranes during an induction, then the low AFI that prompted the induction was either temporary or wrong. It happens, but ultrasound's the best thing we have to go by, even with its inherent error. (emph. added)

This article quotes a 1998 study, which concludes, "that indexing amniotic fluid by measuring the pockets of amniotic fluid...is 'a poor screening test' to identify infants at risk." In this article, several studies and factors can explain the inaccuracies inherent in this method of measurement:

Although the AFI is widely accepted as the standard to diagnose oligohydramnios in the United States,^[1] many studies have found it to be an inaccurate method for assessing the actual amount of amniotic fluid, especially in the lower or higher ranges.^[3,4,6-9] Rutherford et al.^[10] point that poor intra- and interobserver reliability may account for some of the low positive predictive value. Serial measurements have shown mean differences of 1 cm of amniotic fluid volume when conducted by the same ultrasound operator, and 2 cm variance in measures of volume when conducted by multiple operators. Variation can exist because of subjectivity of the ultrasonographer, the amount of pressure applied to the abdomen, and fetal position or movement.^[4] Additional variables that may alter AFI summation of the 4 uterine quadrants of amniotic fluid is the influence of the environmental temperature, altitude, maternal glucose control in diabetes, maternal hydration, and the status of the amniotic membranes.^[6](original linked references in article)

Many factors can influence the measurement of the AFI, not the least of which involve subjectivity on the part of the sonographer(s). Observing and approximating measurements through a solid surface, around a moving object, under constantly changing conditions, is a guess, at best.

So if induction for low AFI does nothing to improve fetal outcomes, what does it accomplish? In short, a higher risk of induction complications, including c-section.

"Although small and insufficiently powered, these studies suggest that isolated oligohydramnios does not appear to be associated with adverse outcomes, but it may cause fetal intolerance of labor, which does result in higher cesarean rates." (ref)

"In a case-control study by Conway, 183 low-risk, term parturients with oligohydramnios were matched to 183 women of similar gestational age and parity who presented in spontaneous labor. The patients with isolated oligohydramnios were induced and showed an increased cesarean delivery rate. The increased rate of cesarean delivery was not due to nonreassuring fetal surveillance and was attributed to the induction process (LOE: 2).²⁵" (ref)

"CONCLUSION: Active induction of labor in term low risk gestations with isolated oligohydramnios translated into higher labor induction, operative vaginal delivery and cesarean section rates. This led to increased maternal risk and an increase in costs with no differences in neonatal outcome." (ref)

"CONCLUSION: Isolated oligohydramnios is not associated with adverse perinatal outcomes. However, it increases the risk for labour induction and Caesarean section." (ref)

One other interesting note. In this article, the question is asked, " Is the increase in cesarean section secondary to fetal intolerance of labor from low AFI or the induction process itself?" I would submit that the question is moot. If the fetus is experiencing stress related to low AFI, would it make sense to add more stress by inducing? In either case, it is clear that induction is a strong contributor to another completely unnecessary c-section, and therefore, that induction for a diagnosis of low AFI is yet another unsubstantiated OB myth.

For more technical information and analysis of various studies and factors related to the assessment of oligohydramnios, check out these two articles: 1 and 2

Neither seen NOR heard

2010-10-09T09:08:00.007-06:00

Once again, mainstream parents have managed to shock me with the lengths they are willing to go to to avoid interacting with their babies.

Today's hottest "must-have" baby accessory

The latest trend on infant accessories is the car seat canopy. This is an outgrowth of the already-established practice of throwing a blanket over the top of a car seat, only these have straps to keep them attached. According to this website, some of the benefits to having one of these things include:

Protection from weather and wind
Darker/more secure environment for sleep
Privacy

You know, I just can't get over how oppressive and bizarre these seem to me. A friend on Facebook posted a link to unnecessary baby products, and I commented this ought to be one of them. Another commenter said this:

i covered up all my kids in the carseat and it was NOT because i didn't want to touch or look at my sweet kids. One would be crazy not to cover up their babies during a WI winter in the middle of 0 degree weather. When you have a newborn in winter the removable carseats are a lifesaver for keeping them warm on snowy/cold days.

While I agree with this, I have yet to see this thing in action during adverse weather conditions. I see them in the store, in church, and anywhere else you don't want to be disturbed by your baby's sights or sounds. I've seen car seats sitting on the floor or in carts, covered the entire 20 minutes, or even 2 hours. I've seen mothers and fathers *only* lift up the cover to give a bottle, and in some cases, prop the bottle and cover it back up again. I've heard babies crying and seen mothers and fathers furiously rocking the car seat without even lifting the cover. But as the above website claims, this is a good thing.

We want our babies protected from the wind and to be warm.

We want our babies to have privacy.

We want our babies to be able to sleep better.

Seems like I've heard and seen this philosophy before...

I believe it makes her feel secure so I try to cover her even though some times I forget.. It also keeps her warm.

I cover the sides to prevent drafts and keep [her] warm

It helps protect them from drafts, helps me to control the amount of light they get, and it seems to make them feel safer and cozier.

it will prevent light and may keep the cage warm. it makes your [baby] feel protected and safe.

I cover her...at night and she has no problem with it. On the contrary, it allows her to get some sleep while I'm up into the night working on book reports and such.

I think it is very important to cover [them]...... Not only do they get a SECURE sleep they need darkness & coziness.. Sleep is VERY IMPORTANT for their health

I only cover them when it's cold out seeing it can get 0 degrees in the winter...

Covering your [baby] doesn't stop them from hearing noises, it stops them from seeing things. My [baby] has a tendancy to start playing...

I got these testimonials from this website. It discusses whether or not to cover your PET BIRD.

Look familiar?

"But Emily," you might say, "How else am I going to keep my baby warm, protected from the weather, protected from germs, and asleep and quiet?" IDK, how about holding your baby?

It won't be long before we start covering their cages....er, cribs...too. Oh wait...

Oh, erm, well at least it's only used with babies. It's not like they will remember, and it won't scar them for life. Anyway, it is just a harmless way to keep them covered; we will stop using it when they get older.

Happy 2nd Birthday Ruby Lynn!

2010-07-10T06:37:00.002-06:00

Two years ago today, I had her in the early morning hours of Thursday, July 10, and had my birth story posted by that night. That's two of the nice things about a home birth: you don't have to worry too much about going "late," and you can lounge around on the computer, watching TV and eating your own food all day. So I wrote the birth story, but I have never been very happy with it.

See, I am a bare bones kind of person. I'm not terribly touchy-feely, and my writing tends to be more analytical than emotional. That is all well and good for research posts, but it doesn't lend much to a birth story. Here is Ruby's birth story, retold. It will probably be very long, so just grab a sandwich and settle in. If you don't want to read this whole thing, feel free to go back and read the first version, which is pretty cut-and-dry.

The perfect, unassisted birth of Ruby Lynn

I planned an unassisted birth with Ruby. I had been to see a couple of doctors and a midwife, but by the 25th week of pregnancy, I decided that I was not interested in sharing my birth with a paid professional, so I declined further prenatal care and finished the pregnancy doing my own prenatal care. I had been having Braxton-Hicks contractions since the second trimester, but around 36 weeks I started having prodromal labor. Prodromal labor is basically practice runs of the "real" labor. Two or three times a week, I would have regular, strong contractions for a couple of hours, then they would just peter out. This usually happened at night, so I was only sleeping 2-3 hours on those nights. In addition, I was peeing every hour, on the hour, and I suffered from SPD, a pregnancy-related connective tissue disorder, which made sleeping and rolling over virtually impossible. I tell you these things so you can understand where I was at the end of the pregnancy. And remember, these issues started worsening about a month before my due date.

I had a photographer friend come out to visit me during the two weeks around my due date. She was to take labor, birth, and newborn photos for me. Well, my due date came and went, and still no baby. We even went out on my due date to take maternity photos. (Word to the wise, don't wait until term to take maternity photos. It's not your best look.) Another week passed, and I still hadn't had the baby. The day came for her to leave, so I drove her to the airport, then drove over to my friend Jenna's house for some visiting. I spent 3-4 hours driving that day. When I woke up the next morning and tried to walk, all of a sudden I couldn't! Not only had my hips completely refused to work, a varicose vein that I had had for years suddenly decided to become a problem. I had sharp, stabbing pain behind my knee and in my hips every time I put weight down on a leg. It was not looking good. Between the varicose vein, the hip issues, the prodromal labor for going on 6 weeks, and the lack of sleep, I could not fathom how in the world I would get through labor. I couldn't walk, I hadn't slept in months, and the only cure to any of it would be to have that baby.

Ruby was doing great in there. She was so active all the way up to the day I had her, there was never any question of her well-being. I had also had the 20-week ultrasound, so as far as we knew, there were no congenital issues to worry about. My other children were all around the 7-8 pound range, so I had no fears about having a big baby (although I wouldn't have cared if she was 12 pounds. My mother had my 11-pound sister at home, so birthing a large baby was certainly no strange or fearful idea to me.) Ruby kept flip-flopping from transverse to head-down, which I am quite sure was the reason for all that prodromal labor. She didn't settle on a position until a few days before she was born.

Interesting fact: The entire pregnancy, we had planned on naming the baby Aaliyah Lily. Two or three days before she was born, Jeremy and I were laying in bed, and I told him I felt strongly that Aaliyah wasn't the right name for her. This really surprised him, since I told him when we settled on Aaliyah that I refused to change her name AGAIN (he is a picky baby-namer, we'd gone through hundreds of names by that point). But I said I felt that she should have a different name. I suggested the name Ruby, the name of a dear friend of mine. Then I realized that Ruby was also the birthstone for July, which I felt was auspicious, since she was due in June, but obviously wanted to come in July. So we agreed on Ruby. Then I suggested Lynn for a middle name because 1) it sounded like a good Southern name, 2) Jeremy's mother's middle name is also Lynn. So there you have it - she became Ruby Lynn at about 42 weeks pg.

Ruby clearly wanted her own birthday. I was due on June 23, which is my father's birthday. She did not come on that day. Then we passed July 1, which is Jeremy's little brother's birthday, as well as Darian's paternal grandmother's birthday. We passed the 4th of July, and July 5, her cousin's birthday. After that day, I began to suspect that she would never ever be born. I have a friend on the internet who had just 2 months prior gone to 45 weeks of pregnancy, so I set my sights on beating her for longest pregnancy.

Many long nights I was awake having prodromal labor. And many mornings I would wake up completely exhausted, and burst into tears that I was still pregnant another day. Every night I would say I didn't know how long I could continue in that kind of pain and exhaustion, but I would rather that than risk induction or cesarean section. I knew that being overdue in itself is not a high risk situation, and with no other indications of a problem, I could not justify putting the baby's health at risk for my own comfort. So I waited. and waited. and waited.

One night, I asked Jeremy to take pictures of my pregnant belly. I wanted to document how far along I was, and I thought it would be a nice change of pace to just play around. Just two days before, I heard that a woman in my church who was due A MONTH after me had her baby, and I was so depressed! I felt like I looked like a big fat cow, but I tried to have fun with it, and wondered how much longer it would be. We went to bed, and I tried to have a positive attitude about the next day.

42 week belly

I woke up about four hours later, at about a quarter to 4 a.m. to go to the bathroom. I was really surprised that I'd slept that long between bathroom breaks, but hey, I wasn't complaining. I got up and felt a distinct POP in my uterus. It felt exactly like water breaking, but I waited and nothing came out. I shrugged and limped off to the bathroom. While on the toilet, I had a contraction that was harder than contractions I had had before, but I assumed I was having another night of prodromal labor. I got up and made my way back to bed, because I figured I would at least get a bit of rest before I had to get up with Bella.

When I got to the bed, another contraction came on. I got on all-fours, just to rest while in the contraction. Now, at that time, we lived right behind railroad tracks. And right at the moment the contraction started, a train started coming. The sound and power, and movement of the train grew as the contraction grew, passed as the contraction peaked, and faded as the contraction faded. It was really cool. I don't know how I knew, but I somehow knew these contractions were different from the prodromal labor, and I knew I was in labor. I woke up Jeremy, and told him I thought I was really in labor this time. He mumbled something and fell back asleep. (He told me later that he figured it was another bout of prodromal labor.) I started gathering stuff between contractions, and told him to get up, it was really real this time! I went into the living room and turned on the TV, just in case it was going to be another teaser.

It was about 10 minutes and Jeremy still hadn't come out of the room. I started feeling like I desperately needed him to be near me, and it was that feeling that convinced me I was really REALLY in labor. I called Jeremy, and he finally came in to the living room. I hadn't bought any supplies for the birth except a drop cloth, but I didn't need it yet, so I told him to wait on that. I tried walking around, sitting down, but the only position that seemed the most comfortable was hands and knees. I wished at that moment I had bought an exercise ball to labor over, but I had to settle instead for the rocking footstool. I was laboring at one point in front of Jeremy, and during contractions, I would have him rub my shoulders, because it felt so relaxing and took my mind off the contractions, which weren't too painful, but were definitely powerful. (I kept asking him to rub harder. He did such a good job, my shoulders were bruised for a few days afterwards!)

I finally thought I should call my friends, who were going to be my labor support, to come over. It was probably 5:15ish by this point, and I was still very reluctant to call them and wake them up, just in case it was another false alarm. I finally decided to call Jenna first and ask whether she thought she should come over, since she lived about 30 minutes away. When I got her on the phone, she asked if I thought it was the real thing. I couldn't answer her because I was in the middle of a contraction! She said she would be right over, and she called Emily, my other friend, for me, to come over as well. I continued to have Jeremy rub my shoulders, and during this time, the contractions started changing from strong and powerful to painful and purposeful. I said to Jeremy, "I have no idea how women transport to the hospital in active labor. You could not pay me enough to get me down those stairs and into the car right now."

It is an interesting and indescribable sensation, transition contractions. It is usually at that stage most women have the feeling that they can't go on, and often the stage at which women begin begging for pain medications. Now, it can be very painful during that time, but more often, it is so purposeful that it feels overwhelming. It triggers the feeling of action - that you need to DO something. If you are at home, and have freedom of movement, it is easy enough to listen to that feeling. I can imagine that for women in the hospital (as it was for me in previous births), being strapped into a bed at that moment would be frightening and create a "caged animal" feeling. Well, in my case, they were definitely painful. I knew now was the time to just hang on and relax, and try my best to get through the contractions until it was time to push, which I also knew would not be long, if I was in transition.

I was well into transition when my friends came in. I never timed a single contraction, but Jeremy told me later that they had gone from 5 minutes apart to 2 minutes apart during that time. I was never afraid of labor in any of my births before, and this was no different. Pain doesn't scare me, and there's only one way to get a baby out, and it's by having labor. I never doubted that I would get through it, or that it wouldn't last forever. I just kept on getting through the contractions, and waiting for it to be over.

Interesting fact: I hadn't vacuumed my carpet in a few weeks by the time I went into labor, with all the mobility problems I'd had. While laboring on my hands and knees, I couldn't help but see how dirty the carpet was, and I was terribly embarrassed about it. When my friends came over, near the end of my labor, I even apologized to them for the messy house between contractions! Right after the birth, Jenna offered to vacuum my carpet for me so my house would be presentable for family when they came to visit.

When Emily and Jenna got there, they took over shoulder and back rub duties for Jeremy, who was getting awfully tired. Emily knows something about massage therapy and reflexology, so she worked on some "pressure points" to help the baby move down, but Ruby was moving down just fine, so I told her to stop as soon as she started. I could feel that baby moving down fast, and it just hurt worse and worse, the lower she went.

As she moved down, I inevitably had to use to bathroom. I was glad to go, because I definitely did NOT want to use the bathroom while pushing, and I also knew that many women say they prefer laboring over the toilet. So I asked Jenna to go with me, in case I needed labor support for contractions. I got sat down on the toilet and a contraction came, and holy cow that HURT. Now, the labor up to that point had been painful, yes, but bearable. I would describe that one contraction as gouge-your-eyeballs-out painful. Clearly laboring over the toilet was not for me.

We moved back into the living room where I continued to labor on all-fours. I thought a few times about asking someone to grab the camera and take pictures during labor, but I didn't want them to stop rubbing my back! I didn't have back labor or anything like that, it was just very nice as a way to distract from the contractions and help me feel supported. Some time during the labor, someone (maybe me? I don't remember) spread out the drop cloth and put down a bunch of old sheets. Also, during the labor I was burning-up hot. I had them crank down the AC as far as they could stand it, and Jeremy got our box fan out to blow right on my face. I don't remember him putting it up, but it was gone by the time the baby came.

My arms and legs were shaking and sore from laboring on all-fours for two hours by this point. Also, because the baby moving down was painful, Jenna suggested I tried a different position. She asked if I would like standing up. I wasn't sure, but I was willing to try. I stood up with Jenna and put my arms around her neck. As soon as the next contraction hit, there was a sharp pain and I screamed NO! and dropped back down. At the exact same time, my water broke. However, only a small amount of fluid came out, probably because she was engaged in the pelvis, so everything else was behind her.

I should mention at this point that I was being very loud. In my previous labors in the hospital, I had always been very quiet and introspective. I never made any, or very little, noise, and did not speak unless spoken to, at the end of my labor. At home, I suppose I felt less inhibited, so I just made whatever noise came out, but most of it was moanings of various intensities. By the end, however, after I stood up, I was straight up hollering. Not screaming or freaking out, but full-voice, almost singing. I watch videos of other women in labor and I am jealous at how quiet and serene they are. I almost feel as if I wasn't doing it right by being so vocal, but I guess you do what you have to do get through it.

During that loud laboring, Darian woke up and came out into the living room. She asked, "Uh guys, what's going on?" Jeremy said, "What does it look like, Darian?" She said, "Labor?" Then she rolled her eyes and said, "I'll be in my room," and she stayed there for the rest of the time. She told us later that it wasn't my noise that woke her up, but a bug bite. She only realized after she was awake that something was going on out in the living room. Thankfully, Bella did not wake up.

I was back on all-fours, and had one loooooooooooong contraction. That one contraction is the only time during my labor that I thought there is no way I can get through this. That contraction had to have lasted three or four minutes, and I felt that baby barrel her way down the birth canal. But I hooted and hollered through it, and as soon as it ended, I felt my whole body bearing down. I like how Rixa described it on her blog as "throwing down" instead of "throwing up" - that feeling that your entire body is working to expel something, but in the case of labor, it is coming down instead of up.

During that one long contraction, Jeremy was kneeling next to me, whispering into my ear, "You can do this. You got this. Come on." (He knows I enjoy guy-type motivation, and he was giving me exactly that.) Once it was over, I got quiet, and started bearing down. Jenna and Emily were behind me. The girls asked Jeremy if I was pushing. He leaned over and looked at me bearing down and said, "Oh yeah, she's pushing!" Meanwhile, I felt her crowning. I felt that good ol' ring of fire, but it wasn't terrible; I knew it would only sting for a second while everything stretched. In the next push, her head was out. I waited for a second, then something was painful in there while she was doing something, I couldn't figure out what. (Jenna told me later she was rotating at that moment.)

The three of them then started having a discussion about how exactly they should catch the baby. I could hear them talking about it, but I didn't bother trying to tell them to not worry about it. I had planned to catch my own baby, but realized in that second I would need to brace myself with my arms, so I lowered my butt down closer to the floor and planned to birth onto the sheets. While they were figuring out what to do, I was already pushing again, and before anyone knew what I was doing, she was already halfway out! Then all three of them reached in to scoop Ruby up, who had halfway landed on the floor, and was somersaulting the rest of the way out. Emily and Jenna helped wrap Ruby up in a towel while I fell forward onto my stomach on the floor.

I laid there on the floor for a minute, stunned and amazed. I couldn't believe it was finally over, but not the labor - the pregnancy! I was so blissfully ecstatic that I was done being pregnant that that was all I could celebrate for a minute. I swore a couple of times in exultation and just laid there, enjoying laying on my stomach, and being glad to finally be off my hands and knees. After a minute or two, I got back up, and Jeremy and Jenna passed Ruby to me between my legs as I sat back against the couch. Someone asked me if we needed a bulb syringe or anything for Ruby, but I could see instantly that she was healthy and purple and awake and aware, so I said she was fine. Jenna had the presence of mind to immediately grab the camera and start taking photos.

Moments after the birth

Ruby Lynn was born just before dawn, at around 6:18 am. The total labor was about 2 1/2 hours long, and there were absolutely no complications, or anything interesting at all about the whole thing. She came out head-down and anterior, in three pushes, and with no tearing.

After about 5 minutes of sitting there, another contraction came and the placenta came sliding out. It felt kinda weird, but not at all painful. Jenna scooped up the placenta into a bowl, as we had originally planned to do a lotus birth, in which you leave the placenta and cord attached until the whole thing falls off together, usually within 3-4 days. Jenna also helped me get cleaned up while Emily and Jeremy went around cleaning up other things around the apartment and grabbing more towels and sheets for clean up. Ruby was sucking on her hand and rooting around, so I offered the breast, and she latched on perfectly right away. I was so relieved and amazed, as Bella had taken a very long time to learn how to breastfeed. I laid back and let Ruby just get the hang of it. While I was looking at her, I was thinking how glad I was that we renamed her a few days before. She absolutely looked like a Ruby.

After about an hour, I wanted to get more comfortable. They helped me up onto the couch, where I sat and nursed Ruby another hour or so, while they cleaned up everything. It really wasn't that messy. There was obviously blood and fluids on the sheets I birthed onto, but they were easily bundled up into a trash bag. There was no mess anywhere else, so there was no cleaning to do otherwise. (There did end up being some slight mess on the couch cushion later, but it cleaned up very easily with a bit of vinegar and baking soda.) Emily boiled up the herbal bath for me while I just recuperated.

Enjoying my new baby

After a while, I was coming out of my baby-haze, and I was feeling ready to clean up properly, and was curious to know Ruby's stats. So I asked Jenna and Darian to help me weigh and measure her. Darian had some out some time after Ruby was born, I'm not sure when, but she was more than happy to help with the baby once she was here. Darian fashioned a little pouch out of an old pillowcase, and they stuck Ruby in the pouch and hung her from the little fish scale we'd purchased a week earlier. The scale isn't terribly accurate, but she looked to be about 8 3/4 pounds, so we called it 8.12. We measured her head at about 15 1/4 inches, so there was my answer as to why her coming down was so painful.

I gave Darian the task of dressing her while I hopped in the herbal bath. I cleaned up in the bath and assessed any damage (there wasn't any.) If you have never heard of an herbal bath, I strongly urge you to go buy some right now. It was amazing and warm, soothing and healing. It reduced perineal swelling and was totally relaxing. And it smelled wonderful.

After the bath, I got dressed and relaxed in the living room. Jeremy was holding Ruby at this time, and he asked if we could go ahead and cut the umbilical cord, since it was somewhat of a pain to maneuver the placenta and bowl around the baby. It had been 2-3 hours since the birth, and I decided I did not have my heart set on a lotus birth, so I said he could go ahead. (It also meant a lot that he was asking to cut the cord, as he had previously been extremely squeamish about it. At Bella's birth, he told the doctor to not even ask him to cut it.) I am ultimately glad that we did cut the cord, as I went on to use the placenta in capsule form, which helped immensely in the postpartum period.

After a little while, Jenna and Emily asked to see Ruby, and Bella woke up. So everyone finally got to meet the new little one.

Sisters meeting for the first time

Jenna meeting her little chublet

I couldn't have asked for a better birth. In a way, emotionally this birth wasn't much different from my hospital births. I had always ignored the staff around me and done my own thing anyway, so I already felt very confident in listening to my body. But the difference was NO HASSLE. No needles, tubes, machines that go Ping!, nurses, doctors, strangers, vitals, meds, beds, smells, stupid questions or irritating orders.

For a long time after Ruby's birth, I felt as if I did everything "wrong." The labor was fast, it was painful, I made a ton of noise, and nothing about it seemed particularly spiritual or life-changing. I had none of the usual cultural rituals surrounding childbirth, such as going-home outfits, footprint certificates, or official visitors. And on top of all that, I could not share my birth story with anyone without getting that, "Are you crazy???" look. It is a sad statement on the state of birth culture in our country when a woman who births naturally, in her own environment, following her human instinct, surrounded by her loved ones, is considered the weirdo.

In any case, it has taken me a good while to understand that a birth experience doesn't have to be anything but what you want it to be. My birth doesn't have to be new-age-y, magical, ethereal or painless for it to be meaningful, and it doesn't have to be supervised, technological, or professionally observed to be safe and successful. In other words, my birth was exactly what it needed to be for me: normal.

Happy Birthday dear Ruby!

Top 10 Mormon Myths

2010-01-21T18:15:00.005-07:00

I am a convert to the LDS church, otherwise known as the Mormons. I was not raised in any one religion, and was never baptized, as my parents wanted me to choose to be baptized when I was old enough to make that decision. We visited lots of churches growing up, and I visited many more with my friends over the years. While I felt that all of those churches were nice enough, and the people were nice too, I felt that they were right about some things, but very wrong about other things. I can't explain how I knew what was "right" and what was "wrong," but I always had a picture in my head of what the True Church of God would look like, and none of these were it. Now, of course, I know I was recognizing the Light of Christ that all of us are blessed with.

So, when I was pregnant at the age of 17, I decided I needed some churchin' in order to be a good mom. I'd been to most other churches and already knew I didn't agree with everything they taught. So I asked God to help me find the right church. I looked in the phone book and came across the LDS church. It was one of the only churches I'd never visited. I called them up, and was invited to come over and meet with the missionaries to learn more about the church. From the moment the Elders opened their mouths I recognized this church as the one I'd always been searching for! I was baptized fairly quickly after that, much to the dismay of my poor mother, who had been raised Church of Christ. Having joined the church in the South, where Mormonism is virtually unheard of, I encountered many myths and assumptions about the church that surprised and entertained. Here are 10 of the most common (untrue) questions or statements I have heard about the LDS faith:

1. Mormon? What is that?

www.mormon.org

2. Aren't you those guys that have multiple wives?

No. Although the church did practice polygamy in the beginning, it was done away with as an official mandate in 1890, and was made punishable by excommunication in 1904. (More on polygamy and LDS)

3. Mormons don't believe in the American flag.

Nope, that's Jehovah's Witnesses. In the early days of that church they chose not to salute the flag, as it might constitute idolatry, but is not an official doctrine of their church to reject the flag entirely.

4. Aren't you those annoying people that come to the door and give me Watchtowers?

Nope, that's Jehovah's Witnesses again. Although Mormon missionaries do go door-to-door sometimes, their aim is slightly different. Mormon missionaries are usually young men, ages 18-21, who go out in pairs dressed in their suits to teach about Jesus Christ, to introduce the LDS church and its beliefs, and to testify of the truthfulness of the Book of Mormon. There are also female missionaries, aged 21-23, who also go out in pairs. The men are called Elders, (in reference to their priesthood office, not their age), and the women are called Sisters.

5. Mormons don't believe in the Bible.

Not true! LDS use 4 standard works of scripture for doctrinal study: the Bible, the Book of Mormon, the Doctrine and Covenants, and the Pearl of Great Price. "We believe the Bible to be the word of God as far as it is translated correctly; we also believe the Book of Mormon to be the word of God." (ref)

The Book of Mormon is a translation of the records of people who traveled from Jerusalem to the new world (Americas), and their history and teachings regarding Jesus Christ. It is, in fact, subtitled "Another Testament of Jesus Christ"

The Doctrine and Covenants is a collection of important or pertinent revelations and teachings given to various early church leaders, and includes the revelations and teachings of Joseph Smith on various doctrinal subjects.

The Pearl of Great Price is a small additional set of scriptures that comprises several small sections that are doctrinally related, including additional scriptures authored by Abraham and Moses, some sections of Bible that were re-translated by Joseph Smith, part of Joseph Smith History, and the Articles of Faith.

6. Mormons aren't Christian because they worship Joseph Smith.

Again, untrue. The name of the church is The Church of Jesus Christ of Latter-Day Saints, or LDS for short. President Gordon B. Hinckley said it best when he said:

"We do not worship [Joseph Smith]. We worship God our Eternal Father and the risen Lord Jesus Christ. But we acknowledge the Prophet; we proclaim him; we respect him; we reverence him as an instrument in the hands of the Almighty in restoring to the earth the ancient truths of the divine gospel, together with the priesthood through which the authority of God is exercised in the affairs of His Church and for the blessing of His people." (ref)

7. Mormons aren't Christian because they do not believe in the Holy Trinity

While it is correct that Mormons do not believe in the doctrine of the Holy Trinity, that does not make them any less Christian than the original 12 apostles. The doctrine of the Holy Trinity is not actually mentioned anywhere in the Bible, nor is it taught. The idea of a "Holy Trinity" was debated and settled at the First Council of Nicaea in the 4th century. After Christ and all the apostles had died and a couple of generations had passed away, no one was entirely sure exactly *what* Jesus had taught on every issue (remember, they didn't have a collected body of written works to refer to!), so they called this council to settle it out as best as they could figure. In any case, there are plenty of places in the Bible where God and Jesus Christ talk to and refer to each other as separate and distinct entities, and also places where the apostles and other people are described "as one." I highly doubt God intended the 12 apostles to be recognized as the "Holy Duodenary."

8. Mormons don't drink coffee.

Okay, this one isn't a myth, but is definitely a genuine point of curiosity. We do not drink coffee or alcohol, consume tobacco or use illegal drugs, and generally try to consume healthy foods and exercise regularly. This doctrine was taught as the "Word of Wisdom," and was a revelation given to Joseph Smith by God about how to properly take care of our bodies. And as modern science now confirms, coffee, tobacco, and alcohol are three significant risk factors in developing heart disease, liver disease, high blood pressure, diabetes, stroke, and other serious conditions. Science also confirms that LDS members who observe the Word of Wisdom have lower rates of all the above conditions. (More on the Word of Wisdom)

9. The Mormon church hates women.

As a woman, I can happily say this is not at all true! The LDS church is organized into a patriarchy, with only men holding priesthood callings. However, women also hold leadership positions in auxiliary groups such as Relief Society (the women's group), Youth organizations, and other adjunct offices. In fact, the Relief Society is one of the oldest, and is currently the largest women's organization in the world. On the whole, the LDS church strongly emphasizes the divine nature of women, and demands that women be treated with the utmost respect and gentleness. From The Family: A Proclamation to the World, the First Presidency of the church officially declared:

Happiness in family life is most likely to be achieved when founded upon the teachings of the Lord Jesus Christ. Successful marriages and families are established and maintained on principles of faith, prayer, repentance, forgiveness, respect, love, compassion, work, and wholesome recreational activities. By divine design, fathers are to preside over their families in love and righteousness and are responsible to provide the necessities of life and protection for their families. Mothers are primarily responsible for the nurture of their children. In these sacred responsibilities, fathers and mothers are obligated to help one another as equal partners. Disability, death, or other circumstances may necessitate individual adaptation. Extended families should lend support when needed.We warn that individuals who violate covenants of chastity, who abuse spouse or offspring, or who fail to fulfill family responsibilities will one day stand accountable before God.

10. I heard that Mormons wear magic underwear.

While we do wear a specific type of undergarments, they are by no means "magical." (Although if they were, I would pick the ones that make me appear skinnier than I am.) We wear these undergarments as a symbol and reminder of God's laws regarding virtue and chastity, in the same way many Christians wear a cross to remind them of Jesus Christ's atoning sacrifice.

So now you know! If you have any other questions or concerns, please feel free to ask. You can also visit the above-listed website, www.mormon.org, for more information.

Nutty as a fruitcake

2009-12-01T20:09:00.004-07:00

Typical citron fruitcake - the "yucky" kind

It's true; I am certifiably crazy. I love fruitcake. Not just like it, or merely tolerate it, but LOVE fruitcake. I make my own fruitcake, and Darian has named me that "crazy lady in the ward who makes fruitcakes and gives it to unsuspecting young moms." Now before you go telling me how nasty fruitcake is, let me tell you a little secret: there are two kinds of fruitcake. The one you are thinking of is the one with all the little candied fruit bits that have a weird flavor. Granted, it does have a weird flavor, but honestly, I love that kind too (don't ask me why). But what you are really missing out on is REAL fruitcake. The fruitcake most people know today is full of little processed, candied fruits which have a flavoring called citron added to them. That's the weird/gross/funny taste most people complain about. REAL fruitcake is made with just plain dried fruits and nuts, and can be customized to suit your particular tastes.

Fruitcake is found in many cultures, and dates back at least as far as Roman times. Fruitcake is basically a pile of dried fruits and nuts, suspended in a small amount of flour and eggs. It has virtually no fat, and does not contain milk. Because of this, and the fact that the fruits and nuts are already preserved, this loaf can be carried and kept for a very long time, without refrigeration. You can imagine how useful this would be to ancient peoples, especially soldiers and travellers. It is a brilliant way to get a lot of protein and energy foods in one meal that can conceivably last for months on the road. And it's really freaking delicious.

If you never liked or tried fruitcake before, I suggest you try this recipe to see what fruitcake is really all about. Or you can just call me; I would happy for an excuse to make more, as I have already almost eaten a whole loaf myself. Feel free to put whichever fruits and nuts you prefer. As for me, I like a tropical fruit mix. It is thought that the longer fruitcake sits, the better the flavor gets, so feel free to let it sit for a while before serving. (Unless you're like me, and can't wait that long to get your hands on it.)

* A word of warning about the cook time: because it is so dense, it must be cooked for a long time to make sure it cooks through the middle. Because it cooks for so long, it can get pretty dark. If you prefer your baked goods lighter, just divide the recipe up into smaller pans, so it cooks through faster.

Not Your Grandmama's Fruitcake

2 c. dried tropical fruit mix (pineapple, mango, and papaya)
2 c. dried dates, chopped
1 1/2 c. pecans
1 c. raisins
1/2 c. red marachino cherries
1/2 c. green marachino cherries
1/2 c. shredded coconut
1 c. flour
1 c. sugar
3/4 t. baking powder
3/4 t. salt
1 1/2 t. vanilla
4 eggs

Heat oven to 300° F. Line large loaf pan (9 x 5 x 3) with aluminum foil; grease foil with shortening.

Mix all ingredients. Spread in pan.

Bake about 1 hour 45 minutes, or until toothpick inserted in the center comes out clean. If necessary, cover with aluminum foil during the last 30 minutes of baking to prevent excessive browning.

Remove fruitcake from pan, in the foil, to a cooling rack. For a glossy top, immediately brush top with light corn syrup. Allow loaf to cool completely and become completely firm before cutting, usually about 24 hours. Wrap tightly and store in refrigerator for up to two months.

My Old Kentucky Home, Conclusion

2009-11-09T23:17:00.003-07:00

Some of you may remember when I went in May to visit my grandmother in Kentucky. I am sad to say that Grandma Nannie has passed on, and the matriarch of our family is gone. Her death was unexpected; she simply failed to wake up from surgery. Granted, she was getting up in years, but she was still very much independent, ornery, and getting around. She was an amazing woman, strong, stubborn, and couldn't care less what anyone else thought. She was self-centered and deeply loyal, and had a personality that wouldn't quit. Nannie always loved us grandchildren more than anything else. I can safely say that each one of us would say that we were her favorite.

Jacquelyn Harton was born April 1, 1932. She grew up in Paducah, Kentucky, and met my grandfather at a high school choir festival. She told me that was the only time in her life she was so forward (I highly doubt that), and she went up and asked my grandfather his name. She skipped lunch to watch him sing, and he had a beautiful voice. My grandmother played piano, and so they raised a very musical family. They had 6 children: Carl Kelly (my dad), Craig, Jim, Jenny, Ken, and Julie. Their children had 15 grandchildren: Samuel, Emily (me), Anna, Cara, Sara, John, Cassie, Molly, Andrew, Shawn, Christopher, Elinor, Ian, Joseph, and Jenna. Their grandchildren have at least 10 great-grandchildren, and counting: Darian, Benjamin (not his real name), Isabella, Ruby, Alaine, Cullen, Sadie, Shelby, Emily, and Bentley.

She leaves behind her sister Jerrie. She had another sister, Jenna, who was killed in a car crash at the age of 16. Her husband, Carl Mabry Howard, died in 1988. Now she can be reunited with her loving husband and her sister, whom she has missed all these years. Tomorrow I fly out to Kentucky to pay my last respects, and mourn the end of an era. I don't know if anyone could fill those shoes, but I hope that I can live my life in such a way that she will always be proud of me, and that I can bring honor to the Howard name. I love you Nannie!

More non-runner's guide to running

2009-09-29T09:33:00.003-06:00

Since I wrote my last post on tips for non-runners to get into running, I have thought of more tips, and thought I would share them with you:

- Invest in an iPod. Download your favorite tunes, preferably upbeat ones. Fast, happy music will not only motivate you, but help to keep your mind off the anxiety or any other mental interruptions you may experience while running.

- Running is a mental exercise, not a physical one. Okay, well it *is* a physical exercise as well, but that is the easy part. Your legs have already been carrying around the 200, 250, 300 pounds you have now, so they will do the job just fine. What you must really conquer is the mental exercise. You will think "I can't do this," "This is crazy," "I'll just give up in a week," "I'm too fat for this," "I'm too old for this," "I hate everything jiggling," "I look ridiculous," "Those skinny joggers must think I'm a fat lard," "What do those cars driving by think of me?" "My legs hurt," "I can't breathe," "I'll never make it." Those types of thoughts will drive you into the ground. The hardest part about running, especially if you've never done it before, is ignoring those negative thoughts and keeping your eyes on the prize. For me, I was especially self-conscious of the fat jiggles, and running by much skinnier people. I changed my attitude, and instead of feeling dismayed about the jiggles, I ran harder, because I figured the harder I run, the faster I will stop jiggling. As for the skinny joggers, I just reminded myself that they are probably proud of me for trying to get healthy, and I look at their bodies as a motivator for me, because I hope someday I will look like that.

- If you think you're going to die, don't worry, you won't. Of course, if you feel serious warning signs, such as sudden chest pain, vision problems, or other such issues, you should definitely get checked out. Also, if you haven't seen a doctor in a while, you should get a check-up before starting an exercise program just so you know if there are any existing factors you need to be aware of. That being said, remember that you are probably way out of shape. Expect to feel light-headed, nauseous, short of breath, tired, achy, and sore. These feelings are okay and will not kill you. One reason I did not run for many years, is because I would start feeling out of breath and light-headed, and I would stop, thinking I was doing something harmful to myself. In reality, I was just out of shape, and needed to push past that anxiety to build my strength and endurance. Again, if you feel you have a serious medical issue, please get it checked out. But remember that while you might feel like you will harm yourself, exercise can only do you good, if you work hard.

(This is NOT medical advice, but it worked for me. It's probably not even good for you, but what I did is take 2 ibuprofen every night when I went to bed for one week. That way, I woke up and did not feel the soreness from the workout the day before. After a week, I was no longer sore, and stopped taking the ibuprofen. If achiness is a stumbling block, and you have no pre-existing medical conditions that would preclude it, consider taking a pain reliever to help you through the first week or so.)

- Pay attention to any persistent, localized aches or pains. If you have a nagging soreness suddenly appear, or one particular spot that bothers you, you may be doing something wrong with your mechanics. For example, my knee starting bothering me out of the blue. I've never had trouble with my knees, and had been running a little while before, so I didn't think the running was causing it, but I wasn't sure. So I starting paying attention to my activities throughout the day, and realized that when I was taking the girls on my morning walk in our big, old, behemoth of a stroller, I was putting too much pressure on my knee when trying to turn the stupid thing. Once I stopped twisting at the knee for that particular move, it stopped bothering me. If you have an ache in your shoulders, maybe you are bunching your shoulders while you run? If you have pain in your heel, maybe you are pushing off too hard with your toes, putting strain on that tendon? Listen to your body and work with it.

- Fake it 'til you make it. That is a saying used in many programs in which people are trying to make major changes in your life. It won't be easy. You relate to your family and friends, and they relate to you, the way you are now. Your life, schedule, job, and activities are all based on your lifestyle right now. If you change your lifestyle, ALL of that must also change, and it is NOT EASY. You may have to decide if some of your relationships are continuing to encourage unhealthy habits. You may have to learn new concepts and change the way you think about things. Even your house will change, as you bring new things in and put old things out. This kind of change is not comfortable or easy. It's like buying a new pair of cute shoes. They are super-cute, and you know they will go perfectly with that one outfit. But the first time you wear them, they rub your feet in all the wrong places, and you have to wear them for a while to really "break them in." Changing your lifestyle is like that. You just have to keep telling yourself that once you break in that new lifestyle, it will make you look and feel like a million bucks. That's why you have to "fake it" for a little while. It might not feel normal or comfortable, but it will eventually become a habit, and then a part of your life. Hang in there!

- Make variety your watchword. I have about 15 different routes of varying lengths that I run, depending on my mood and energy level. Keep yourself from getting bored. Keep looking for new places to explore, and have several options available to you, so you don't feel stuck on one particular route.

- It takes a long time to change, be patient. It took you 20, 30, 40, or more years to establish the lifestyle you have now, you won't be able to change it in a month. Plan on losing maybe 5-6 pounds a month, on average. For me, that means at least 10 months of exercise and diet to get to my target weight. That's nearly a year. That may sound depressing, but remember that you are making changes that will last a lifetime, and that is worth the time you invest to make it happen. Try not to get discouraged if you don't see big changes happening right away. Just remember why you are doing what you are doing, and just keep at it, and one day, you will go into the store to buy new clothes, and realize that all of a sudden, you have to shop in the regular sizes section. That's a great feeling! Don't give up until you get there!

I hope these tips I have shared with you will help you to be more successful in implementing exercise into your life. I am enjoying running now, something I never thought would happen in my lifetime. I can see changes in my life and my body. I still wish it would go faster, but all I can do is just keep running. I know if I keep working hard, it WILL pay off in the end. Good luck to you!

The non-runner's guide to running

2009-09-08T08:36:00.003-06:00

When I tell people I get up at 5:15 in the morning and run 4-5 times a week, I get two common responses: "Oh, I hate runnning," or "Oh, I could never get up that early, I'm so not a morning person." But let me tell you a little bit about myself prior to this year...

Growing up, I was always a night owl and a late sleeper. I always missed out on breakfast, and my brother and sister usually left me either no milk or no cereal or both by the time I woke up. In my teen years, I often slept until 1 or 2 in the afternoon on the weekends, and would wake up as late as humanly possible on school mornings. I've lost jobs before because I couldn't get up early in the morning, and I've almost flunked classes that were the first classes in the morning. Let's just say I am not a morning person. However, when I decided I wanted to start exercising, I discovered that the only time I would have to do it would be before my kids woke up in the morning. Jeremy goes to school during the day and works at night, so there is rarely any time during the day when I don't have the kids with me. I could go running at night, when Darian is home, but I'm usually too tired by the end of the day to want to go exercise, so I know I would never get out there and get it done. So, my only option left was to go before anyone woke up. That is 5:15. Yes, it hurts to get up that early in the morning. But the feeling I get for the rest of the day because I started the day off with a little good honest work is almost worth it.

As far as running itself goes, prior to age 30, I had run 1 mile exactly once in my entire life. I hated PE with a passion, and it was because of my poor performance in running the mile (as well as other fitness tests) that I got placed in remedial PE for one semester. You read that right: remedial PE. That is, PE for the fat and lazy kids who couldn't even pass off the minimum fitness levels. (I actually enjoyed that class because instead of having minimum fitness goals, the only requirement was to do the best you could do.) Anyway, after that semester, I ran the mile once to pass it off, and vowed never to run again, and I didn't run again until I was 30. That year, I tried out for a half-triathlon (I know, quite a leap), and practiced running between 1-2 miles while training. In the race itself, though, I still did not run the distance. That was about 3 months of running a few times a week, and I had not run since.

When I started working out at the gym last December, I still remembered my hatred of running, and instead just worked on weight training. I did that for about 6 months, and was not losing any weight, so I started to get discouraged. And I realized that if I was serious about losing weight, I would need to put some aerobic activity in there somewhere. I hate aerobics class, or any class for that matter, because I don't like feeling scrutinized. At the beginning of the summer, I bought a bike and a bike trailer, with the intention of pulling the kids around town and getting exercise that way. Unfortunately, within a couple of weeks of having bought the trailer, it got stolen. I had to face the music: running was my best option for exercise. And to be honest, I finally got to the point in my life where I hated being fat worse than I hated running.

When I started running, I just ran around the block. I wanted to start small so I could feel competent at what I was doing, and because I just wasn't sure what I could do. I ran around the block a few times and soon realized that it seemed too easy! My confidence was bolstered by that feeling, and I started running a little bit further every day. I still didn't know how far I had been running, I just kept running until I couldn't keep going. Then I found the website MapMyRun.com. I went back and mapped the routes I had already run, and found out, much to my delight, that the block runs had been a little over a mile long, and my longer runs had been around 2 miles. I couldn't believe that I had been running the exact distance that I couldn't run when I was younger and skinnier, and it was EASIER. I still wasn't losing any significant amount of weight, but I was clearly getting skinnier, because my clothes just kept getting bigger and bigger on me. I began to get discouraged again, until I saw my after picture on the Body After Baby challenge, and realized that it had been making a difference. I started paying more attention to what I was eating (Although I cook most everything from scratch and eat plenty of produce, I was being sabotaged by white flour, cooking fats, and semi-monthly "dollar menu" runs.) and stepped up my running schedule to 4-5 days a week, and walks during the day with my girls, instead of the 2-3 times a week, or whenever it was convenient.

I don't know how much weight I've lost in the last two weeks, but I know if I lose another 5 pounds I will have to buy new clothes. Nearly everything I own is starting to look baggy, and if I lose any more weight, I will look like I'm playing dress-up. I have about 50 more pounds to go to hit my healthy target weight range, and the funny thing is, I will be even healthier, stronger, and more athletic than I was in high school. If any of my readers are thinking about trying to take up running, I want to share a few tips from a non-runner's perspective on how to maximize your chances of starting something you will want to finish. (And some of these might be repeated from my last post on tips to getting healthier.)

1. DON'T try to do a lot of exercise all at once. You can't expect to run a marathon when you can't even walk a mile. If you can't run yet, then just walk. Take the stairs instead of the elevator. Walk around the block when you get home, or when you wake up. You might not have a lot of strength or endurance now, but I promise it will come with practice.

2. DON'T pay attention to the numbers, the times, or the distances. It doesn't matter how far or how fast you run, unless you are in a race. If it's just you, just do what you feel comfortable doing, and when you feel like you are ready, do a little more. Fitness isn't defined by numbers as much as it is defined by healthy habits and a desire for change.

3. DON'T put too much pressure on yourself to do an exercise a certain way, or in a certain amount of time. Remember, it's not a race! You can slow down, stop, or take a break whenever you like. Just remember to keep going.

4. DO some kind of activity every day. It doesn't matter if you run, walk, swim, bike, anything. Just keep moving. I found out that by only running 2-3 days a week, I tended to be more sore and "rusty" on the days I did run, which made the whole experience considerably less enjoyable. When I started running every day, it almost seems easier to run because I don't have to shake off any cobwebs or deal with much soreness from sitting around the day before. Also, when you get in the habit of doing something every day, it becomes a part of your life and routine, instead of just an occasional hobby. And when it becomes a part of your life, you miss it when it's gone, and you want to keep doing it.

5. DO make and print a schedule. When you book time for exercise, you are more likely to do it, because you have time set aside. If you don't feel like you have time for exercise, find time.

6. DO try to see yourself as a healthy person. I know it's hard, after years of poor habits and bad body image to imagine yourself as healthy, thin, or athletic. But try to imagine it anyway. Call yourself a runner. Visit running websites and blogs. Buy running equipment (or biking, or swimming, or whatever activity you choose.) Try to see yourself as belonging to that group of people who care about their bodies and who work hard to get the results they want. You can have anything you want, as long as you work hard enough!

Monday Munchies

2009-08-17T09:00:00.004-06:00

The two most popular kinds of quick breads are banana bread and zucchini bread. I used to love banana bread, but the first time I had zucchini bread, I was converted! Zucchini bread is an excellent way to get a little veggie into your day, and it is yummy besides. Also, zucchini bread is spiced, which gives it a more interesting flavor than banana bread, which is basically a pound cake with bananas in it.

This recipe, is super easy and fast, using one bowl. It is an easy way to use up your summer garden surplus, and it makes great gifts and potluck contributions. It is highly customizable, and you can easily make it vegan by substituting egg replacer for the eggs. You can also make it healthier by using wheat flour, and reducing the sugar and oil, without sacrificing the taste.

Zucchini Bread

3 c. shredded zucchini (about 2-3 medium)
1 2/3 c. sugar
2/3 c. vegetable oil
2 t. vanilla
4 eggs
3 c. flour
2 t. baking soda
1 t. salt
1 t. ground cinnamon
1/2 t. ground cloves
1/2 t. baking powder
1/2 c. nuts
1/2 c. raisins

Move oven rack to lowest position, so that the tops of the pans will be in the center of the oven. Preheat oven to 350°. Grease bottoms only of two loaf pans, or one 9 x 13 casserole.

Mix zucchini, sugar, oil, vanilla, and eggs in large bowl. Stir in remaining ingredients except nuts and raisins, mix well. Add nuts and raisins, pour into pans. Bake loaf pans about an hour, or casserole about 1hr 20 minutes, or until toothpick inserted in the middle comes out clean. Cool 10 minutes in the pan, then turn out and let cool completely. Wrap tightly and store at room temperature.

Monday Munchies

2009-08-03T06:00:00.003-06:00

This recipe is the last in the three-part series of Indian cooking. Together, this bread recipe with the chicken saag and jeera pulao should make a whole meal. When looking at recipes from other cultures, don't be put off by the foreign-sounding names. Look at the recipe ingredients and decide if you might like something based on what's in it. Once you taste it, then you can decide whether to keep it or not.

This bread recipe is simple, as far as yeast breads go. But if you have never done yeast breads before, it may seem like a bit of work. It is simple to put together, but requires about 2 hours of processing time.

Naan Bread

2 1/4 t. yeast (or one packet)
1 c. warm water (110° F)
1/4 c. sugar
3 T. milk
1 egg, beaten
2 t. salt
4 1/2 c. flour
2 t. minced garlic

Dissolve yeast in warm water. Let sit 10 minutes, or until frothy. Stir in sugar, milk, egg, and salt. Add flour until a soft dough forms that you can knead without it sticking to your hands. Knead for 8-10 minutes, until the dough is smooth. Put the dough ball in a greased bowl and let rise 1 hour, or until doubled.

Once dough is risen, punch the dough down. Knead in the 2 t. minced garlic. Pinch dough into golf-ball-sized balls, and set on a tray. Cover with a towel and let rise 30 minutes, or until doubled. Heat oven to maximum temperature.

Roll out the dough balls to a flat disc and place on a cookie sheet (4-6 at a time). Place the cookie sheet in the oven, bake 4 minutes. Take bread out, brush lightly with butter, flip over. Put back in the oven for 2 minutes, or until browned. Take out and place in a towel-lined bowl and keep covered while cooking the rest.

Monday Munchies

2009-07-27T06:00:00.002-06:00

In this second part of my three part mini-series on Indian cooking, I include a rice side dish. Growing up American, my conception of rice dishes included stir fry and casseroles. And always, rice is cooked separately, then put into something. I never really considered making rice itself a dish. When looking into side dishes for the chicken saag, I found this rice recipe, and thought I would give it a try. I was put off by the fact that it had a good deal of ground cloves in it. Again, owing to my American upbringing, cloves are only ever used for spiced desserts, like pumpkin pie or zucchini bread. I was dubious as to how it would taste in a supper dish. But I was very pleasantly surprised to find that cloves add a wonderful, savory flavor, and a beautiful aroma to the meal. I was also happy to discover a whole new world of rice dishes opened to me - time to go shopping!

This rice dish is simple and delicious. You should make sure ahead of time you have the required spices. Also, a word about the rice itself: you can use any rice you like, but you have to adjust the water. The hardier types of rice, like brown rice, take a little more water. The lighter types, such as white rice, take a little less. So if you choose to use a lighter rice, the rice-to-water ratio should e 1:2.

Jeera Pulao

1 T. oil
1 c. brown rice
1/2 t. cumin
1/4 t. salt
2 bay leaves
3/4 t. ground cloves
1/4 t. ground black pepper
dash of cardamom
2 1/2 c. water

Sauté rice and spices in oil until rice starts becoming translucent. Add water, cover and reduce heat to low. Simmer until water is absorbed, without stirring.

Monday Munchies

2009-07-20T06:46:00.001-06:00

I grew up watching my parents in the kitchen, and learned a thing or two about cooking from them, but did not develop a strong interest in it until junior high. When I was in the 7th grade, I was in cooking class (which was in the broader curriculum of "Home Ec." Do they even have that anymore?) The first thing we made were peanut butter cookies. I got to take with me my portion of cookies, about 3-4, in a little paper bag. I carried that warm, delicious, greasy bag of cookies around all day, so proud of my accomplishment. I didn't even like peanut butter cookies! But it was that experience which taught me my first lesson in cooking: that I could make whatever food I could conceive of, as long as I had the recipe for it. Of course, it would be a few more years before I could control the ingredients that came into the house, and a few more years after that before I felt confident enough to try making foods that were somewhat complicated, but when I was ready to try, I was still buoyed by that first sense of pride and accomplishment, sure that I could make anything, as long as I had the directions.

Once a month or so, I like to try out a recipe for a food I've never tried before, or a challenging recipe of something I've never been brave enough to attempt before. Sometimes what I make doesn't turn out, or I just don't care for it, but I gain a little more knowledge every time I expand my boundaries. A couple of months ago, I decided I wanted to try cooking Indian food. I'm not sure why, as I had only ever tasted Indian food twice in my whole life before that, but I felt impressed to try it. So I got online and found a relatively simple-looking recipe and gave it a shot. I LOVED IT. My whole family loved it! We liked it so much, it got inducted into my recipe box, and I made it again this week. I also made two new recipes, Indian side dishes, to go with it, which also turned out heavenly. All three recipes will be featured here over three weeks, as part of a mini-series. Enjoy!

If you've always wanted to try cooking Indian food, this would be the recipe to start out on. This recipe for a kind of chicken/spinach stew is fairly easy, but required the use of a blender or food processor. You can do it without one I suppose, but it won't be as easy then. This recipe is also a little on the spicy side, maybe medium? So if you want to cut back on the spicy, leave out the cayenne pepper. Also, the spices in this (as in other Indian) recipe are non-standard for our American household, so you might need to do a bit of shopping ahead.

Chicken Saag

1 whole chicken, cooked and diced
1/4 c. water
4 bunches of spinach (it seems like a lot, but you'll need it!)
1 T. oil
5 cloves garlic, minced
2 onions, diced
1 in. piece of fresh ginger, minced (or 1 t. ground, if you don't have fresh)
2 tomatoes, pureéd
1/2 t. cayenne pepper
1 t. coriander
1/2 t. turmeric
1/2 t. ground cardamom
2 cloves (a dash ground cloves)
1 T. water
4 T. milk
1 t. garam masala
2 T. butter

Boil the spinach in a large pot with 1/4 c. water in the bottom, until wilted. Set aside to cool a bit. In large pot, sauté garlic, ginger, and onions, in oil until onions are translucent. Add tomatoes and spices (except garam masala), and sprinkle with 1 T. water. Simmer 10 minutes. Add chicken and milk, simmer until chicken is tender. While that is cooking, pureé the spinach in a blender or food processor. Add spinach pureé and garam masala to the pot. Cook until the spinach starts sticking to the sides of the pot. Remove from heat, add butter, and cover until ready to serve.

Monday Munchies

2009-07-13T08:00:00.000-06:00

What do you think of when I say "comfort food?" I think it is different for all of us, depending on our cultures and where we grew up. It's no secret I grew up in the south, mostly Arkansas. However, I have several family members from New Orleans, so while I was raised on fried foods and barbecue, I also grew up with a taste of cajun cuisine. So it's no wonder that when I made a big pot of spicy jambalaya and a pan of cornbread, I got a little homesick. But of course, I won't let my melancholy get in the way of sharing some Southern goodness with you.

So what is jambalaya? Jambalaya is a cajun version of paella. It is a sweet, spicy, chunky, chicken and rice dish, cooked the same way, only with different spices. The traditional way to cook jambalaya is to cook the rice, veggies, and sausage in the same pot as the chicken, but I prefer to cook the elements separately to save time. I can cook up the chicken and rice ahead of time, so that when it comes time to make dinner, all I need to do is sauté the veggies and throw everything together. You can use whatever onions and peppers you like, although I prefer to pick lots of different colors just because it is pretty.

That's 1 white and 1 purple onion, and 1 red and 1 yellow bell pepper

And like paella, you can serve this with a hot pan of buttered cornbread.

Jambalaya

1 whole chicken, cooked and shredded
1 lb. smoked sausage, sliced (I prefer kielbasa myself)
2 c. cooked rice
2 T. butter
5 cloves of garlic, minced
2 medium onions, diced
3 bell peppers, diced
1 large can diced tomatoes (or 3-4 medium tomatoes)
1 T. chili powder
1/2 t. cayenne pepper
1/2 t. Tabasco
1 t. worchestershire sauce
5 bay leaves
1 can tomato paste

Cook chicken and rice, set aside. Melt butter in large pot. Sauté garlic, onions, and peppers until translucent. Add tomatoes, spices, and bay leaves, and simmer 15 minutes. Add chicken, sausage, rice, and tomato paste, and simmer until heated through. Serve with hot cornbread.

Nestlé cares about mothers

2009-07-11T08:00:00.000-06:00

Which is why they have most graciously agreed to sponsor the Canadian Perinatal and Pediatric Nutrition conference. Naturally, some people aren't convinced of their altruistic motives. However, as in other Mommy Wars issues, others are finding ways to change the focus of the debate from conflict of interest to formula vs. breastfeeding.

In her blog post, Racheal at Yummy Mummy Club says she doesn't understand why the "lactivists" are so upset about Nestlé sponsoring the conference. She says

Nestlé's is sponsoring a conference. It's being put on by Alberta Health Services, and they would not be able to do it without Nestlé's help. Why is that wrong? It should also be noted that the conference is for healthcare professionals. Clearly the lactivists didn't read that when they started sending me messages like:

"there's an inherent conflict of interest and a real danger of women getting mixed health messages"

Some people only use cloth diapers. Should they be boycotting those mommy movie matinees because they're sponsored by Huggies?

It is interesting that she writes that lactivists apparently don't "get it" that Nestlé, a company which holds a significant portion of the world's market share for artificial infant nutrition, is sponsoring a conference about pediatric nutrition, which would be their target consumer base. Perhaps the analogy she should have used is this:

Some people only use cloth diapers. Should they be boycotting a symposium on cloth diapering that is sponsored by Huggies?

And of course, the answer to that question, is YES! It isn't that Company A is sponsoring a random conference for Issue B. It is that Company A has a specific and vested interest in capturing the consumer base for Issue B. Let me put it another way: Should Budweiser be allowed to sponsor a conference for Alcoholics Anonymous?

Conflict of interest is defined as "when an individual or organization...has an interest that might compromise their actions...More generally, conflict of interests can be defined as any situation in which an individual or corporation (either private or governmental) is in a position to exploit a professional or official capacity in some way for their personal or corporate benefit." (ref) This situation looks like a pretty cut-and-dry conflict of interest to me.

(In fact, conflict of interest is a serious problem in Big Pharma in general. Drug manufacturers often sponsor conferences for their target consumer base, and even sponsor studies that are intended to prove the safety of their own drug that they want approved. This is also true for infant formulas. As it stands right now, many health care professionals and law makers in our country are more influenced by sponsorships and lobbyists than they are by evidence-based medicine or public health and welfare. But I should write more about that another day.)

Okay, so it seems that Nestlé may have more interest in the matter than just promoting public health. But surely Nestlé isn't nefarious in their dealings. After all, we are talking about the health of the world's children. Well, there was that one thing in the 70s, but that was years ago, surely they have cleaned up their act by now? Not so, according to the International Baby Food Action Network, in their publication, Breaking the Rules/Stretching the Rules 2004, which outlines violations of the WHO's International Code of Marketing of Breastmilk Substitutes and details the ways in which infant formula manufacturers, including Nestlé, are operating illegally and unethically to undermine the health of the world's children TODAY.

So the question that we "lactivists" have is this: Why is Nestlé, a company known for injuring and killing millions of babies worldwide by intentionally and dishonestly marketing its baby milk substitutes, being allowed to sponsor a conference about pediatric nutrition? I believe it is a valid question to ask.

Sadly, this is not the same conclusion Racheal came to:

So to the lactivists out there: hug your children tight and be grateful that you could give them your milk, but please don't come down on those who couldn't or chose not to.

I guess I missed the part where actively fighting to hold corporations responsible for their unethical and harmful actions equals being judgmental towards mothers who use infant formula?

Okay, everyone knows I don't have a terribly high opinion of women who don't think that using formula is any big deal. However, I understand as well as anyone that the majority of women, rather than not wanting to make the healthiest choice possible for their children, are misled into less-healthy choices because of the aggressive and unethical business practices of formula manufacturers, as well as our non-breastfeeding-friendly culture. Ladies, the answer to that is not to be angry at each other, but to be angry at the culture and government that allows this to occur.

This issue of Nestlé sponsoring an infant nutrition conference isn't about breast vs. bottle at all. It is about trying to raise awareness and rally women together to protect our children and the children of the world by refusing to allow corporate greed to dictate public health policy. Put down the bingo card and pick up your activist hat, and get to work!

For more information on the campaign to boycott Nestlé and unethical infant formula manufacturer practices, please visit the following sites:

Nestlé - The Baby Killler?
Baby Milk Action
International Baby Food Action Network (IBFAN)
INFACT Canada

Ruby's birth story - One year later

2009-07-10T07:00:00.001-06:00

A year ago today, I was 2 1/2 weeks overdue with Ruby. I had her in the early morning hours of Thursday, July 10, and had my birth story posted by that night. That's two of the nice things about a home birth: you don't have to worry too much about going "late," and you can lounge around on the computer, watching TV and eating your own food all day. So I wrote the birth story, but I have never been very happy with it.

See, I am a bare bones kind of person. I'm not terribly touchy-feely, and my writing tends to be more analytical than emotional. That is all well and good for research posts, but it doesn't lend much to a birth story. After a year of reading beautiful, emotional, touching birth stories, I want for my own to be more poetic than it is now. (Part of it also has to do with the mode of birth - it wasn't exactly a lovely, quiet, spiritual romantic experience. Ruby's birth was fast and hard, more like a "wham-bam-thankyoumaam!" That's not easy to put into flowery prose.) So, a year later, that is what I will attempt to do now. Here is Ruby's birth story, retold. It will probably be very long, so just grab a sandwich and settle in. If you don't want to read this whole thing, feel free to go back and read the first version, which is pretty cut-and-dry.

The perfect, unassisted birth of Ruby Lynn

I planned an unassisted birth with Ruby. I had been to see a couple of doctors and a midwife, but by the 25th week of pregnancy, I decided that I was not interested in sharing my birth with a paid professional, so I declined further prenatal care and finished the pregnancy doing my own prenatal care. I had been having Braxton-Hicks contractions since the second trimester, but around 36 weeks I started having prodromal labor. Prodromal labor is basically practice runs of the "real" labor. Two or three times a week, I would have regular, strong contractions for a couple of hours, then they would just peter out. This usually happened at night, so I was only sleeping 2-3 hours on those nights. In addition, I was peeing every hour, on the hour, and I suffered from SPD, a pregnancy-related connective tissue disorder, which made sleeping and rolling over virtually impossible. I tell you these things so you can understand where I was at the end of the pregnancy. And remember, these issues started worsening about a month before my due date.

I had a photographer friend come out to visit me during the two weeks around my due date. She was to take labor, birth, and newborn photos for me. Well, my due date came and went, and still no baby. We even went out on my due date to take maternity photos. (Word to the wise, don't wait until term to take maternity photos. It's not your best look.) Another week passed, and I still hadn't had the baby. The day came for her to leave, so I drove her to the airport, then drove over to my friend Jenna's house for some visiting. I spent 3-4 hours driving that day. When I woke up the next morning and tried to walk, all of a sudden I couldn't! Not only had my hips completely refused to work, a varicose vein that I had had for years suddenly decided to become a problem. I had sharp, stabbing pain behind my knee and in my hips every time I put weight down on a leg. It was not looking good. Between the varicose vein, the hip issues, the prodromal labor for going on 6 weeks, and the lack of sleep, I could not fathom how in the world I would get through labor. I couldn't walk, I hadn't slept in months, and the only cure to any of it would be to have that baby.

Ruby was doing great in there. She was so active all the way up to the day I had her, there was never any question of her well-being. I had also had the 20-week ultrasound, so as far as we knew, there were no congenital issues to worry about. My other children were all around the 7-8 pound range, so I had no fears about having a big baby (although I wouldn't have cared if she was 12 pounds. My mother had my 11-pound sister at home, so birthing a large baby was certainly no strange or fearful idea to me.) Ruby kept flip-flopping from transverse to head-down, which I am quite sure was the reason for all that prodromal labor. She didn't settle on a position until a few days before she was born.

Interesting fact: The entire pregnancy, we had planned on naming the baby Aaliyah Lily. Two or three days before she was born, Jeremy and I were laying in bed, and I told him I felt strongly that Aaliyah wasn't the right name for her. This really surprised him, since I told him when we settled on Aaliyah that I refused to change her name AGAIN (he is a picky baby-namer, we'd gone through hundreds of names by that point). But I said I felt that she should have a different name. I suggested the name Ruby, the name of a dear friend of mine. Then I realized that Ruby was also the birthstone for July, which I felt was auspicious, since she was due in June, but obviously wanted to come in July. So we agreed on Ruby. Then I suggested Lynn for a middle name because 1) it sounded like a good Southern name, 2) Jeremy's mother's middle name is also Lynn. So there you have it - she became Ruby Lynn at about 42 weeks pg.

42 week belly

I woke up about four hours later, at about a quarter to 4 a.m. to go to the bathroom. I was really surprised that I'd slept that long between bathroom breaks, but hey, I wasn't complaining. I got up and felt a distinct POP in my uterus. It felt exactly like water breaking, but I waited and nothing came out. I shrugged and limped off to the bathroom. While on the toilet, I had a contraction that was harder than contractions I had had before, but I assumed I was having another night of prodromal labor. I got up and made my way back to bed, because I figured I would at least get a bit of rest before I had to get up with Bella.

When I got to the bed, another contraction came on. I got on all-fours, just to rest while in the contraction. Now, at that time, we lived right behind railroad tracks. And right at the moment the contraction started, a train started coming. The sound and power, and movement of the train grew as the contraction grew, passed as the contraction peaked, and faded as the contraction faded. It was really cool. I don't know how I knew, but I somehow knew these contractions were different from the prodromal labor, and I knew I was in labor. I woke up Jeremy, and told him I thought I was really in labor this time. He mumbled something and fell back asleep. (He told me later that he figured it was another bout of prodromal labor.) I started gathering stuff between contractions, and told him to get up, it was really real this time! I went into the living room and turned on the TV, just in case it was going to be another teaser.

It was about 10 minutes and Jeremy still hadn't come out of the room. I started feeling like I desperately needed him to be near me, and it was that feeling that convinced me I was really REALLY in labor. I called Jeremy, and he finally came in to the living room. I hadn't bought any supplies for the birth except a drop cloth, but I didn't need it yet, so I told him to wait on that. I tried walking around, sitting down, but the only position that seemed the most comfortable was hands and knees. I wished at that moment I had bought an exercise ball to labor over, but I had to settle instead for the rocking footstool. I was laboring at one point in front of Jeremy, and during contractions, I would have him rub my shoulders, because it felt so relaxing and took my mind off the contractions, which weren't too painful, but were definitely powerful. (I kept asking him to rub harder. He did such a good job, my shoulders were bruised for a few days afterwards!)

I finally thought I should call my friends, who were going to be my labor support, to come over. It was probably 5:15ish by this point, and I was still very reluctant to call them and wake them up, just in case it was another false alarm. I finally decided to call Jenna first and ask whether she thought she should come over, since she lived about 30 minutes away. When I got her on the phone, she asked if I thought it was the real thing. I couldn't answer her because I was in the middle of a contraction! She said she would be right over, and she called Emily, my other friend, for me, to come over as well. I continued to have Jeremy rub my shoulders, and during this time, the contractions started changing from strong and powerful to painful and purposeful. I said to Jeremy, "I have no idea how women transport to the hospital in active labor. You could not pay me enough to get me down those stairs and into the car right now."

It is an interesting and indescribable sensation, transition contractions. It is usually at that stage most women have the feeling that they can't go on, and often the stage at which women begin begging for pain medications. Now, it can be very painful during that time, but more often, it is so purposeful that it feels overwhelming. It triggers the feeling of action - that you need to DO something. If you are at home, and have freedom of movement, it is easy enough to listen to that feeling. I can imagine that for women in the hospital (as it was for me in previous births), being strapped into a bed at that moment would be frightening and create a "caged animal" feeling. Well, in my case, they were definitely painful. I knew now was the time to just hang on and relax, and try my best to get through the contractions until it was time to push, which I also knew would not be long, if I was in transition.

I was well into transition when my friends came in. I never timed a single contraction, but Jeremy told me later that they had gone from 5 minutes apart to 2 minutes apart during that time. I was never afraid of labor in any of my births before, and this was no different. Pain doesn't scare me, and there's only one way to get a baby out, and it's by having labor. I never doubted that I would get through it, or that it wouldn't last forever. I just kept on getting through the contractions, and waiting for it to be over.

Interesting fact: I hadn't vacuumed my carpet in a few weeks by the time I went into labor, with all the mobility problems I'd had. While laboring on my hands and knees, I couldn't help but see how dirty the carpet was, and I was terribly embarrassed about it. When my friends came over, near the end of my labor, I even apologized to them for the messy house between contractions! Right after the birth, Jenna offered to vacuum my carpet for me so my house would be presentable for family when they came to visit.

Moments after the birth

Ruby Lynn was born just before dawn, at around 6:18 am. The total labor was about 2 1/2 hours long, and there were absolutely no complications, or anything interesting at all about the whole thing. She came out head-down and anterior, in three pushes, and with no tearing.

After about 5 minutes of sitting there, another contraction came and the placenta came sliding out. It felt kinda weird, but not at all painful. Jenna scooped up the placenta into a bowl, as we had originally planned to do a lotus birth, in which you leave the placenta and cord attached until the whole thing falls off together, usually within 3-4 days. Jenna also helped me get cleaned up while Emily and Jeremy went around cleaning up other things around the apartment and grabbing more towels and sheets for clean up. Ruby was sucking on her hand and rooting around, so I offered the breast, and she latched on perfectly right away. I was so relieved and amazed, as Bella had taken a very long time to learn how to breastfeed. I laid back and let Ruby just get the hang of it. While I was looking at her, I was thinking how glad I was that we renamed her a few days before. She absolutely looked like a Ruby.

After about an hour, I wanted to get more comfortable. They helped me up onto the couch, where I sat and nursed Ruby another hour or so, while they cleaned up everything. It really wasn't that messy. There was obviously blood and fluids on the sheets I birthed onto, but they were easily bundled up into a trash bag. There was no mess anywhere else, so there was no cleaning to do otherwise. (There did end up being some slight mess on the couch cushion later, but it cleaned up very easily with a bit of vinegar and baking soda.) Emily boiled up the herbal bath for me while I just recuperated.

Enjoying my new baby

Sisters meeting for the first time

Jenna meeting her little chublet

Happy Birthday, dear Ruby!

ABCs of the blogosphere

2009-07-09T07:25:00.001-06:00

For those who are new to the blog scene, I have here a list of blogging terms that may help you become more familiar with how it all works:

AWARD: A meme in which bloggers bestow each other with virtual honors in order to create a carnival without all the hassle.

BRAVE: Used to refer to someone else's blog post about some controversial, intensely personal, usually TMI topic. Ex. "Check out Susie's brave new blog post about picking your nose in public."

CARNIVAL: An event in which one blogger invites other bloggers to write blog posts on the theme, to be compiled in links in one blog post on a specified date. Also called "free publicity."

DELETE: The most powerful of all blogging tools, usually used to control wayward commenters, or remove evidence of hastily-written missives.

EDIT POST: A helpful blog function that all bloggers can use, but most don't enough.

FIRST: A comment left by those who aren't smart enough to think of anything that would contribute to the discussion in any meaningful way.

GIVE-AWAY: What some bloggers do to attract sponsors, then subsequently get rid of the boxes of promotional items that are cluttering their desk.

HTML: A programming language used to create blog formats and elements which, thanks to real computer experts, has been made accessible to the average housewife by way of templates, hosting sites, and Google.

INTEREST: What some bloggers have a conflict of, when they write about a subject for which they are being sponsored.

JUMP: The preferred method of forcing stalkers to leave their reader to read the rest of the post on the actual blog, in order to at least register a page hit. Ex. "It really bugs me when people... follow the jump to read the rest of the post"

KARMA: The thing that eventually comes back to haunt you if you don't remember what you wrote in past blog posts or on other blogs.

LINKS: Colored, and sometimes underlined, words in a blog post (hopefully a blog with good traffic), which are hyperlinked to another blog post (hopefully yours).

MEME: A popular day-of-the-week theme that bloggers often adopt in order to guarantee at least one blog post each week that can be made without much thought or planning, just in case they get busy. Ex. Monday Munchies, Friday Fill-ins, Wordless Wednesday.

NAVELGAZING: Stereotypically assumed to be the "point" of writing a blog in general, it is a specific style of writing which involves publicly publishing the type of soul-searching introspection usually reserved for teen diaries.
OPINION: What every blogger has.

PUBLISH/POST: The hardest button for a blogger to click.

QUOTE: The HTML shortcut button which allows bloggers to separate long block quotes with a different set of margins, thereby giving readers a taste of what they would be reading if they clicked on the blogger's friends' link.

RSS: The button used to become a stalker.

STALKER: Reader of a blog who has read every single post on the blog, knows every detail of the blogger's life, and subscribes to a blog, but never comments. Also known as a "lurker."

TAGS: Labels used to classify and organize blog posts by subject. Used as a search function, only slightly less awkward than searching past posts by date.

UNIQUE: What all bloggers think they are, but aren't.

VLOG: Short for "video blog," it is a way for bloggers to speak their thoughts in three minutes or less, in a stilted voice, by the light of their computer screen.

WEEK: The amount of time a serious blogger has to prove themselves.

X-RAY: Has nothing to do with blogging, but isn't what they usually put for "X" on these types of lists?

YELLOW: The most annoying text color. Ever.

ZEALOT: A blogger who has a fierce, opinionated blog on any subject, usually controversial. *cough*

Doctors and breastfeeding

2009-07-02T12:43:00.004-06:00

If I had a nickel for every time I heard or read about, or personally experienced a doctor giving erroneous information on breastfeeding, I would be a billionaire by now. It's not that doctors want women to fail at breastfeeding, or that they aren't smart. It is just that most doctors have neither the time nor the inclination to study up on the latest information about breastfeeding practices or to be familiar with all of the hundreds of medication options and their breastfeeding-compatible status. In addition, doctors must study many different disciplines in medical school, and breastfeeding is only one small component of their studies. For these reasons, doctors often rely on information (correct or incorrect) they picked up along the way, and give this advice to mothers, who in turn will take that information as gospel truth, and may end up damaging or ending their breastfeeding relationship prematurely.

I went to the doctor the other day knowing I would need some prescriptions, and knowing that the most commonly prescribed prescriptions in that situation are not breastfeeding-friendly. So I spent the entire day before the appointment researching all my medication options. Now granted, I am not a pharmacist or a physician, but I hoped that by bringing a list of breastfeeding-friendly medications, and discussing it with my doctor, we could find a reasonable choice that would still allow me to safely breastfeed. (Isn't that what the commercials tell you to do anyway? "Discuss it with your doctor to see if this is right for you!")

I got to the appointment and told the doctor what I was there for. She said she would write me a prescription, and then told me what side effects to look for. I asked what medication she would be prescribing me, and as I expected, she suggested the most common medication, which is not breastfeeding-friendly. I reminded her that I am still breastfeeding, and I suggested an alternative. She then asked how old my baby is.

I told her Ruby was almost a year old, and she got an astonished look on her face and exclaimed, "Oh no, you do not need to be breastfeeding her anymore!" She then proceeded to tell me that after one year, babies receive no more nutritional value from breast milk, and that therefore she did not need to nurse any longer. Of course, this is patently false. (See why here.) Why would breast milk magically become devoid of nutrition, antibodies, and protein at exactly 12 months after the day of the baby's birth? The answer is, it doesn't! She then proceeded to tell me that even the alternative medication I suggested would still be present in some small degree in breast milk, and that she would rather I not breast feed at all before prescribing the medication, and subsequently refused to prescribe me any medication until I weaned my baby. This is clearly an abuse of power!

First of all, as a patient I have a right to informed consent of any test, procedure, or medication. If I choose an option, knowing the risks, it is still my choice to make as the patient who is taking the drugs. Now, if the medication I was suggesting was potentially harmful to my baby, it is indeed arguable whether I still would have the right to take it. However, the medication I was suggesting is generally considered safe for breastfeeding women to take. Rather than do research to confirm my own findings, or try to find another safe, but suitable medication, the doctor chose to dismiss my suggestion, and instead suggest (erroneously!) that I wean my not-quite-one-year-old. (For more breastfeeding myths, click here.)

Second of all, how is it that this doctor, who specializes in women's health, is unaware that the medication she is prescribing me is not breastfeeding-friendly? And why does she not know which medications are suitable alternatives? Of course, doctors cannot be expected to know every single medication that exists, its side effects and benefits, and lactation risk category. But surely she is obligated to find out that information if a patient wishes to continue breastfeeding and wants to find the safest option possible? More importantly, she should not be actively discouraging breastfeeding when a mother clearly considers it a priority.

I left the office empty-handed, but was still able to wake up the next morning and nurse my baby, who still isn't even close to being ready to wean. For that matter, I'M not yet ready to wean! If a situation presents itself in which I may have to wean for some reason, or if I must take medication which requires it, I will feel confident that my baby got the very minimum amount of breast milk that she should have. However, if a reasonable compromise can be found, which will allow me to continue giving my child the best benefits of breast milk possible, why not continue as we are?

How many women are told that they must wean before they take certain medications? How many women do their research to learn whether or not this is true? How many women value their breastfeeding relationship over bruising the ego of their care provider?

Please, do your research, and be prepared to fight for your right to breastfeed! Select a care provider who values your opinion and judgment, and who is willing to discuss with you your treatment options, and allow you to make the final decision. DO YOUR RESEARCH! We no longer live in the days when doctors were the sole possessors of medical knowledge; we have resources both in the libraries and on the internet, and we have an obligation as intelligent adults to make an informed decision, especially where our babies are concerned.

For more information on breastfeeding and medications, please visit the following sites:

LactMed
kellymom
more resources

Cesarean section is NOT the reason the maternal mortality rate has gone down

2009-06-30T11:51:00.010-06:00

It has been a while since I posted another OB myth. Today's myth comes to us courtesy of Dr. Amy. Another Amy, Amy Romano, wrote a blog post in which she questions the lack of attention to the maternity care situation in an article written by Dr. Atul Gawande. In her blog post, she says,

Gawande saw a fall over time in perinatal and maternal mortality and attributed it to advances in hospital-based obstetrics. But he knows as well as anyone that correlation is not the same as causation. While a few medical advances — oxytocics and ergot derivatives to control hemorrhages, antibiotics to treat infection, and surfactant to treat respiratory distress in premature infants — have certainly prevented deaths, much of the fall in mortality likely comes from basic improvements in public health and hygiene. By looking through the bifocal lenses of medicine and history, Gawande makes an erroneous assumption that, when it comes to giving birth, more technology is inherently better. What he fails to ask is the very question at the heart of The Cost Conundrum: could we get the same or even better outcomes with fewer risky and costly procedures?

Of course, leave it to Dr. Amy to come around and champion the cause of medical technology. In the comments section, she says,

Basic improvements in public health and hygeine occured in the late 19th and early 20th Century. The spectacular drop in maternal mortality (99%) and neonatal mortality (90%) occurred between 1940-1980, long after basic advances in public health.
One of the advances most closely associated with the drop in maternal and neonatal mortality is the development and improvement of epidural anesthesia, making Cesarean section far less risky and far more common.

But Dr. Amy makes the same mistake that Amy Romano pointed out Dr. Atul Gawande made, and that most hospital birth advocates make: correlation is not the same as causation.

Dr. Amy mentions that the "spectacular drop" in maternal mortality, which occurred between 1940-1980, can be largely attributed to the use of the epidural, and therefore the relative safety of the cesarean section. This is an inherently illogical conclusion, as it assumes that cesarean sections were previously risky due to the method of anesthesia. In fact, the two biggest risks of cesarean section were (and still are) blood loss and infection, neither of which have anything to do with the method of anesthesia.

One of the main causes of blood loss during cesarean section prior to the end of the 19th century was the fact that physicians did not suture the uterus closed, fearing infection from the internal sutures. In 1882, Max Saumlnger, of Leipzig began arguing in favor of uterine sutures, and together with the development of silver wire sutures, physicians began using internal sutures, which necessarily reduced the rate of severe hemorrhage. From the late 1800s to the 1920s, physicians continued to improve the procedure itself, including performing the surgery earlier in labor, before the mother was on the verge of death, and using a transverse incision. (Please view this publication for more on the history of the cesarean section.) The first spinal block was not used until 1943 (ref), so while the epidural certainly contributed to overall improvements in the surgery, advances that directly eliminated or reduced factors that contributed to maternal mortality were already in place.

So what were women dying in or after childbirth dying from? The most feared complications of childbirth pre-1950s were hemorrhage, obstructed labor, and infection.

Hemorrhage

Blood loss is one of the most feared complications in childbirth. It is a reasonable fear! When the placenta separates from the uterus, several minor and major blood vessels are left exposed, and continue to pump blood until the uterus clamps down and closes them off. In some cases, the uterus does not do this adequately, or fast enough, which can result in blood loss, shock, and eventually death for the mother. Prior to the 1930s, there was not much modern medicine could do for blood loss. Midwives had traditionally used herbal remedies, such as ergot, to treat hemorrhage, but it was slow-acting and had serious side effects, including the potential to cause death. In 1909, oxytocin, the hormone which was known to stimulate contractions (and therefore assist with stemming a hemmorhage), was discovered, but was not commercially available. In 1935, the specific oxytocic agent in ergot was isolated, and scientists were able to create limited preparations. But the real discovery came in 1953, when the biochemist Vincent du Vigneaud discovered a way to create a manufacture-able, synthetic version of oxytocin (now known as pitocin), making this hemmorhage agent widely available. (ref) Women today think of pitocin as an induction drug, when in fact, its primary purpose was to force the uterus to contract, in an effort to stop bleeding.

No one can argue that the discovery of oxytocics was a significant step in advancing women's health, but equally significant was the improvement in women's lifestyles and nutrition. A study was done in Maryland which looked at a certain population of women's diets, which diet was considered to be comparable to that of women in the late 19th century, and found that 70% these women were severely anemic, and many had contracted pelvises (more on that in a minute). (ref) According to this publication, anemia in pregnant women reduces a woman’s ability to survive bleeding during and after childbirth, and is associated with 22% of mother's deaths (as of 2006). While oxytocics can slow a postpartum hemorrhage and prevent many immediate deaths, a reduction of severe anemia in pregnant women helps ensure they will survive in the days and weeks following a major hemorrhage. With increased proper nutrition among childbearing women over the years, it's no wonder that the maternal mortality rate has continued to decline. It is interesting to note that severe anemia due to poor nutrition still accounts for a significant portion of maternal deaths today in developing countries and poorer populations.

(It is also worth noting that while postpartum hemorrhage is typically associated with vaginal birth, the average blood loss from a c-section is twice that of an average vaginal birth. (ref) In addition, since 1998, the rate of blood transfusions in the US among all delivering women has increased by 90%. (ref))

Obstructed Labor

Obstructed labor, for various reasons, was a common cause of death previous to the improvements made in the safety of the cesarean section. If a baby was transverse, or stuck in the pelvis, or for whatever reason could not be delivered, it resulted in the mother's death. Prior to the improvements made to the overall safety of the cesarean section, if a woman did not die from the obstructed labor, she would certainly die from any surgical attempt made to save the baby. In that respect, one could argue that cesarean sections are the one of the main reasons for the reduction of maternal deaths due to obstructed labor. However, at the same time as improvements in obstetric care were developing, the number of obstructed labors were decreasing.

Obstructed labor is usually due to three main causes: malpositioned fetus (as in transverse lie), malpresentation (as in brow first), and cephalopelvic disproportion (CPD). One of the main causes of CPD is an inadequate bone or skeletal structure, directly related to poor nutrition. (See this article for a more detailed discussion of nutrition and obstructed labor). In the late 19th century, this often meant rickets. Women and children in urban areas, working in factories where they were largely not exposed to sunlight, and eating poorly, suffered this condition which often resulted in pelvic deformities.

In the book, Women's Bodies: A Social History of Women's Encounter with Health, Ill-Health, and Medicine, the author estimates that in some areas at this time, one out of every four women suffered from some degree of pelvic contraction. The percentage of women with contracted pelvises who died as a result of obstructed labor varied, from 20% of mildly contracted pelvises to almost 50% of severely contracted pelvises. With the total percentage of women presenting with a malpresentation or or malposition averaging around only 4% of total births, the reduction in the number of women with some degree of pelvic contraction, who accounted for perhaps 25% of all births in some areas, would have a particularly important effect on the overall maternal mortality rate.

How was this achieved? By the 1920s, researchers had learned what was causing rickets and other similar bone-deformity diseases. They realized that these diseases were caused by a nutritional deficiency, and successfully patented a method of irradiating food with Vitamin D (not actually a vitamin but a type of hormone), the key missing factor in deficient diets. Scientists began a campaign to irradiate commonly eaten foods in an attempt to lower the incidence of rickets, (ref) and by the 1940s, Vitamin D-fortified milk was ubiquitous, and the incidence of death of children due to rickets had been reduced to less than 75 cases a year. (ref)

So while the improved safety of c-sections certainly positively impacted the maternal mortality rate among women with malpresentations or malpositions, the largest reduction in maternal morality rate from obstructed labor has quite clearly come from better nutrition and lifestyle, which prevents contracted pelvises in the first place.

Infection

In the early days of hospital birth, another common cause of maternal death was "childbed fever," or puerperal sepsis. Puerperal fever is an infection caused by transmission of bacteria (most often Group A Streptococcus) to a woman, resulting in sepsis, and if untreated, death. Prior to the advent of antibiotics, puerperal fever was one of the leading causes of death among women in hospitals. Puerperal fever was known to kill postpartum women before the advent of hospital birth, but the incidence of it was apparently uncommon. When birth moved into the hospitals, doctors themselves caused outbreaks of the infection by going from patient to patient and performing vaginal exams without gloves, clean clothes, or washing their hands. In some cases, doctors would go from an autopsy to an exam of a pregnant or recently-delivered woman. (Read this article for more discussion on the history of childbed fever.)

In the mid- to late 19th century, several doctors put forth the idea of bacteria transmission as the cause of puerperal fever, but were dismissed. By the turn of the century, the theory of bacteria transmission was widely accepted, but aseptic routine was still not widely practiced. According to the article referenced above, the maternal mortality rate continued to stay the same until the 1930s, the United States continuing to have the worst maternal mortality rate among industrialized nations.

In 1935, a German doctor introduced the use of prontosil, a sulfonamide dye, the precursor to the use of penicillin and modern antibiotics, as a treatment for puerperal fever. It worked remarkably well, and by the end of WWII, penicillin was widely available and used to combat all types of infections, puerperal fever included. The result was that by 1949, the maternal mortality rate in the United States dropped by more than 700%. (ref)

What does all this mean? It means that the time period which Dr. Amy was referring to - the 1940s - might have seen the advent of the epidural, but that was almost certainly not the reason why our maternal mortality rate declined. The 1940s saw a reduction in bone deformity diseases, a reduction in anemia, a reduction in transmission of bacteria, and a successful way to treat bacterial infections. These advances were by and large brought about by cleaner conditions, better health, and better nutrition. The cesarean section has certainly had its place in the preservation of women's lives, but was not the first or the last word in maternal mortality, as proponents would like to argue.

But even if the c-section were the saving grace of modern women, surely we should be seeing an even more dramatic drop in maternal mortality today? Not so. In 2003, the maternal mortality in the United States ROSE to 12.1 deaths per 100,000 live births, to a rate higher than it had ever been since 1976. (see more numbers here.) The United States ranks 41st, continuing to rank last among industrialized nations as we did before all these new advances, for maternal mortality. Women are still dying in or after childbirth! Study after study continue to come out that show the risks of cesarean section relative to vaginal birth, and show the benefit of low-intervention births. It is obvious that the cesarean section, while essential to many women in high-risk situations, is NOT the primary reason maternal mortality rates fell in our country.

And I would like to ask the Dr. Amys and Atul Gawandes of the world what Amy Romano is asking: could we get the same or even better outcomes with fewer risky and costly procedures?

Monday Munchies

2009-06-29T07:14:00.002-06:00

One of my favorite salads is the Waldorf salad. Waldorf salad is a mayonnaise-based salad with fruit and nuts. I had never tried it before a few years ago, when it was served at a bridal shower I was attending. I normally don't like salads with fruit in them that aren't dessert-y, but I was hungry that day, so I got some to try. It was delicious! After that, I went in search of a recipe to make my own. I also like to put chicken in mine and serve it on bread, as a twist on the standard chicken salad recipe. It is light, sweet, and crunchy - a perfect summer sandwich.

Chicken Waldorf Salad

2 c. cooked, diced chicken
2 apples, peeled and chopped
2 stalks celery, diced
1/3 c. chopped nuts
1/2 c. mayonnaise
1 T. lemon juice
1 T. milk

Combine all ingredients in large bowl. Serve on croissant rolls.

Sleep training is like rape

2009-06-27T11:26:00.002-06:00

Haha, okay it's not. But that is the unfortunate conclusion some people are drawing from PhDinParenting's new post about how sleep is like sex. In her post, PhDinParenting says this:

If someone is obsessed with sex, it is appropriate for them to use gentle, loving, techniques to try to convince a partner to have sex. It is not appropriate to use force to get someone to have sex with you. It is also not particularly respectful to complain and push, complain and push, complain and push with intermittent reminders that you love the person until that person finally gives in. Same with sleep. If someone is obsessed with sleep, it is appropriate to use gentle, loving techniques to try to get your baby to sleep so that you can get more sleep too. It is not appropriate to force a baby to sleep using methods like the extinction method of cry it out...

Whether we are talking about sleep or sex, I conclude that a gentle, loving approach the best way to get it. It is the humane way to get it. It is the respectful way to get it.

I agree with Annie that a loving and gentle approach is the most appropriate and respectful way of getting your children to sleep. But what do you do when despite your best efforts, after all the rocking, nursing, and cuddling in the world, your baby still will not sleep?

(Disclaimer: I am not referring to any baby under 6 months old, or maybe even under 9 months old. Babies need some time to learn that you are always going to be there for them, and that the world is not a scary place. Plus it takes a few months for them to even physically be ready to sleep through the night.)

When Ruby was about 9 months old, I was feeling pretty run down. She would not go to sleep before 11 or 12 at night, and Bella, being an early riser, would have me up at 6 o'clock in the morning. In addition, Ruby refused to take naps. Every time I would lay her down, she would cry, so I would go back and get her. At night, I just let her play until she passed out, because I couldn't stand to hear her cry when I put her in the crib before then. This was a big change for me, because Bella had always been an easy sleeper. All I had to do was lay her down, and she would just roll over and go to sleep. Ruby was not the same way. And despite all my best efforts at helping her to get to sleep, Ruby was just not an easy sleeper.

When we don't get enough sleep, we feel irritable, crazy, and lack concentration. For me particularly, lack of sleep triggers a pattern of emotional instability. Now, when you have a newborn, you expect to be short on sleep for a while. But after a year of being sleep-compromised (I wasn't sleeping much in the last 2 months of pregnancy either), I was really feeling the effects. One night, I had gone and laid Ruby down three separate times, after walking, nursing, and soothing for almost 2 hours. I was beyond exhausted, and we were approaching midnight. I laid her down again, and she began crying again, and I felt so upset, I knew I needed to walk away from her for a few minutes to calm down. I went into the living room and just sat there, trying to collect myself. After about 30 minutes, by the time I felt calmed down enough to try to go back in there, she had fallen asleep.

This is when I gained a plain and simple truth: kids don't like going to bed. As a matter of fact, *I* don't even like going to bed. And sometimes, no matter how sweetly or respectfully we ask them to, they will disagree. And you know what? That is the nature of parenting. Sometimes we ask our children to do things they don't want to do, and sometimes no matter how gently we ask, they still don't want to do it. That is where being the adult comes into play.

In the comments section of her blog post, PhD in Parenting says:

The comparison that I was making there is that just because a society is accepting of one person forcing their will on another, doesn’t mean that we have to accept that. In some societies, women are considered lesser human beings than men. In our society, I think often we treat children like lesser human beings.

I think this is a typical and extreme view of attachment parenting proponents these days, and exactly why some mainstream parents reject AP as a whole: the idea that "forcing your will on another" and "treating children like lesser human beings" is abusive, harmful, or contrary to the laws of nature. In actuality, "forcing your will" on your child, and treating them as "lesser human beings" is called BEING A PARENT.

Now, one can go too far to the other end of the spectrum. Just because you have the power and ability to force your will on your child doesn't mean you should abuse that power. It also means that, as a parent, you have a sacred responsibility to teach and guide and mold in a loving, respectful, and gentle manner. However, there will come a time (many times really) when there will be a conflict of opinion as to whose way should take precedence, and where it is fundamentally important, the parent's way should always take precedence. After all, why else would it be designed this way? What are the point of parents at all if not to be the final word on how to be a human?

Whether a child puts on this color shirt or that color shirt is not a conflict of eternal significance, so there is no point in having a battle of wills over it. However, if your child runs into the busy street, that is no time for gentle correction and talking it out. If your child runs into the street, and you go to collect them, and they fight against you kicking and screaming, does that mean you should stop in the middle of the road to gently and respectfully explain to them why they should not play there? Absolutely not. There are times in parenting where it is important for you to subjugate the child to your judgment, because you have knowledge and experience that the child simply cannot understand, and because the situation demands you exercise that executive privilege. I believe sleep is one of those situations.

N0w, I am not suggesting that you take your small child, drag them kicking and screaming to bed, and lock them in the dark room for the rest of the night. That would just be cruel. However, if it comes time for bed, and you have done the bed time routine, given cuddles and hugs, and even sips, and the child is still protesting loudly about going to sleep, this is one of those situations where your knowledge and experience tells you that the child must go to bed for their own health. Not only is it common knowledge that it is healthful to get a reasonable amount of sleep, but it establishes a regular routine, which has also been proven to be healthful, and teaches the child good sleeping habits. Sometimes, if a child does not want to go to bed, you just have to say, "I'm sorry, but it is bed time, and that is the end of it." It will not kill them to cry because they disagree with your decision. (Once again, let me state that I do NOT advocate the "cry-it-out" method of sleep training, where you just toss a baby in a crib in a dark room to cry for hours until they pass out from exhaustion. But if, after you do everything to help them feel comfortable with bed time, they need to cry or fuss for a few minutes to express their disagreement or frustration with your decision, that is just part of life.)

It is not cruel or disrespectful to a child to tell them that they may not have a say in certain decisions - it is parenting. Too many AP proponents suggest that parents must respect the child as they would another adult, but this is inherently flawed. Children are not adults. They lack the knowledge, experience, and judgment to fully and appropriately participate in some decisions. That is why, after all, they have come here to be children to a set of parents: to learn these things.

There is a happy medium! You do not have to be a cruel, heartless mother by leaving your babies alone to fend for themselves, and you don't have to be a tired, sleep-deprived family with no proper boundaries or structure; you can find a way to lovingly and gently respect your children's wants and needs while still maintaining a sense of order and expectations. It is not abusive or disrespectful to insist your children adhere to certain standards - that is responsible and mature parenting! Furthermore, when you expect your children to have appropriate and worthy standards, they will live up to your expectations (provided you do so in a loving and respectful manner.)

Ruby is now approaching her first birthday, and she has learned about bed time. She and Bella go to bed at the same time, and they both sleep through the night, and wake up early. They also both nap at the same time, for two hours. There was no weeping and wailing and gnashing of teeth involved - Ruby never screamed and cried for hours on end alone in the dark. I simply nursed her, rocked her, loved her, sang to her, then laid her down at the same time every night. Some nights she falls straight to sleep. Some nights she disagrees and cries for 5-10 minutes before falling asleep. Cruel? I don't think so. She is happier than she has ever been, and now sleeps a reasonable amount of time every night. *I* am happier than I was, and much better able to cope with life's stresses since I am also getting a reasonable amount of sleep.

I personally think it is much more inappropriate to allow your children to stay awake until all hours of the night, only to get up early, never take a nap, and be cranky and difficult to manage the entire day from being over-tired. I think it is unreasonable for the entire family to revolve around the demands of said over-tired child. And I frankly think it is disrespectful to teach a child that they do not have to respect your own authority as a parent and adult. We DO have authority as a parent and a adult. That is part of the job description, and it is not mean or inappropriate to assert that authority. Children know this instinctively, and I believe we harm them when we choose not to fill our role as leader and teacher.

Sleep training is not evil or harming our children's self-esteem. Treating them cruelly, leaving them to fend for themselves, and ignoring their basic needs ARE harming, but sleep training and cruelty are not synonymous. Give people some credit - maybe some have found a way to lovingly and gently teach boundaries and set standards. Maybe you could learn something from them.

For more on why sleep training is not inherently evil, please check out Feminist Breeder's post on the same subject.

Human Rights

2009-06-15T18:19:00.003-06:00

This is going to be a post that is 100% rambling, musing, opinion. No facts, no research just plain ol' conjecture. So if you disagree, that's fine, just disagree respectfully. This post is not intended to be a debate post, even though I will be exploring some highly debatable topics. I'm not going to debate, and will delete any flaming comments (although I will welcome intelligent discussion on the matter). This is just food for thought.

With all the recent hullabaloo over the AMA's Resolution 710, and the murder of Dr. Tiller, I have been thinking a lot about human rights, and how it applies to pregnant women. The thing is, when it comes to pregnant women, there is no easy answer.

When you have a pregnant woman, you have two individuals. However, both individuals inhabit the same body, so to prioritize the rights of one, you must necessarily subvert the rights of the other. The trouble we have in our country is that we can't decide whose rights trump whose, and under what circumstances. And even then, we can't be consistent about each instance.

The people who are "pro-life" have decided that the baby is an individual with rights, and that a woman does not have the right to decide to kill it. However, one of the criticisms made against pro-lifers is that they cease to be as interested in the baby's rights once it is born. These same people who argue that the baby's life is precious and important are not also lobbying for funds and support services to be made available to women once they have their babies, in order to provide for these children. And generally speaking, it is conservatives who support pro-life policies, but do not support welfare-type programs to help just the sort of women who are most likely to need abortions in the first place.

The "pro-choice" people like to say that a woman has all the choice in the world about what to do with her own body. However, are they not concerned about the baby having a choice? Along those same lines, pro-choice people are the same people who fight for the rights of women in general, and because of that, are often people who fight for the rights of minority and underprivileged groups. If you were to suggest to them that a disabled child's life was not worth living, and that they ought to have been aborted, you would get flamed to a crisp! Pro-choice people seem to be very concerned about your right to choose when you are around to say you choose it, but are not concerned about those who aren't physically present to voice their disagreement. Are they saying choice only counts for those who have a voice?

And these aren't the only contradictions. People in the pro-choice movement are often only concerned with choices in the beginning of pregnancy. Once you start talking about choices at the end of pregnancy, they become decidedly less interested. Planned Parenthood, one of the biggest pro-choice organizations out there, refuses to get involved in the fight for the rights of laboring women to informed consent and the right to demand birth options. They also advocate for choices for certain people and not others, i.e. women should have a right to demand abortion, but a pharmacist should not have the right to refuse to provide an abortifacient. So it would seem that they have a specific agenda to promote, and that agenda is not just about a woman's right to choose.

At the same time, pro-life people, while arguing about how precious that fetus is, also largely refuse to weigh in on the birth choices controversy at the end of pregnancy. They think killing a baby is wrong, but don't seem to see anything wrong with giving it narcotics or risking its life in mode of delivery. In addition, the argument that brings us the concept of "fetus rights" is the same argument being used to force women into unnecessary and dangerous procedures, such as a repeat cesarean section, during labor.

So how do you decide who lives and who dies? And who gets to be the decider? What if a woman in labor chooses a course of action that would save her own life at the expense of the baby's? What if a doctor wanted to save the baby, and might end up killing the woman in the process? What about rape and incest? Well, I guess that is why this is such a controversial subject.

I would have to say I am inclined to be pro-life, simply because I don't think anyone has the right to kill anyone else on purpose, and especially when the other person doesn't get a say as to whether or not they prefer to stay alive. (And for the record, murdering a guy who does abortions is just dumb, because you just did what you said was wrong for him to do. I absolutely do not condone crap like that.) That being said, I know that abortions will always exist, and there ought to be a safe way to accomplish it. But surely there is some way to do this without condoning the practice in the first place?

I know I am speaking in generalizations here, so don't feel like you have to tell me you are the exception to the rule. I know there are exceptions out there, I am just musing on the theory and politics of it in general.

One more thing. I know this is a little extreme, but bear with me here. The condemnation in other cultures of women who are victims of rape or participants in extramarital affairs is roundly denounced as misogynistic, double-standard, and cruel. But I wonder if part of the reasoning for it is to avoid just the sort of situation I bring up in this post. Men certainly won't face any physical repercussions during the pregnancy or delivery, and if women are the primary caretakers of the children, would have very little, if anything, to do with the product of such an encounter. What if some cultures adopted that as a method of avoiding embarrassing, tricky, or controversial social situations, particularly in close-knit communities? I mean, as in the Arab nations, would it not be more cruel to cast a pregnant woman out into the desert to die a slow death for lack of supplies or transportation? I'm not saying it's right, I'm just wondering out loud here...

So what are your thoughts? Where does the right to swing one's fist end? Where the other's face begins?

Monday Munchies

2009-06-15T17:45:00.003-06:00

When I first moved out to Utah with my new husband, we went to a company "barbecue." I say it in quotes because when we got there, it was clear that the West's definition of barbecue is different than the South's definition. The meat was dry, the potato salad was white, there was no hot sauce or paper towels to be seen, and of course, no coleslaw.

I am from Arkansas, and most of us out there prefer Memphis-style, or Kansas City-style barbecue, which usually involves barbecue sauce that is sweet and tangy, and lots of it. I like my barbecue good and sloppy (hence the paper towels). That is the one thing I have missed out West more than anything else - good ol' Southern cooking, and most especially, REAL barbecue. Consequently, if I want anything good to eat out here, I have to make it myself. So if you were ever wanting to make your own authentic barbecue sauce, I'm here to tell you it is easy, fast, and oh-so-delicious! (And just so you know, barbecue sauce only properly goes on pork. Please leave the beef for hamburgers and steak.)

KC-Style Barbecue Sauce

2 cloves garlic, minced
1 c. ketchup
6 T. vinegar
2 T. worchestershire sauce
4 t. brown sugar
1/2 t. ground mustard

Combine all ingredients in a pan. Heat to boiling, reduce heat and simmer 10 minutes. Brush over ribs, or mix in with some pulled pork.

The Cult of the Bad Mother

2009-06-12T21:45:00.003-06:00

So a new theme is making the rounds of the blogosphere: the Cult of the Bad Mother. There's been several billion blog posts written on it in the last week (or at least 7 or 8), and I don't feel like linking them all, like some dysfunctional blog carnival. Just go google the phrase; you'll come up with plenty of links.

Anyway, this blogging trend speaks to the cultural trend in general to glorify character flaws and parenting mistakes, commiserate with other "bad mommies," and link arms in solidarity against the condemnation and judgment of the rest of the "sanctimommies."* Much time and space has been spent in trying to define "good" and "bad," and trying to decide whose morality trumps whose.

You know what it sounds like to me? A whole lot of insecurity. My blog is peppered with my opinion on the responsibilities of parents to their children, so I won't go into it at length here. But I will sum it up by saying this: while it is true that certain parenting choices are entirely up to the parent making them, and don't ultimately make a hill of beans difference in the way the world rotates, there are some parenting choices that are ALWAYS good, or ALWAYS bad. The thing is, it takes work, sacrifice, and maturity to choose those Always Good things, even at your own personal expense. What I see with the "bad mommy" movement is a group of women who are asking for a carte blanche to behave in whatever way they see fit without condemnation, or even without having to hear others' opinion on the subject.

What I also see with the "bad mommy" movement is a trend among our culture in general, of the rejection of established cultural values (whichever culture(s) you happen to be a part of). It is a sort of anarchist world view, that morality is relative, that if whatever a person chooses is "right" for themselves it is right, and a rejection of the cultural imposition of consequences for choosing to live outside of the established values. Okay, I am getting into dissertation territory here, so I will cut it short and simply say this: a little peer pressure can be a good thing. Cultural norms exist to protect and preserve the culture. Just like a routine is good for children to thrive and feel safe, a set of rules and consequences are good for adults for the same reason. And just like with children, if you choose to break the rules, you must be willing (and expect) to suffer consequences.

Okay, so what are these "rules" I speak of? Well, most of the rules depend on the culture which you are a part of. However, some things are pretty much universal. I think the problem with these "bad mommies" is that they are unable or unwilling to differentiate between the debatable merits of the cultural norms of whatever culture they identify with, and the immutable laws of the universe. For that matter, I guess that is pretty much everyone's problem these days. Everyone seems to be equally confrontational over issues like cloth vs. disposable diapering, and giving narcotics to newborns. Now, of course being environmentally friendly is always a good thing, and an extremely important position to have, but will not ultimately determine your child's emotional and physical well-being. However, giving drugs to newborn babies is Always Bad. Maturity and confidence is defined by being able to know the difference, and then feeling secure about the decisions you make based on that discernment.

The problem with these "bad mommy" types is that they don't want to be told about ANYTHING they are doing wrong, when they might actually be doing some things very wrong. Now, we all make mistakes. I've done more than my fair share of mistakes. But there is a world of difference between owning your mistakes and resolving to do better, and wearing your mistakes like a badge of honor, and getting offended when someone suggests it is nothing to be proud of. (Okay I said I wouldn't link anyone, but I do want to say Natasha over at Becoming Something made a couple of very good points to this effect. I don't want her to think I stole her ideas, but I would like to credit her with being much more tactful than I am at expressing them.)

Not only that, I am frankly beyond underwhelmed with the "confessional" style of blogging. I have had my own share of emotional issues in my life (haven't we all?), and if I have learned one thing, I have learned that dwelling on your problems doesn't solve anything. And furthermore, hanging out with people who also dwell on the same problems does even less for you. (In fact, in the case of addicts, it is suggested to not have anything to do at all with people who have the same problems, as the mob mentality tends to take over, and everyone ends up dragging each other down. Sick people have a vested interest in those around them not being well.) And I am not at all impressed reading about mothers who have done the same mistakes I have. If anything, I think these are things I would never admit to anyone, and certainly never be proud of. The answer to making mistakes is not to own your character flaw but to own the mistake itself, admit responsibility, and resolve to do better. Admitting you make mistakes is not heroic or praiseworthy; the miracle comes in changing in spite of the mistakes you have made.

In any case, it's silly to call mothers "bad" or "good," because as we all know, people just are, only choices are "bad" or "good." If you feel a need to defend your position, then perhaps you should examine why you feel defensive about it. On this blog especially, when writing about controversial issues, I get a TON of negative feedback from women who want very badly to justify the decisions they have made, and think they can accomplish that by calling me names or telling me what a mean and horrible person I am for simply stating what is plain truth. What insecure and immature people do not realize is this: 1) making bad choices does not make you a bad person, 2) if you believe you made the right decision, you have no need to justify it to anyone, and 3) whatever decisions you make, no one else is obligated to support you in them.

So enough with all this whining and complaining about feeling oppressed and judged by people who have a different opinion than you. If what they say has factual merit, then take it and decide what you want to do with it. If it just a matter of opinion, then ignore it. Whatever you do, please stop cluttering up the blogosphere with insecure, overly-defensive, ersatz intellectualism. Move on, because most of us already have.

* What I find most amusing about this whole stupid trend is the women who tend to crow the loudest about feeling oppressed are usually women who are in the majority in the first place. I find it incredibly hard to swallow that the 90% of women who birth in hospitals with epidurals, feed their babies formula, spank and vaccinate their kids, feed their kids crap food, and send them to daycare, feel somehow attacked and marginalized by the 10% of those who don't. Maybe that's what some other bloggers mean when they accuse the "bad mommy" types of being bandwaggoners - the chutzpah to be living in the majority, and enjoying all the privileges thereof, and then subsequently complain about the dirty looks they get from the minority, seems to be the exclusive domain of the popular crowd.

World Birthing Rights Day

2009-06-07T19:00:00.004-06:00

Over at ZGZ - Pro Parto Natural, they are bringing our attention to World Birthing Rights Day, which happens to be today, June 7th. (These are also the lovely people who brought us a home birth on a TV commercial for a mattress. Please go visit their blog and favor them with some hits.)

The blog is in Spanish, so I will translate the page for you here. Even if you don't speak Spanish, I would still encourage you to click the link to give the blog the credit it deserves. Go ahead and click on it, then come back and I'll tell you what it says. And I completely agree.

On June 7th we celebrate "World Birthing Rights Day."

The objective is to raise society's awareness that birth is a crucial rite of passage in the life of every human being, that it is his welcome to this unfamiliar (to him) world, and that is it a key moment in his psychological development that will leave an indelible mark on his very being and feeling.

Also, the act of giving birth [ed. note: literally translated means "to bring to the light." How beautiful!] is a highly-charged emotional experience for the woman, and such a unique experience that every woman should have the right to decide where and in what manner to carry it out.

World Birthing Rights Day is a call to respect the natural process of birth, to provide informed consent to mothers about their birth options, to make it possible for mothers to birth in whatever manner they prefer, to facilitate the initiation of the breastfeeding relationship at the moment of birth, and to not separate mother and baby unless absolutely unavoidable.

Here we have included the 10 commandments for birthing rights, from Plataforma Pro Derechos de Nacimiento (Program for Birthing Rights):

Birthing Rights

These rules speak about the rights a baby acquires when we decide to give it the opportunity to be born.

From that moment, we are obligated to properly accompany [the baby] in this life adventure, having been charged with carrying it out in the most gratifying, enriching, and successful manner possible.

Research shows that vivid experiences in the first stages of life (pregnancy, birth, and infancy) leave on the human being an indelible mark, which consequences will accompany him for the rest of his life.

With the intention of preventing later psychological consequences, we invite mothers, fathers, and health care professionals, to honor these guidelines.

1. The baby has the right to realize his full physical and emotional capacity, in utero, outside of the uterus, and especially during the transition between both.

2. The baby and his mother have the right to intimacy and respect, before, during, and after the birth.

3. The baby has the right to be personally cared for by his mother, at minimum, for the first year. The mother has the right to enjoy intimate contact with her baby whenever she desires.

4. The baby has the right to enjoy breastfeeding on demand, at minimum, for the first year. During his stay in the hospital, the "10 Steps to Successful Breastfeeding" established by UNICEF and the World Health Organization, and recommended by the Asociación Española de Pediatría (Pediatric Association of Spain) should be respected.

5. The baby and his mother have the right to stay together in the first hours and days after birth. There is no hospital visit or stay that justifies separating mother and baby.

6. The premature baby has the right to be incubated by the Kangaroo Mother Care method. No aspect of neonatology is of greater benefit to the baby than his mother's skin.

7. The baby and his mother have the right to have the momentum, rhythm, atmosphere, and company of labor and delivery respected, physiologically as well as emotionally. A healthy baby and mother have the right to not be treated as though sick.

8. The baby in utero has the right to his mother's emotional well-being not being disturbed by excesses or abuses by health care providers during the pregnancy.

9. Parents have the obligation to research, and the right to receive, information and good counseling, and to take personal responsibility for the decisions related to the well-being of the baby.

10. The premature baby has the right to stay attached to his mother's body until he reaches his optimal weight and health status. No aspect of neonatology is of greater benefit to the baby than his mother's skin.

Monday Munchies

2009-05-25T14:52:00.002-06:00

Brownies. Need I say more?

Brownies

1 stick butter
3 eggs
1 2/3 c. sugar
2 t. vanilla
15 T. baking cocoa
1 c. flour

Preheat oven to 350° F. Grease bottom and sides of 8 x 8 square casserole. Melt butter in a bowl and set aside. Combine eggs, sugar, and vanilla in large bowl. Using a mixer, beat on high speed for 5 minutes. Add melted butter and cocoa. Mix on low speed until smooth. Add flour and stir just until flour is moistened. Pour into pan and bake 40-45 minutes, or until brownies start to pull away from the sides of the pan. Let cool. (Haha yeah right. Okay, let them sit at least 10 minutes before you cut into them. Otherwise you'll have a crumbly mess.)

Variations:

Marshmallow brownies - sprinkle mini-marshmallows on top of the pan of brownies right out of the oven. Let sit and cool.

Rocky road brownies - make marshmallow brownies, then drizzle caramel sauce over the top of them.

Nut brownies - Stir in 1/2 c. of your favorite nuts in with the flour.

Overdue is NOT an emergency

2009-05-20T13:01:00.005-06:00

In 2005, a report was released which showed the average length of pregnancy in America has lessened from 40 to 39 weeks. According to this article, the biggest factor in this shift is due to the significant increase in late-preterm deliveries, with an increase 12% of all babies being being born at around 34-36 weeks. However, the author only mentions in one line of that article that during the same time, there was a 21% decrease in the number of deliveries occurring after 40 weeks. Are American women not able to hold their babies in as long? No. From 1990 to 1998, the rate of induction in the US doubled (ref), and according to the 2006 Listening to Mothers II survey, had risen to 41% of all surveyed women. In that same survey, of those women who reported their caregiver wanted to induce them, fully 25% of them were encouraged to induce for being "overdue." Why all this rush to induce women when they are overdue?

Typical human gestation is 266 days, or 38 weeks from the date of conception (40 weeks from average last menstrual period). The normal range of delivery is from 37-42 weeks, so a woman is not overdue, or does not fall outside the normal range until after 42 weeks of pregnancy, or at 43 weeks. After 42 weeks, health care providers become concerned about the baby's health for the following reasons, not all of which have merit:

1. Fear of stillbirth
2. Fear of loss of amniotic fluid
3. Fear of macrosomia (big baby)
4. Fear of fetal distress, which may result in meconium aspiration
5. Fear of problems with placenta functioning.

For these reasons, several studies have been done over the years to see if induction at a certain point in pregnancy would prevent or significantly reduce the number of negative pregnancy outcomes. I am not an statistician, so I will not have a detailed discussion here about the merits of those studies. (Henci Goer has a brief discussion about the failings of one review of said studies.) However, in some of those studies it was determined that induction at 41 weeks of gestation decreases the stillbirth rate. For this reason, doctors typically feel that they must induce by 41 weeks to avoid a dead baby, but this is just not supported by evidence.

Fear of Stillbirth

The incidence of stillbirth increases with gestational age. Naturally, the medical profession has concluded that the earlier you induce women, the more deaths you will prevent. The problem with this reasoning involves a lot of numbers.

First of all, the average length of pregnancy for first-time mothers is 41 w 1 d. If all women were induced at 41 weeks to avoid stillbirth, you would have a significant number of women who were not even ready to go into labor in the first place. Picking an arbitrary date on which to induce women does not take into account the difference in gestation between all women, and even between pregnancies. There is also the problem of accurate dating. In the article I linked above, I discussed how due dates are determined, and it is possible that due dates can be off by as much as 2 weeks in either direction. That means if you induce a woman at 41 weeks, she could possibly be only 39 weeks. Induction based on no other indication besides dates is not sound medical advice, as no method of dating is 100% reliable.

However, for argument's sake, let's look at the stillbirth rates and some of the numbers that support induction at 41 weeks. According to this review of several studies that support induction at 41 weeks, there were fewer stillbirths in the group that were induced at 41 weeks, as opposed to the group that was expectantly managed at least one more week (some may have gone on to be induced after that.) The stillbirth rate for the group that was not induced at 41 weeks came out to 2.4/1000. Not a terribly high stillbirth rate in the first place, and not a significant difference between the two groups, as the review concluded: "A policy of labour induction after 41 completed weeks or later compared to awaiting spontaneous labour either indefinitely or at least one week is associated with fewer perinatal deaths. However, the absolute risk is extremely small."

But even if we were to feel that no risk of stillbirth would be acceptable, let's consider inducing or c-sectioning every woman who went past 41 weeks. The infant mortality rate after c-section is 1.8/1000 (ref). So while induction at 41 weeks may lower the stillbirth rate, i.e. forcing delivery of a baby who is still alive, you only trade your risk for infant death due to factors related to infection or injury resulting from medications and major surgery. Now, I did say c-section, and this post is about labor induction. However, labor induction, especially when involving certain factors, such as Bishop's Score (see here and here), can more than double a woman's risk of ending up in a c-section.

That is to say, if a first-time mother goes in for an induction at 41 weeks, with no dilation or effacement, and the baby has not yet dropped, before the average first-time mother would even go into labor, she has more than a 50% chance of ending up in a c-section, which carries its own set of risks for infant mortality. How is this better than waiting another two weeks? And if you think the risk of induction is worth avoiding the risk of stillbirth, then you should read this article about why every week of pregnancy counts (although that article does mention a bit of "old placenta" nonsense, but more on that in a minute).

And just so you know, 96-99% of all women will have delivered by 43 weeks gestation. The chances that a pregnant woman will go into labor spontaneously prior to 43 weeks is phenomenally higher than the chance her baby will have died in utero beforehand.

Fear of Loss of Amniotic Fluid

Busted in this post.

Fear of Macrosomia

Already busted this OB myth in another post.

Fear of fetal distress and resulting meconium aspiration

The incidence of fetal distress does increase with gestational age. However, it is neither predictable nor preventable. The incidence of passing meconium also increases with gestational age. However, the presence of meconium is not so much a danger itself, as an indication of some other distress that may or may not be occurring. Meconium aspiration syndrome, which occurs in a fraction of those cases, is cause for concern. However, to return to the numbers problem as with stillbirths, the fraction of babies that may die or be seriously injured from the fraction of cases in which MAS occurs, may be far outweighed by the risks of induction or c-section.

Fear of "old placenta"

This is my all-time least favorite reason to induce. Studies have shown time and time again that the calcification of the placenta is a physiologic process of no clinical significance (Fox, Fujikura, Jeacock, Tindall and Scott, etc). And no study, as far as I can tell, has ever linked placenta calcification with stillbirth. It is has been shown that placenta calcification is more severe in women who smoke (ref), but there is still no correlation between placenta calcification and fetal demise. If anything, placenta calcification can be a risk for intrauterine growth retardation (IUGR), but that will be seen long before a woman's due date in the form of a baby who is not growing. The placenta is not an on-off switch; if the placenta begins to function less efficiently, the baby will not die suddenly (unless the connection between the placenta and the uterus is severed completely, as in abruption). The baby will simply fail to thrive, and a baby that is failing to thrive will show problems before the due date. Placenta calcification means absolutely nothing.

If a woman goes in for late-term ultrasound, the doctor may tell her there are "spots" on the placenta, which indicate the placenta will somehow stop functioning and cause her baby to die. This is patently false. The placenta does not have an expiration date, and unless it is removed from the uterine wall altogether, will continue to serve its purpose as long as the baby is in there.

43 weeks

Normal human gestation is 37-42 weeks. As in, through 42 weeks, up to 43 weeks. In low risk pregnancies with no other risk factors except that she hasn't gone into labor yet, there is no reason whatsoever to induce a woman prior to 43 weeks. A woman and her care provider may choose to start monitoring the baby after 41 weeks, but I would strongly caution against that. Monitoring is only as good as the moment in which it is being performed. Studies have never shown improved pregnancy outcomes with the use of NSTs; that is, that NSTs neither predict nor prevent problems or stillbirths. The only outcome I have ever seen with NSTs are unnecessary labor inductions.

If you are amongst the 1-4% of women who make it to 43 weeks, you may consider monitoring or induction at that point, as stillbirth rates do increase significantly at that point. However, I personally would not consider an induction with no other indications. For me, the risk of medications, interventions, and possibly surgery are too great when the baby appears to be perfectly alive and well in there. After all, if you're not in labor yet, the baby is clearly not ready.

If you are seeing an OB who begins to pressure you to induce after 40 weeks, you can simply refuse. Doctors are prohibited by law from dropping you from their care within 30 days of your due date, without providing you with reasonable accommodations. That means if your doctor threatens to drop you from his care, he is legally prohibited from doing so, unless he provides you with another physician to take his place. You are the patient, and as such, have rights. You simply wait to go into labor, then come in when you are ready - your doctor will still attend you.

If your doctor tells you that there is some medical reason why you must induce, tell him you will think about it, then go home and do your research. Think about it: if you are not being whisked away to emergency surgery, the doctor clearly does not consider it a matter of life or death. If your baby's life is truly in danger, why would the doctor tell you to come in the next day to be induced? And even if your baby was somehow compromised, would a forced induction with strong oxytocic drugs not be more stress on an already-compromised baby?

Induction of labor is only truly indicated in a very few circumstances. If your baby is in imminent danger of dying, you will be taken to surgery. If not, what is waiting another day? Or two? Or five? Obviously I am not speaking to those for whom an induction is medically indicated, such as in the case of pre-ecclampsia. But for women for whom there are no other indications except being past her due date, the numbers are far and away on their side. Being overdue is NOT an emergency.

Monday Munchies

2009-05-18T18:31:00.003-06:00

Now that the weather has gotten hot (well, in this part of the country anyway), it's time for some light and cool recipes. This one calls for chicken, but you can substitute any meat for it. I especially like to use this recipe for leftover turkey. As always, you can adjust amounts to suit your tastes.

Chicken Salad

2 c. cooked chicken
2 stalks celery, diced
2 boiled eggs, diced
1/2 bell pepper, diced
1/2 c. nuts
1/2 c. mayonnaise
1 T. milk
1 t. lemon juice
1 t. dijon mustard
salt and pepper to taste

Combine all ingredients in large bowl. Serve on bread.

My Old Kentucky Home, pt. 2

2009-05-17T15:14:00.007-06:00

We went to Kentucky to visit my paternal grandmother, and other family that live in the area. My father's side of the family settled some of that area of Kentucky, and my grandmother was born and married there. She moved away for most of her adult life to Florida, and then returned with my grandfather after their kids left home. They used to live out in the old farmhouse in the country that my great-great-grandfather built with his own two hands, but a few years after my grandfather died, she moved into town

The old farmhouse

Her youngest daughter never left the area, and her second-oldest son and his wife just moved up there to be closer to her in the last year. So I was able to spend time with my grandmother, my great-aunt (her sister), my great-great aunt (her aunt), my aunts and uncles and the younger cousins. This was a terrific blessing, as I had not been out to see my grandmother or aunt in almost 6 years. I was a little nervous to see my grandmother, who had been having many health problems in recent years, but I was worried for nothing. She is a "tough old bird" as we like to say!

In my father's family, cooking is an art form. Every family member is expected to contribute in some way in the kitchen, and status is conferred on the basis of your cooking abilities. Every time our family gets together, each person who is within driving distance of a usable kitchen brings several dishes from scratch, and there is always pie. Lots and lots of pie. It is extremely bad form to bring anything store-bought, and in fact, I can't remember seeing a single dish at any family gathering that wasn't brought from home. I can't be sure, since I've never seen it happen, but I would bet that bringing a frozen pie or a box meal to a family meal at my grandmother's house would be quite scandalous.

I have always considered myself a good cook, but in previous years, was always considered too young and unproven to help out with the cooking (although there was never a minimum age for clean-up). Six years ago, when I visited my grandmother over Christmas, she had a heart attack on Christmas Eve. She went to the hospital, and I and my sister were suddenly faced with preparing Christmas Day supper for the entire family and guests. Not only that, my grandmother had not even made up the stockings for the children coming to visit. Fortunately for us, my grandmother had made several lists of the meals she had planned, and had put all the stocking supplies in a box, so we had the instructions at our fingertips.

My grandmother insisted we carry on with the meal preparations, and my aunts and uncles saw to her in the hospital. My sister and I whipped up that Christmas supper with whatever we had on hand. If I remember, my gravy didn't turn out, but all the other dishes came out very well. My sister handled the casseroles and I managed the main dishes, and everyone else brought sides and pies. We also had the stockings ready Christmas morning, and handed out gifts to all the visitors. Everyone went on to visit Grandma at the hospital later that day while I stayed behind to clean up and pack, as we were leaving soon after. I never knew if my efforts were appreciated until two weeks ago. (Well, of course they were appreciated, but my grandmother was in no position to thank me kindly while unconscious in the hospital.)

Two weeks ago, four days before we were supposed to leave on vacation, my grandmother called me to tell me she had back problems, and may need to go in for surgery. My heart dropped, because I thought she was calling to tell me not to come. I told her I didn't want to impose, and surely she wouldn't want a house full of noisy babies while she was not feeling well. Instead, what she said both honored and shocked me - she said that she most definitely wanted me to come, but because of her back, she would not be able to entertain me. In other words, I would be THE cook the entire time I was there.

Now, for those of you for whom cooking is not a past-time, cooking all the meals for your host and family while on vacation may not seem like much of a vacation for you. But for me, coming from my amateur-chef family, and not often having been allowed to help cook before, this was a true honor, a rite of passage. Not only was I being asked to help in the kitchen, I was being charged with my grandmother's kitchen, and maybe even her reputation. And this would also cement my standing as a trustworthy adult in the kitchen. I had come of age.

So I did. I cooked breakfast and supper. I cooked biscuits and gravy, eggs and bacon, stir fry, rice, potatoes and onions, and dinner rolls (although those were from the store, but only because grandma doesn't make yeast bread anymore, so no yeast in the house.) One night we went to my aunt and uncle's house, where she cooked supper. And there was lots of pie. Grandma even had my gravy for leftovers the morning we left. My aunts and uncles enjoyed my cooking (or so they said), and according to my husband, my grandmother spent a good amount of time bragging about her granddaughter on the phone to her friends and other family members. Now, this is not to brag on myself; I felt honored and pleased to be given that responsibility, and I felt like I discharged my duty well. I think this makes me older too, as I have now graduated into the corps of The Adults in the family who bring all the meals to the gatherings. It will be me shooing kids out of the kitchen at the next gathering, and it will be me sitting around the table with the older folk relaxing and chatting, while the kids clean up. Strangely enough, I don't mind this brand of getting older. It feels like an appropriate transition to another phase in my life, and a fulfillment of the natural order of things.

I won't bore you with the details of the rest of our stay in Kentucky. We went to a park, we spent time with my Great-aunt Virginia, who is turning 100 next month, and has a terrific sense of humor. We spent time with my aunts and uncles and younger cousins, whom I had not seen since they were babies. We ate at the Waffle House, since those don't exist out West, much to my chagrin. I slept on the front porch for a nap, and so did my baby. I would have liked to spend more time playing grandmother's piano, but was too busy cooking, visiting, and tending kids.

Grandma, still looking fine at something over 50.

On the day we left, I cleaned up the house. I gathered the linens and made sure the kitchen was clean. We put up all the toys and packed our bags. Our plan had originally been to have a farewell lunch at the local barbeque joint we always went to every time we visited, but grandma's back just wouldn't support it, so we decided to just grab lunch on the way out of town. We kissed and hugged and said our goodbyes, and headed off for the Big City, with one stop along the way. That day turned out to be much longer than we had planned for!

Next time: Travel day #2.

Anatomy of a c-section

2009-05-16T07:22:00.003-06:00

Last night I was chatting amongst my internet friends, and one of them mentioned a recent birth story that she had read that culminated in a c-section, and that she was sure was justified. My curiosity was piqued. Being a very vocal natural childbirth advocate, I often have people tell me birth stories that they are convinced were the one exception to the unnecessary-interventions-that-lead-to-c-sections rule, and they want me to confirm, in my opinion, that theirs was the one necessary c-section, but I am usually disappointed. Out of the hundreds of c-section birth stories I have read, only a handful qualify to me as true emergencies* (or at least emergencies that weren't caused by preceding interventions.) And this story was just another in a long line of women who will be forever convinced their bodies do not work simply because everyone told them it wouldn't. (Before you start telling me I am big ol' meanie for picking on this woman's story, I can assure you this story is the same story told a hundred times over, and I would be willing to bet it will apply to someone you know. It truly is any woman's story.)

The story begins with a woman who was 42 weeks pregnant. Right there, I can tell you that any woman in America who is seeing an obstetrician at 42 weeks pregnant will probably end up with a c-section. The medical community in America seems to think that at 42 w 1 d, babies will implode or something similar. The truth is, due dates are unreliable, ultrasound dating is notoriously inaccurate, and the stillbirth rate doesn't actually increase until 43 weeks (but still isn't even as dire as it sounds. I will write a blog post soon about this, so look for my references.)

But this woman wasn't seeing an obstetrician; she was seeing a midwife. A licensed midwife. One must be wary of any care provider who is legally constrained, and has their scope of practice dictated by modern obstetric practice. While they may practice more holistic medicine, they must necessarily be mindful of liability, which will inevitably trump safety and bodily integrity. This was obvious in the beginning of the birth story, when she described how her midwife had been trying to "naturally" induce her to cause her to deliver before 42 weeks. (There is no such thing as "natural" induction. If you are trying to force your body into labor, then it is not natural.) By this fact alone, you can see the midwife viewed pregnancy and labor as a disaster waiting to happen. Otherwise, why wouldn't she have just let the mother go until the baby decided it was ready to be born? Then enters the second motivation: liability. It is likely this midwife was legally constrained from attending home births past 42 weeks of pregnancy. As I said above, if liability becomes a priority, health and safety suffer.

Now, in our current obstetric climate, most health care providers, and indeed, most pregnant women, believe that after 42 weeks the baby enters some sort of danger zone, where they are likely to die at any moment. And with the rush to induce prior to 42 weeks to "save" the baby, coupled with all sorts of tests and procedures to make sure the baby is still alive in there, is it any wonder that women in America are ready to have a nervous breakdown at 41 w 6 d? And this mother was no exception. At 42 weeks pregnant, she felt concerned that her baby wasn't moving as much as usual. This is perfectly normal, babies slow down considerably in the days preceding labor. She called her midwife to ask her advice. Instead of coming over to check the mother, or reassuring her that it was normal, the midwife had her proceed straight to the OB's office for an ultrasound and non-stress test (NST), which reaffirms my suspicion that the midwife herself either was not convicted about natural pregnancy and labor, or was mandated by liability to act contrary to the best interests of her patient.

Why would going in for a NST be contrary to the best interests of a pregnant woman? Because NSTs have never been proven to improve pregnancy outcomes. If a baby were to be in distress, an NST would only be helpful if they happened to be testing at the exact moment a baby was in distress. NSTs are also implemented routinely after 40 or 41 weeks, when women are on the post-dates timetable, already surrounded by fear, anticipation, and the "we must get this baby out NOW!" mentality. What happens most often are borderline results and false alarms that trigger a series of "life-saving" interventions. I have read about more inductions as a result of questionable NSTs than almost any other test or procedure. The top 5 bogus reasons doctors induce women after NSTs include:

1) big baby (busted)
2) low fluid (Not by itself a reason to induce. But even if it was, why would you induce an already-compromised baby? busted)
3) "old" placenta (One of my least-favorite reasons to induce, because it means absolutely nothing. refs post coming soon)
4) cord around the neck (busted, although this one is generally used to "emergency" section women.)
5) borderline or less-than-favorable activity or heart rate.

Which is exactly what happened to this woman.

She was told the amniotic fluid was low, the baby was not moving "as much as they liked" (Are babies not allowed to have lazy days too? Heck, I was barely moving off the couch yesterday. Does that make me in imminent danger of slipping into the Great Beyond?), and placenta calcification. So everyone felt it was "best" to induce, by the use of cytotec, no less. I can't believe that they are still legally allowed to use this drug, which is killing women and babies at an unconscionable rate, and the fact the midwife agreed to it cements my opinion of her has a "medwife."

Does anyone know the dangers of cytotec? If not, read this article. Now. I'll wait.

She began induction with the cytotec and continued to labor for the next 20-some-odd hours. I won't bore you with the details of all the vaginal exams, position changes, shift changes, monitoring, and general hovering about of the medical staff. The doctor came in to break her water at one point. (Which right there shows the fallacy of inducing for "low fluid," since those inductions almost always involved artificially rupturing membranes. Yeah, that makes a lot of sense - rob the baby of what you just said they were about to die from having so little of in the first place.) After being scratched on the head with the amniohook and being forced down through the uterus with unnaturally strong contractions and before she was ready, naturally the baby had "reactivity" issues, and mom was put on oxygen and monitoring throughout the course of the labor.

Fast-forward to the end of the labor, and mother is getting her 357th vaginal exam, which is still showing "not as much progress as they would like." Is it any wonder mother is having trouble relaxing and concentrating on labor, between the audience, the hands up her vagina, belts around her belly, mask on her face, and the pressure of "isn't she done yet?!" Even so, she was dilated to 7 cm. The doctor decided she wanted to "help things along" by manually dilating the cervix another cm. Can you say OUCH? Why do birth attendants continue to insist on using their hands as tools to force things to happen before they are ready to? Ugh.

More laboring, and more vaginal exams, and mother has only (ONLY?) progressed to 8 cm. The doctor speculated that previous cervical surgery was preventing the cervix from dilating any further, but they agreed to allow mom to labor a bit longer. Has anyone noticed that almost all birth stories in which c-sections and/or failure to progress (FTP) are mentioned, but labor is allowed to continue, everyone seems to have given up and it ends up in c-section anyway? It's like saying to a recovering alcoholic: "Well, you've done very well so far. I have some beer in the fridge, but I'm sure you won't be wanting it. You just hang out while I drink and watch the movie, and when the movie's over you can head on home." But back to the previous cervical issues: does it not occur to anyone that if the mother had already dilated to 8 cm it is ridiculous to assume it would just suddenly stop?

But we all know it wasn't the cervical issues, and it wasn't the lack of fluid. It wasn't even fetal distress, although there had even been a touch of that in the labor. Ultimately, "we speculated that my uterus was getting tired of pushing down...and the muscles were wearing down and exhausting." So, failure to progress. Or as they like to say over at ICAN, "failure to wait." She got c-sectioned because everyone decided they were tired of her being in labor, and convinced her that her body would go no further. This is after they already convinced her that her baby would suddenly die if not delivered on that magical number of 42 weeks.

It makes me angry. It really does. It angers me that this woman was put at significant risk, all on the advice of people who were supposed to be interested in her health and well-being. Perhaps they thought they were being concerned for her well-being, but everything they said and did simply corralled her to the choice they thought she should have in the first place: major surgery. It angers me that because of our climate of fear and liability, she will probably be forced to have a c-section next time, because no one will "allow" her to do a VBAC, thereby forcing her to choose between surgery or unassisted home birth. It angers me that she will forever be convinced that something is wrong with her body because it wouldn't have the baby, not knowing that it was the interventions she allowed that prevented it from happening.

And most of all, it angers me that she will tell this story to all her friends and families, and share this story with her children, and confirm in the minds of hundreds more women that pregnancy, labor, and delivery are scary and painful experiences, likely to go wrong, frought with danger, and likely to end up in surgery anyway. She will perpetuate that her c-section was necessary, and every other woman who has the same series of events will, because of her story, believe that theirs was necessary too. And the c-section rate continues to rise.

* What, might you ask, qualifies me to decide if a c-section was justified in any birth? Nothing. I am not a medical professional and do not claim to be. I am, however, a very well-educated natural birth advocate, and am particularly skilled at recognizing patterns. I like to analyze birth stories so I can understand why things happen that lead to unnecessary procedures. When it is not my birth story, I have the advantage of being impartial and analytical, and have a over-arching view of the series of events. And to those who claim I can only understand the circumstances if I was physically present, I would ask why you are so emotionally invested in believing yours was the one exception to all the many thousands of stories just like yours, of women who believed the health care profession could be trusted with their bodily integrity, and came away with a liability scar.

My Old Kentucky Home

2009-05-06T10:34:00.002-06:00

If you wonder where I've been, wonder no further. We are traipsing around the States, visiting family and friends. We also went to Wicked, which was Darian's Christmas present.

I'll post some pictures tomorrow of our vacation, and when I come back, I will share all the details. Hope everyone has a nice week.

Monday Munchies

2009-04-27T07:28:00.003-06:00

Now that we're having another weird cold snap in the middle of spring, I got a request from Darian for one of our favorite cold-weather meals, chicken and dumplings. Chicken and dumplings is yet another example of a dish I hated as a kid, but learned to enjoy as an adult, when I could make it more to my tastes.

The way I grew up eating chicken and dumplings was a chicken stew with batter dropped in to form little dough balls. It wasn't until I was an adult that I learned that some people make dumplings in long, flat strips. I don't consider that chicken and dumplings though; that's more like chicken noodle soup with really big noodles. And believe it or not, some people make their dumplings by dropping pop biscuits* in the stew.

This is a very easy recipe, and takes one pot to make it in.

Chicken and Dumplings

1 whole chicken
2 c. flour
4 t. baking powder
2 T. parsley
1 T. salt
1 t. pepper
4 T. shortening (or bacon grease, if you have it)
1 c. milk

Boil the whole chicken in a large stock pot. Take the chicken out and let cool. When cool, pull the meat off, putting the meat back into the pot. Heat the chicken stock back to boiling. While heating, put together the dumplings.

Combine the flour, parsley, salt, and pepper in a large bowl. Add shortening and blend in. Add milk and stir just until everything is moistened. Drop by spoonfuls into the boiling chicken stock. Cover and simmer for 15 minutes, without peeking! Serve hot.

* Pop biscuits are what we call those biscuits that come in a tube, that "pop" open when you peel back the paper. I was always too chicken to peel the paper back, so I "whop" them on the counter edge, which I guess makes mine whop biscuits.

Monday Munchies

2009-04-20T10:43:00.004-06:00

When I was a kid I hated pot pies. My mother would buy those 10 for $1 frozen turkey pot pies, and I just couldn't stand them, and refused to ever eat them. A few years ago, I got a weird craving for pot pie, so I decided to give them another try. This time, I got chicken, and found I liked those much better than the turkey, but still wasn't a big fan of them. Then it occurred to me that I might like pot pie better if it was home-made, so I set out to make my first chicken pot pie. It was an instant success, and has been a regular favorite in our house ever since.

Incidentally, that is the idea that turned me on to cooking when I was a teen: that I could make anything I wanted to eat, as long as I had the instructions, the ingredients, and the time. And I can always make time for chicken pot pie!

This is a somewhat difficult recipe, and may take some time. When you boil the chicken, be sure to reserve the broth. Also, you can use any combination of vegetables you prefer; carrots, peas, and broccoli are all good ideas.

Emily's Chicken Pot Pie

Filling

1/3 c. butter
1/3 c. flour
1 T. salt
1/4 t. pepper
1 3/4 c. chicken broth
2/3 c. milk
1 T. parsley
1/2 t. marjoram
1/4 t. sage
1 whole chicken, cooked and pieced
1 c. corn
1 c. green beans
3 potatoes, diced and boiled

Pie crust

3 c. flour
1 1/2 t. salt
1 c. plus 3 T. shortening
cold water

Preheat oven to 425° F.

To make the filling: Melt the butter in a large pot over medium heat. Stir in flour, salt, and pepper. Stir constantly, until mixture is bubbly and starting to darken. Remove from heat. Add broth and milk, stirring constantly. Then return to heat, and add the spices. Heat to boiling, stirring constantly. Boil and stir for one minute. Add vegetables and chicken, and set aside.

To make the pie crust: In a large bowl, combine the flour and salt. Add the shortening, and cut in with a fork or pastry blender. Blend until the shortening is evenly distributed throughout the flour - it will be in pea-sized clumps at this point. Then add cold water, 1 T. at a time, until you are able to form a dough ball that is not sticky, but holds together. Divide the dough ball into two parts, one being twice as big as the other (like into thirds, with two-thirds being one ball.) Lightly flour a work surface, and roll out the larger ball into a rectangle, larger than the pan you will be using (I use a 2 1/2 qt. casserole dish.)

Fold the dough in half, then half again, and lay into your pan. Unfold the dough, and press into the sides of the pan. Pour the filling into the pie crust-lined pan. Roll out the smaller dough ball, large enough to cover your pot pie. Lay the crust on top of the filling and pinch the edges shut with the bottom crust. Cut off any excess crust. With a knife, make slits in the top pastry. Place pot pie in the oven for 30-40 minutes, or until the crust is a golden brown. Remove from the oven and let sit for 5 minutes. Serve, and enjoy!

Why I might use a midwife next time

2009-04-18T08:38:00.004-06:00

As most of you know, I had my last baby at home, without the assistance of a paid birth professional. I am considering a midwife for the next, although I'm not pregnant yet.

When I had an unassisted birth (UC) it was definitely something I needed to do. I needed to step outside the system; to push all the boundaries, so I could know which boundaries I would like to set. That is not to say I was birthing specifically to "buck the system," although in our current restrictive birthing climate, one must almost UC just to be able to have some choices in their labor. No, when I say I needed to step outside the system, I mean I needed to reframe my perception of labor and birth. When you birth with the assistance of a paid professional, it is human nature to defer to their perceived authority. I wanted and needed to discover my OWN authority regarding my body and my labor. Now that I have done that, I have found my inner strength. Okay, I know that sounds terribly corny. But until you have birthed on your own strength, and with no one to rely on but yourself, you will not understand what I mean by that. There is something to be said for taking total responsibility for the outcome of your pregnancy and birth.

Now that I've done that, I don't feel a need to do it again. Now I feel that, even if I had a paid birth attendant present, I know what I want for myself. I know what I can do for myself, and what I would like to have done. Also, having done it myself, I do not feel obligated to do what the birth attendant suggests, simply because she suggests it. I have the knowledge and the confidence to birth on my own, and to accept help when it is needed, but not be corralled into choices I do not feel comfortable with, on the advice of "authority." I have come to understand that I am the authority in my birth, and any birth attendant is just that: there to attend me, should I need help.

Having done a UC, I learned a few things. Even though my husband and friends were prepared for the "what-ifs," I learned I'm not comfortable putting that pressure on them. If something were to go wrong, they have zero experience or training. Many UCers say that if something bad happens in birth, all you need is instinct to get you through, but I do not believe that is true in some cases. Instinct may tell you something is wrong, but instinct is not another pair of hands to help rotate a stuck baby under the pubic bone.

And while I do believe that anyone can learn life-saving techniques, and be prepared in case of emergency, there is something to be said for experience. If, in the instance of shoulder dystocia, a manuever is required to unstick a baby, my husband may be able to get the baby unstuck, but may not know how to do the procedure correctly, and inadvertently cause a birth injury. Or what is more likely, if something life-threatening were to become evident, someone untrained or inexperienced in being faced with life-threatening situations may just freeze up.

Lastly, not everyone is emotionally prepared for the fall-out in case something Really Bad were to happen. One thing I am not sure many UCers truly understand is that when you take responsibility for your birth, you take responsibility for all possible outcomes. If your baby is injured or dies under your direction, you must be prepared to accept that. Now, in my last birth, I was prepared to accept that, but I'm not sure my friends and family were. What's more, I am not sure that it is fair to expect them to be. When you pay a birth attendant, you expect them to bear some of the responsibility for the outcome (although all women should take their own measure of responsibility, but more on that in a minute), and they are emotionally prepared to bear that responsibility. That is their job, after all. But your friends and family just want to see a happy and healthy mom and baby at the end of it all. They cannot or should not be expected to bear that burden (unless of course, they want to.)

In addition to the emotional nature of birth, I found that the postpartum care offered by one of my friends was beyond valuable. Before I had Ruby, I was not sure that I wanted or needed to be "fretted" over. When my friend showed me that loving act of service by cleaning up, fixing a bath, getting me something to eat, helping me with the baby, talking to me, and celebrating with me the birth of my baby, I learned how valuable it is. In fact, I might say that was the most important part of my entire birthing experience, and I finally understood what they mean by "with woman."

I know my friends would be ready and willing to do that again in a heartbeat. However, if I hired someone to provide that for me, I wouldn't need to worry if my friends were unable to stay, or have to worry if they had to bring her little ones. And because no one knows when they will birth, there is no guarantee that my friends would even be available, particularly if the birth happens in the middle of the night. With a paid attendant, I would be guaranteed postpartum care. Not only that, a midwife provides other services, such as prenatal care, postnatal and newborn check-ups, and filing paperwork for the birth certificate. Not that I can't do those things myself - I did once before. But honestly, it is just really really nice to have.

It is sort of like changing a tire on your car. It isn't hard, and everyone needs to learn how to do it, just in case they get stuck somewhere with a flat tire. I've changed a few tires in my day. But if I am in a position to pay someone to do it for me, I'd rather do that. Just because you know how to do something doesn't mean you necessarily want to, or have to.

In all this, I find I am getting a lot of crap from my natural childbirth groups, because they all think I've become a "hypocrite" to the cause. And I'm not the only one.

That is completely ridiculous. It's not like I'm having a hospital birth with an epidural*; it's still a home birth. Same team! Same team! It is a symptom of a larger problem in the unassisted birth movement right now - the tendency to view UC as the ultimate goal, as the upper end of the natural childbirth spectrum. But it's not. UC is not the epitome of natural childbirth; it is the epitome of personality. UC is certainly not for everyone, and not even for every birth. It is not an indication of how much one "trusts birth."

In fact, I think we need to get rid of that phrase: "trust birth." Instead, we need to say "take responsibility." After all, if one is birthing outside the hospital at all, they must obviously trust that birth is inherently normal and safe. The point is not to have a competition over who "trusts birth" more--sort of like a game of chicken, birth-style. The point is to learn to take responsibility for your birthing choices, and decide how much responsibility one wants to have for the outcome. If that means you want to birth alone in the sea and take whatever comes, you have the right to take that responsibility. If you want to have an elective c-section, and you are aware of all the risks, and choose to take that responsibility on yourself, that is your choice (not that I support that choice, but hey, I can't stop you from making it.)

Yes, we desperately need to work hard to abolish this sense of fear and trepidation surrounding the birth process in our culture. Home birth is a perfectly safe option, and has been proven time and time again to be just as safe as hospital birth, with a midwife in attendance. As far as I know, there aren't any studies on the relative safety of planned unassisted birth with appropriate back-up facilities, but I would say from anecdotal experience it isn't any more dangerous, in terms of mortality. The numbers on unassisted birth remain to be seen**, but with quality emergency services available in most areas, it just isn't the "bleed to death on your livingroom floor" experience that a lot of people envision. So in that sense, yes, we need to learn to trust that birth is designed to go right most of the time, and the times that it goes wrong, appropriate care can be had in a reasonable amount of time.

However, more important than this idea of "trusting birth," women need to learn to trust themselves. They need to learn to take responsibility for their birth choices, whether they are seeing an OB or a midwife, whether birthing at home or in a hospital. All women need to prepare for unassisted birth to some degree, as there is no guarantee you will make it to the hospital in time, or that your midwife will arrive in time. All women should educate themselves on proper nutrition and exercise during pregnancy. And whenever any care provider suggests a course of action, it is incumbent on the pregnant mother to do her research, and find out what the risks and benefits of any procedure, test, or medication is, and decide for herself if that is what she wants to do. YOU are the authority when it comes to your body and your baby. If you choose to abdicate your authority, and not to take the time or make the effort to learn what your choices are, and you end up with an unnecessary c-section, you shoulder some of that responsibility. However, if you do all the work and make a truly informed choice, you will likely end up with the birth experience you want. And if, after all you can do, there arises an emergency, you need not feel ashamed that your birth did not turn out the way you expected, because you know you did everything you could to ensure an optimal outcome.

* I do not support the use of medical interventions, especially the use of narcotics in labor, when not medically indicated. It has the potential to harm the baby, and that is never cool. I do not condemn women who choose it, as that is their choice to make, but I do not support it.

** There are some stats in some studies regarding unattended births, but those numbers can not be relied upon to describe the relative safety of planned unassisted births. The births in those studies usually include ALL unattended births, including unplanned births, such as precipitous births, back-alley births, dumpster babies, drug addicts, and roadside deliveries.

Birth on TV

2009-04-16T08:04:00.002-06:00

A new commerical, aired in Spain, shows a birth on a bed at home. The commercial is for a brand of mattress. You can view the commercial here.

The commercial shows a couple preparing for the birth of their baby in their home. Here I will translate the voice-overs:

Mother: We talked and decided that the best option for us would be to have our baby here, in our bed, in our little home.
Father: It's the place where our first child was born, and to do the same thing, in the same bed, was very important for us.
Mother: It's a miracle, no? To bring a life into the world, to help them come out, and to be able to do it however you want, wherever you want, and in your own home.
Father: It is traditional to birth in the most intimate manner.
Mother: There is a certain light, a certain smell, a certain warmth in the place where a baby arrives. It's very special.

Then the commercial shows the mother pushing the baby out on her bed, and bringing baby up to her breast. The commercial shows the baby with the subtitle:

Waira was born on March 21, in a Flex Bed.

And the commercial closes with the company's slogan. Flex: Your Bed. The most important place in the world.

It was truly a beautiful commercial. Much better than the silly wine glass. If I lived in Spain, I would totally buy THAT mattress.

Monday Munchies

2009-04-13T09:00:00.003-06:00

I have mentioned meatloaf before, and here I will share with you my meatloaf recipe. I didn't always like meatloaf. I only started liking it when I created this version of it. (Although I still don't make meatloaf often. It is a little weird to me to eat a loaf o' meat.) This version is sweeter and more moist than the standard version. It is a good choice if you are particular to savory foods.

Emily's Meatloaf

2 potatoes, thinly sliced
1 pound ground beef
1 c. tomato juice
3/4 c. oatmeal
1 egg, beaten
1/4 c. onion, diced
1/2 t. salt
1/4 t. pepper
1/8 c. molasses

Preheat oven to 350 degrees. Grease a loaf pan. Put two layers of sliced potatoes into the bottom of the pan. Combine all other infredients and press into pan. Bake one hour, or until meat is no longer pink. Drain grease. Garnish with ketchup and bake 10 more minutes.

Plagiocephaly, continued

2009-04-12T07:25:00.005-06:00

When Darian was a baby, 15 years ago, I remember seeing a few parents had these infant carriers. They were plastic buckets with handles, in which you could carry the baby around. I didn't really understand why people were carrying their babies around in those things, when it seemed to me it would be easier to just carry your baby, instead of your baby plus a 10-pound seat, which was unwieldy besides. What I didn't realize I was seeing then were the first car seats designed for small infants. However, at first those carriers were not widely used, because they had to be installed and uninstalled from the car every time. It didn't take long for car seat manufacturers to invent a more convenient design for those car seats. They created a two-piece set, in which a base was installed in the car, and the seat itself became detachable, so parents could take their child in and out of the car in the seat itself as a sort of carrier. For parents, this was incredibly more convenient - no more bending over in the car to thread the seatbelt through the paths in the car seat every time they wanted to take the baby in or out of the car in their seat. You could just buckle your baby in the seat in the comfort of your own home, then just snap the seat into the base of the car. If a child happened to fall asleep in the car, the entire seat could be easily removed and the sleeping infant moved from the car to the house without disturbing the baby. Also, as more people used these detachable seats, they discovered that the seats also made a convenient place to put a baby down when they needed free hands. Babies who could not yet sit up unassisted could be left semi-reclining, and babies who were mobile could be restrained. Aside from swings, at the time there weren't really many options for places to put a baby upright who could not yet sit up on their own. And infant car seats were portable and didn't take up much space, so they became a fixture in American households. It seemed between swings, bouncers, walkers, playpens, and now infant car seats, the full spectrum of places to set your infant was achieved, and now there was rarely a need to hold one's infant at all, which brings us to our current dilemma - plagiocephaly, or flat head syndrome.

As I mentioned in my previous post about plagiocephaly, the Back To Sleep campaign has created a culture of supine babies. Together with all the contraptions designed to hold our babies for us, we have a generation of babies with flat heads. A typical day in the life of a modern baby goes like this:

Baby is put down for bed on her back, in her crib, where she will lie for about 12 hours (with the occasional getting up for eating.) In the morning, she will be moved to a changing table, where she will lay on her back to be changed, then picked up and held to be fed. Then she will be laid down on the floor, on her back, on an activity mat to "play" for a little while. Once she gets bored playing on the floor, mother may move her to a bouncy chair, where she will remain on her back. If she gets fussy, and mother is busy, she may get a bottle propped up to her mouth, so she can eat while mother is finishing things up. When it is time to run errands, mother will place her in the car seat and buckle her in, then take her out to the car, where she will stay in the car seat, on her back, the entire time. If mother needs to run in to a store, she will just detach the car seat from its base and set it in a shopping cart - no need to get the baby out of the seat at all. If baby falls asleep while out and about, when they get home mother will take the car seat out of the car and bring it in to the home, and set it on the floor, where the baby will continue to sleep for a while. When baby wakes up, mother will finally get her out of the car seat, and lay her on her back to be changed, then may pick her up to feed her. She may play with her baby for a few minutes before setting back down on the floor or in a seat of some type, on her back. When it is bed time, mother may place the baby on her back in a reclined bath seat for a bath, then dress the baby, and lay her down in the crib, on her back, where she will remain for the next 12 or so hours.

Do you think this sounds like an exaggeration? I don't believe that it is. I have been to church, where I have seen the majority of the small babies carried around in these same car seats for the entire 3 hour block of meetings, only to be taken out of their seats for diaper changes, then put back in. I once saw a man swinging one of those car seats around for 20 minutes, with a crying baby inside of it. I have seen babies in car seats fussing and crying, and the mother or father furiously rocking the seat on the ground. I have been to the store and seen babies in infant seats perched on the shopping cart crying, and instead of getting picked up, have a bottle or pacifier stuck in their mouth. I would guess that a good percentage of babies today spend 20 out of 24 hours laying on their backs. Why this cultural reluctance to touch or hold our babies for any length of time, or for any other purpose but feeding them or quieting them (and sometimes, not even then)?

In the section on babywearing in The Baby Book, Dr. William Sears describes this cultural ideal of content, unattached babies very well:

You may envision your picture-book baby laying quietly in a crib, gazing passively at dangling mobiles, and picked up only to be fed and played with, and then put down; you may think that "up" periods are just dutiful intervals to
quiet your baby long enough to put him down again.

To understand babywearing, reverse this view: Carry your baby much of the time, and put him down for longer nap times, night time, and to attend to your personal needs. Take a balanced approach to babywearing. Allow baby to enjoy down periods and freestyle movements on the carpet, but pick her up when she signals the desire to be carried. You will notice an interesting contrast in behaviors. "Down" babies learn to cry to get picked up; "up" babies learn non-crying body language signaling their need to get down.

All these things advertised to make our lives easier: bottles, swings, infant seats, etc, are really just ways to avoid parenting our children. It seems that in today's culture, having children is fashionable, while parenting them is not. Mothers who breastfeed, co-sleep, and wear their babies are called old-fashioned, judgmental, crunchy, or freaky. But it is those mothers who have babies with round heads. Far from being martyrs or fad-followers, mothers who choose to do these things do what they know is best and right for their babies. They do not do it to sacrifice or be better than other women - they do it gladly, knowing they are making the best possible choices for their children. Setting your baby down occasionally isn't a crime; but if your baby has a flattened head, you may want to reevaluate your parenting practices.

It is not just a cosmetic issue. It is about interacting with your babies in a meaningful way, and enjoying being a mother, rather than just setting them aside and killing time until they can take care of themselves. There is also some evidence that the entire Back To Sleep philosophy and resulting plagiocephaly is disrupting physical and emotional development (more on that in another post.) Whatever the case, having a mis-shapen skull cannot be a good thing.

Please pick up your babies. I promise you can't hold them too much.

Plagiocephaly and heresy

2009-04-10T08:00:00.000-06:00

One trend that has become alarming to me is plagiocephaly, or flat-head syndrome. More and more, at church, at playgroups, and at stores and restaurants, I will see a mother pick a baby up out of a car seat carrier or stroller, and the back of the baby's head will be flat. Even more disturbing to me is that no one else seems to notice this trend, or find it particularly distasteful. Or maybe they do, and they aren't saying anything? The biggest reason for all these flat heads is the Back To Sleep campaign. (A secondary reason for these flat heads is the rising trend in parents not wanting to actually HOLD their babies during the day, but that is another blog post.)

In 1992, the National Institute of Child Health and Human Development, along with a few partners, launched this campaign in an effort to reduce the national SIDS rate. According to their website, the campaign has been completely successful, resulting in a more than 50% drop in the rate of SIDS since its inception. However, this success has come at a price: the incidence of plagiocephaly has increased between five- and sixfold (various resources) ever since. The medical community accepts this negative outcome of supine sleeping, and claims that the benefits far outweight the risks, as supine sleeping has greatly reduced the incidence of SIDS. What I want to know is, how can they be so sure that it is supine sleeping alone that has reduced the incidence of SIDS?

As with many things in life, the end result of reduced incidence in SIDS could be due to a number of factors. I'm not sure that the dramatic increase in cases of plagiocephaly is necessarily justified by exclusive supine sleeping. Now here is where the heresy part comes in: to suggest that the Back To Sleep campaign is not the only, or even the primary reason for the reduction in SIDS rates is not a popular idea. Or at least, it is not spoken of openly. Ask around in any circle of mothers, and you will find more than a few women who admit to putting their children to sleep on their tummies, because they seem to sleep more soundly that way.

It just doesn't make sense to me that something beneficial to us would cause deformity. If we were designed right in the first place, logically we shouldn't require an unnatural sleeping position to be told to us in order to survive. So I set out to find what ELSE may be contributing to the fall in SIDS deaths.

According to this CDC chart, the rates of smoking have declined considerably in the last 40 years, with a steep drop in smoking among pregnant women (those about to have babies), starting in the early 1990s. Smoking is a major risk factor for SIDS deaths.

This article puts forth an interesting theory that SIDS can be attributable to the chemicals used to treat baby mattresses to make them flame-retardant. The article claims that in New Zealand, a campaign to wrap mattresses in a sealed cover has resulted in zero SIDS deaths among cover users in an 11-year period, and a overall reduction of SIDS rates in New Zealand by 70%. If this theory is true, then some cases of SIDS could be attributed not to sleeping position, but the indirect effect of the sleeping position causing the baby's face to be closer to the mattress, and therefore the chemicals.

In 1991, the new vaccine combo DTaP was introduced, because of the high vaccine injury rate of the DPT vaccine. Could the reduction in SIDS rates be attributable to the removal of this particular vaccine? (And incidentally, the highest time frame for SIDS is 2-4 months, when the DTaP vaccine is routinely administered. Ninety percent of SIDS deaths occur prior to 6 months, after which the DTaP is only administered once, and that not until after 12 months.)

Between 1993 and 2000, the number of cosleeping families in the US doubled, from 5.5% to 12.8%, according to this study. Some research suggests that responsible co-sleeping reduces the risk of SIDS, although there are no studies which prove it outright. Cosleeping certainly doesn't increase the risk of SIDS, as some of these studies might suggest, unless when done irresponsibly, as with smoking parents or on an unsafe surface. In any case, if cosleeping were dangerous, the fact that the number of cosleeping families in the US doubled in the same amount of time as the rate of SIDS being reduced by half would not make sense. Rather, the opposite is true - it would seem to support the theory that cosleeping reduces SIDS.

Since 1990, breastfeeding rates have continued to rise. A recent German study showed that breastfeeding reduces the risk of SIDS by 50%. Could the rising breastfeeding rates contribute to the reduction in SIDS? (In another interesting confluence of events, SIDS deaths peak at 2-4 months of age, the same time frame in which American women typical return to work, and most switch from breast milk to formula.)

SIDS is still a mystery. No one knows exactly what causes it, but all can agree that the contributing factors are too numerous to decide that any one factor is the primary cause of SIDS - not even sleeping on the tummy. I can't fully endorse the Back To Sleep campaign, because it clearly causes negative results for babies in other areas, and cannot be conclusively shown to have single-handedly reduced the SIDS rates in America.

Herpes and vaginal birth

2009-04-09T10:44:00.005-06:00

It is common knowledge that any woman who has genital herpes, and has an outbreak at the time of labor, will require a c-section to deliver her baby. This hits home for me, as I also have genital herpes. (Long story, but the short version is, I had an unfortunate youth.) When I was pregnant with Ruby, and interested in having her at home, unassisted, this was a serious concern for me. Herpes virus transmission to a baby can have serious risks, and I needed to know exactly what the risks were.

Genital herpes is a sexually-transmitted disease caused by the herpes simplex virus (HSV). It is a highly contagious skin condition in the same family of viruses as chicken pox, cold sores, and shingles. GH causes lesions in and around the genitals, which come and go in "outbreaks." It is uncomfortable, but not life-threatening, and there is no cure for it. (For more information on GH, please see here and here.) However, while GH is not life-threatening for adults, if a newborn acquires the herpes virus at birth, it can lead to severe brain infection, and death.

There are some that have suggested all women with herpes should be c-sectioned, regardless of outbreak status, since it is generally agreed upon that viral shedding can occur even in the absence of an outbreak. However, most care providers will instead have a pregnant woman with GH take an antiviral medication in the last trimester to reduce the probability of viral shedding, and permit a vaginal birth, provided there are no active lesions. During my own pregnancy, when visiting with health care providers early in the pregnancy, they all suggested I take an antiviral medication in the last trimester to reduce the likelihood of an outbreak at delivery. But this bothered me on a two different counts: First, I have never taken any antiviral medications. I rarely have outbreaks, if ever. In fact, I can count on one hand how many outbreaks I have had in the last 10 years. On top of that, I'd already vaginally delivered two babies since being diagnosed with GH. I didn't see why I would need to take medication, with potential side effects for me and my baby, to prevent something that was extremely unlikely to occur in the first place. Second, even if I took the antiviral medication, it would not guarantee that I would not have an outbreak, which would mean that I could be taking that risk for no reason, and could still end up with a c-section.

So I set out to find what would happen if I chose to birth unassisted, and still ended up with an outbreak at the time of delivery. Several things came to my mind when considering transmission of herpes to the baby:

1) It is generally considered possible to transmit the herpes virus even when not having an outbreak. It's called asymptomatic shedding. Little is known about why or when it occurs, and it is not predictable nor detectable. From this perspective, it doesn't seem to make any sense to c-section women with herpes only during an outbreak. If asymptomatic shedding is true, then a woman could be shedding the virus at any time...so why not just c-section all women with GH?

2) Women with GH may continue to have outbreaks after the baby is born, and have the potential to transmit the disease at any time to their babies after birth. This is also true of any care provider who has GH. So theoretically, all people who have GH should be prevented from having contact with babies during an active outbreak, but this is not the case.

3) What if a woman has an outbreak and has a precipitous delivery? What if a woman's GH status is unknown at the time of delivery?

These questions prompted me to do more research into GH and vaginal delivery. I was not about to go under the knife unless I was absolutely sure the benefits outweighed the risks. There is not much information out there on herpes and vaginal birth, because they are always c-sectioned during an outbreak. But what I did find leads me to declare that c-section is not always indicated during an outbreak.

This link is some midwives talking about their clinical experiences with genital herpes during labor and delivery. While it has no statistics or studies, it indicates to me that the doctors involved in these cases don't seem to be particularly worried about it.

This website provides a lot of good herpes in pregnancy general information. It states earlier in the article that a c-section is always indicated for active lesions, but then goes on towards the end of the article to post these stats:

Maternal illness following a cesarean is approximately 28%, compared with 1.6% following a vaginal delivery. Cesareans require long recovery times, and in some instances can even be fatal. "If we were doing C-sections on every mother with genital herpes, we'd end up losing almost as many women as we were saving babies," says Zane Brown. Furthermore, the protection offered by C-sections is not absolute. In various studies, between 16% and 30% of infants infected with neonatal herpes were born by cesarean (in most of these cases the cesarean was performed after the membranes had ruptured). At the same time, babies delivered vaginally, even in the presence of active lesions have an infection rate of only 0.25%-5%."Every center that does research has cases where a lesion is identified after delivery," explains Brown. "The obstetrician will notice it while stitching the mother after an episiotomy, for example. In most cases, those babies don't get infected". This again shows the protective power of maternal antibodies.

You can see from this excerpt why c-sections are not indicated for all women with GH across the board. The complications from the surgery itself would far outweigh the small percentage of babies who would have been saved from a potential GH infection. So they choose to section only those women who are obviously shedding, as in during an outbreak. But as this article points out, you can still transmit GH in a c-section. And did you notice the percentage of GH transmission in a vaginal birth? Not very high.

In fact, in this 1999 California study, in looking at hospital discharge data between 1985 and 1995, it was concluded "The proportion of infants 1-42 days of age who were discharged from the hospital with a diagnosis of HSV infection did not change over this time period despite a decrease in deliveries by cesarean section and an increase in the proportion of women with a diagnosis of genital HSV infection who gave birth to infants by vaginal delivery."

This article and this article both make an interesting assessment: Nearly half of all those newborns infected with herpes virus are preterm. Primary herpes causes infection in infants about 50 percent of the time and only one to five percent of the time with recurrent disease. (Primary herpes is first-time infection during pregnancy, recurrent herpes means the woman has had herpes prior to getting pregnant.) Again, we can see that the rate of transmission of GH during an outbreak, in women who had it before, is still pretty small.

It seems that the data shows that women who have had herpes prior to getting pregnant have little chance of passing on the disease while delivering vaginally, even with an active lesion, provided the lesion is not in the birth canal itself. More importantly, the risk of serious injuries to the mother are much higher by surgery than the risk of transmission to the baby by vaginal birth (in women with recurrent herpes).

If a woman has had GH for any length of time prior to getting pregnant, her body has already been making antibodies against the disease, which will be passed onto the baby. Women who acquire GH during pregnancy have a much higher risk of transmission, because their bodies have not had time to make antibodies, which put their babies at a much higher risk. Also, outbreaks during primary herpes are often in the birth canal itself, while subsequent outbreaks more frequently occur outside the vagina. If a woman acquires GH for the first time during pregnancy, and has an outbreak during the time of delivery, a c-section may be indicated.

Preterm babies are, of course, at a higher risk of any kind of infection. If a woman has an active outbreak and goes into labor prematurely, a c-section may be indicated.

It seems that a woman with an active herpes lesion can be delivered safely vaginally, as long as a protocol is followed. This protocol, in my own words, can be summarized thus:

1. The mother should have had herpes prior to getting pregnant. Contracting herpes during pregnancy carries significant risk of transmission, as there has not been enough time to produce antibodies for the fetus.
2. No instruments or internal fetal monitoring (IFM) should be used in the event of an active lesion, to reduce the risk of breaking the skin of the fetus, which will raise the risk of transmission.
3. If active lesions are present, provided they are not in the birth canal itself, the lesion(s) can be simply covered with a bandage or cloth to reduce the risk of transmission.
4. Active lesions in the birth canal itself warrant a c-section.

I don't feel that this issue is as cut and dry as breech vaginal birth, as there are definite risks to delivering a baby vaginally during an outbreak. A woman must decide for herself if the risks of major surgery are greater than those of transmission. For me, they were too great.

For the record, I did not have an outbreak at the time of Ruby's birth.

Monday Munchies

2009-04-06T08:15:00.002-06:00

As I am traveling along the path of healthy lifestyle changes, I have been trying to incorporate more variety of foods in my diet. I grew up on grits, gravies, bread, and fried everything. My family are also cheese- and choco-holics. One thing I have never really gotten into is fish. I don't like the smell or the taste of it. However, as I get older and more experienced with cooking, I am finding all sorts of tasty and creative ways to learn to enjoy foods I didn't always enjoy before.

Fish is extremely good for you, and contains several oils and minerals that are essential for good physical and emotional health. If you can find more ways to incorporate fish into your diet, I encourage you to do so. And I hope this recipe might be one of those ways! This recipe calls for ahi tuna, which is a thicker, sturdier fish with a milder flavor. If you are new to fish, you might want to start with this one, which doesn't taste very strongly of fish, and has more of a "meaty" texture.

Also, a note about aioli sauce: it's a little on the hard side. Aioli is basically a garlic mayonnaise. The ingredients are pretty simple, just the process is labor-intensive. However if you have a little patience, anyone can make this rich, delicious sauce.

Cajun-blackened Ahi with Lemon Aioli Sauce

Fish:
2 ahi filets
1 T. Tony Chachere (or other cajun seasoning)
2 T. butter

Aioli sauce:
2 cloves garlic
3/4 t. salt
2 egg yolks
1 1/2 T. lemon juice
dash of cayenne
3/4 c. olive oil
1/4 c. olive oil (yes I put it twice for a reason)

Make the sauce first. Crush the garlic cloves in a garlic press, or using the side of a knife. You want the garlic as much of a paste as possible. Combine in a bowl with the salt, egg yolks, lemon juice, and cayenne. Whisk until smooth and foamy.

(now here's the patience part)

Add 3/4 c. olive oil slooooooowly. As in, a few drops at a time. While dropping in the oil, whisk continously. (This can also be done in a blender or food processor to save a little arm strength. Just make sure to add the oil in just a few drops at a time.) The reason you're doing it a little at a time is that you're trying to blend all that oil into just a little bit of egg yolk solution. You have to do it a little at a time to get a smooth sauce. Otherwise you get this.

As you get to the end of the 3/4 c. olive oil, your sauce should be getting thicker and resembling the consistency of thin mayonnaise. Once you're done adding that amount, add another 1/4 c. olive oil, whisking constantly. This amount of olive oil you can add more quickly, in a small stream, until all blended. Your aioli should be pretty thick now, like mayo. You can leave it like that, or add a little water to thin it out a bit, if you want a pour-able sauce. That part is up to you.
Set the sauce aside.

Melt 2 T. butter in a large skillet. While bubbling, add the filets. Sprinkle lightly with the cajun seasoning. Cook 4-5 minutes on one side, then turn. Cook 3-4 minutes on the other side, or until cooked through. Serve over rice with the aioli sauce. Enjoy!

Breastfeeding is not obscene

2009-04-05T13:17:00.002-06:00

In my continuing quest to normalize breastfeeding in this country, I happily stumbled upon this blog, titled Breastfeeding is Not Obscene. The only purpose of this blog is to display photos of breastfeeding with no shame or stigma, in the hopes that the more women see other women breastfeeding, the more they will come to view it as natural and normal.

Yes, part or all of a breast might be exposed in these pictures. So what? These breasts and nipples are not being displayed for sexual gratification - they are incidental to the act of feeding a baby. To those who would ask, "Why post pictures of yourself breastfeeding on the internet, for the world to see?" This is why. It is deplorable, repressive, and ridiculous to expect women to hide their bodies in shame and guilt while doing what is a perfectly natural act. It reminds me of this.

If you think breastfeeding in public is obscene or inappropriate, I encourage you to spend 10 minutes every day for one month looking at the photos on BFINO. Pay attention to the television you watch, and take note of how much breast you see displayed in a sexual fashion. Read this article. Then decide which is the truly inappropriate display of boobage.

If you support breastfeeding as normal and appropriate, please submit photos to the blog author, at barbbarry-at-ymail.com. Let's get images of breastfeeding out there so our young men and women can see that it IS normal and appropriate, and that they are not the only ones. Let's support women's rights by normalizing breastfeeding.

p.s. See the smiling, happy mom in the April 4th entry, nursing her newborn, Ruby? That's me.

Big baby is NOT an emergency

2009-04-03T20:40:00.004-06:00

Another OB myth being used as an excuse for induction and c-sections these days is the discovery that a woman may be carrying a Big Baby. Despite the fact that the ACOG itself does not recommend induction for suspected macrosomia (big baby), doctors around the country are encouraging women to induce or have a c-section before their due date, telling them that if they attempt to deliver a big baby, they risk being confronted with one of the scariest obstetric complications around: shoulder dystocia.

Shoulder dystocia is one of the most anxiety-provoking emergencies encountered by physicians practicing maternity care. Typically defined as a delivery in which additional maneuvers are required to deliver the fetus after normal gentle downward traction has failed, shoulder dystocia occurs when the fetal anterior shoulder impacts against the maternal symphysis following delivery of the vertex. Less commonly, shoulder dystocia results from impaction of the posterior shoulder on the sacral promontory. (ref)

In other words, shoulder dystocia is when a baby gets stuck at the shoulders. It is potentially life-threatening, and unpredictable. It has been assumed that this must necessarily occur as a result of a baby who is too big to fit through the pelvic canal. However, research says otherwise.

This 1996 study shows out of 4480 deliveries, there was a 2% shoulder dystocia (SD) rate. Of that 2%, 93% of the SD births were non-macrosomic (not big babies). However, interestingly, of the 17 macrosomic (big baby) births, 6 (35%) were complicated by SD. This shows that while larger babies seem to have a fairly high incidence of SD, SD itself is not predicted by macrosomia, since the majority of SD overall occurs in non-macrosomic babies.

These articles are about prevention of SD. They both make the same conclusions, but the second is more concise. Here are some excerpts from the second article:

Macrosomia – numerous studies have consistently documented a causal relation between SD and fetal size. Temporality, coherence, and strength have been based on observing higher SD rates with increasing fetal size. However, specificity is rather low since it has been established that 48 to 89% of SD occur in non-macrosomic fetuses. Although fetal size is the most reliable risk factor for SD, it has been repeatedly estimated that >100 unnecessary CSs are needed to prevent one case of SD, and ~1000 unnecessary CSs are needed to avoid one BPI.

This excerpt just shows what I already wrote above, that while there appears to be a relationship between SD and big babies, it is not a direct relationship because of the other findings that SD occurs more often in non-macrosomic babies.

Avoiding macrosomia – since macrosomia cannot be diagnosed accurately by clinical or sonographic means, there is no accurate way to predict the assumingly preventable cases of SD, and therefore studies failed to prove the benefit of labor induction for suspected macrosomia.

Basically, there's no accurate way to predict macrosomia, not even with ultrasound. And studies show no benefit to induction, i.e. no reduced incidence of either macrosomia or SD. So the only (theoretical) way to avoid some cases of SD is to keep women from making big babies in the first place.

Since the diagnosis of macrosomia is inaccurate, all safeguards will not eliminate SD. Hence, SD is obviously unpredictable and will occur unexpectedly. Training should include “SD drills” so that when SD occurs, the performance of the obstetrical personnel may be improved. It should be remembered that there are no experts for relieving SD.

In summary, SD is unpredictable and unexpected in non-macrosomic babies. The increased risk associated with large fetuses resulted, as expected, in many unnecessary CSs.

SD is unpredictable in non-macrosomic babies. And while there is a higher incidence of SD in macrosomic babies, there is no way to predict macrosomia. So basically, there is no way to predict SD. As this article astutely pointed out, any methods used for prevention of SD (induction or c-section) are primarily used for liability purposes and are not proven to reduce the incidence of SD.

This 1995 study concluded, "The antenatal prediction of fetal macrosomia is associated with a marked increase in cesarean deliveries without a significant reduction in the incidence of shoulder dystocia or fetal injury."

I haven't yet found any studies that look specifically at the relationship between positioning and SD, but all studies I've read about home birth vs. hospital birth indicate a MUCH lower incidence of SD in home birth, which would point to hospital protocol, medications, and/or positioning being a major risk factor for SD, since the number of "big babies" surely isn't any less in home births.

In this article, the author makes this statement:

The studies I've looked at found that shoulder dystocia was more likely where labours were induced, accelerated with oxytocin, and particularly where forceps or, especially, ventouse deliveries are attempted [6, 19].

Perhaps this is because:

a) These interventions were employed because progress was slow, but progress was slow for a reason? Baby needed more time to turn, mother needed more time to move?

b) If you're having oxytocin you're probably being continuously monitored, and thus are probably lying down/semi-recumbent...great position for trapping a baby. Discussions on web articles [2,3] listed below give more info about specific increases in pelvic diameters when mother moves to all-fours.

c) Other factors about assisted deliveries - eg the speed with which the head is brought down, or the angle - which makes shoulder dystocia more likely. Article [1] says one of the situations where shoulder dystocia is more likely is "when truncal rotation does not occur (as with precipitous labor)." There is also mention on the USA Midwife Archives [2] about the need for the shoulders to rotate properly to fit through the pelvis, and that with assisted deliveries the head may be pulled down before this has happened. Apparently shoulder dystocia linked to assisted delivery is more common in smaller babies; in larger babies, it's more likely to happen even with spontaneous birth of the head.

And here's the study he quotes in his footnotes for the above statement:

This study looked at 100 cases of babies predicted over 4,500g, whose average birth weight turned out to be 4,730g - about 10lb 7 oz...
TITLE: Shoulder dystocia. A complication of fetal macrosomia and prolonged second stage of labor with midpelvic delivery. AUTHORS: Benedetti TJ; Gabbe SG SOURCE: Obstet Gynecol 1978 Nov;52(5):526-9 In the absence of prolonged second stage (PSS) and midpelvic delivery, the incidence of shoulder dystocia was 0.16%. However, with PSS and midpelvic delivery (ie assisted delivery), the incidence of shoulder dystocia was 4.57% ..When PSS occurred and midpelvic delivery was attempted, the incidence of shoulder dystocia was 21% in infants weighing in excess of 4 kg.. All shoulder dystocias and failed vaginal deliveries occurred after use of the vacuum extractor. Immediate neonatal injury was apparent in 47% of infants with shoulder dystocia after PSS with midpelvic delivery. There were no maternal or fetal deaths related to shoulder dystocia during the study period.

This 1993 study looks at outcomes of elective induction for suspected macrosomia (big babies). The results show that the rate of SD was TWICE as much for induced labors as for spontaneous labors.

Results: With elective induction, the cesarean rate was 57%,significantly higher than the 31% rate with spontaneous labor(P<.01). The induced group also had a significantly higherEFW and birth weight. When logistic regression was used to controlfor birth weight, parity, and care provider, elective induction was still associated with a higher risk of cesarean delivery than was spontaneous labor (adjusted odds ratio 2.7, 95% confidenceinterval 1.2-5.9; P<.02). Shoulder dystocia occurred in oneof 19 vaginal deliveries with elective induction (5.3%) andin two of 79 with spontaneous labor (2.5%).
Conclusion: Because elective induction of labor increased thecesarean rate and did not prevent shoulder dystocia, we concludethat mothers with macrosomic fetuses can safely be managed expectantlyunless there is a medical indication for induction.

All of these studies go to show that big baby is probably not the primary cause of SD.

If your care provider is telling you that you should consider an induction or a c-section because your baby is going to be "too big" you should switch care providers immediately. Ultrasound is extremely inaccurate at predicting the size of your baby, and can be off by three weeks or more by the third trimester. If you go in for induction, you are more likely to end up with shoulder dystocia or a c-section than if you had just gone into labor naturally, even with a 10-pounder.

Big babies are NOT an emergency. Except in the case of untreated gestational diabetes or some other pre-existing condition, your body will not make a baby that is too large to come out.

WIC and infant formula

2009-04-02T08:00:00.003-06:00

In the recent uproar over Hannah Rosin's article, The Case Against Breastfeeding, it has been pointed out that the choice to not breastfeed is largely a class issue. PhD in Parenting makes a case for why breastfeeding is a particular thorny issue for low-income families. In her post, she says:

In individual families, not breastfeeding perpetuates poverty by having an immediate impact on the family’s finances. Formula is expensive and can cost between $750 and $3200 for a year. For a poor family, that can be a substantial amount of their budget.

She then goes on to list various reasons why low-income women may choose not to breastfeed, including lack of community support and non-breastfeeding-friendly work environments. However, one factor she failed to mention (I suspect because she lives in Canada, and may therefore be unaware of) is the role WIC has in encouraging low-income women in the United States to choose formula over breast milk.

In 1972, the Women, Infants, and Children (WIC) program was created. The purpose of WIC was to provide some basic staple food items, such as milk, cheese, cereal, carrots, and tuna, to low-income pregnant and nursing women and children under five years old. Although the program was written up in legislation in 1972, the first office didn't open until 1974. Up to that point, eligibility was only extended to breastfeeding mothers, pregnant mothers, infants, and children. In 1975 they changed the eligibility requirements to include non-breastfeeding women, up to six months. I'm not sure why the switch was made. (ref)

Under the WIC program, new mothers are eligible to receive vouchers for free infant formula. This answers a lot of questions by those who wonder how low-income mothers are able to afford formula in the first place. While WIC is supposed to provide counseling and support for breastfeeding, I have found this not to be universally available. WIC office policies can vary by state, and even by city. In many cases, a pregnant woman receives counseling in the form of a 20-minute video they will watch some time during their pregnancy, and maybe a phone number to a local lactation consultant. WIC offices usually provide pumps for free, but this is often not advertised - one must ask for it. Once the new baby arrives, unless a mother indicates otherwise, she is issued vouchers for formula. (As I said, WIC office policies vary by state, so some may be more aggressive than others at promoting breastfeeding. These conclusions reflect my personal experiences with WIC, as well as those of other women I have talked to.)

This article has a brief summary of the legislation involved with the WIC program. It mentions that in 1989 the WIC program was mandated to begin aggressively promoting and educating breastfeeding, as well as allocating more resources toward those goals. It does not mention it in this article, but it's interesting to me that 1989 is also the year WIC began its "formula rebate" program.

WIC is the largest purchaser of infant formula in the United States. WIC is on contract with the formula companies to provide the formula at wholesale cost. After purchase, WIC is then eligible for rebate from the formula companies at up to 85% of wholesale costs.

In September 2000, the wholesale prices for a 13-ounce can of milk-based liquid concentrate infant formula with iron varied by company—$2.27 for Carnation, $2.91 for Ross, and $2.94 for Mead Johnson. The wholesale price used by WIC is the manufacturer’s lowest national wholesale price. Consequently, the wholesale price for an individual manufacturer, used for the determination of its net price, does not vary by State (U.S. territories and Indian Tribal Organizations are excluded from this discussion). On the other hand, the amount of the rebate, determined by the contract awarded by submission of sealed bids, varied by both manufacturer and State, ranging from $2.06 in New Jersey to $2.84 in South Carolina (fig. 3-2). Net price, defined in a WIC infant formula contract as the wholesale price minus the rebate, also varied greatly by State, ranging from only 6.5 cents per can in Florida, to 44.7 cents per can in Nebraska and South Dakota. The average net price among the States was 20 cents. Rebates as a percentage of the manufacturer’s wholesale price ranged from about 85 percent in Nebraska and South Dakota to almost 98 percent in South Carolina. In other words, the infant formula purchased through the WIC program cost the South Carolina WIC program about 2 percent of its wholesale cost, plus the amount of the retail markup. (ref)

This link includes links to other such documents that detail an overview of the WIC program and various cost analysis reports. So not only does WIC gets a great deal from the formula companies, it gets cash back on top of that, which amounts to a net cost of a fraction of a dollar per can. This does not take into account any incentives or kickbacks each state agency may receive from the bidding companies. (See here for more details about the history of the rebate program.)

Consequently, WIC spends more net money on dairy milk than they do on formula, which is likely a big reason why they often offer hypoallergenic formulas but no dairy alternatives, such as soy or rice milk (may vary by state). Milk and cheese alone account for over 42% of WIC expenditures, post-rebate, while all infant formulas combined account for only 17.4% post-rebate. (2005)

Could it be that some low-income women choose formula simply because it is handed to them? At least in my own personal experience, many, if not most of the women I have known who are also on the WIC program (including myself, 15 years ago) choose to use formula before their babies are even born, or plan ahead of time to switch to formula as soon as they return to work, just because it is available to them. I don't believe I have ever personally met a low-income mother on WIC who switched to formula only after much trial and tribulation, and as a result of pressure from work, family, and society (although I am sure they are out there.) I realize these are generalizations, and do not represent a statistical measuring of the subject. But if anecdotal evidence has any weight, my personal experiences would suggest that many women on WIC do not feel the need to give any more than a token effort, if any, at breastfeeding, because they have free formula waiting for them should they choose to switch. (For the record, I breastfed my last two children, while receiving WIC services. I quit the program because in my state, they do not offer cow's milk alternatives, and my toddler has a dairy-milk sensitivity.)

Some have made the proposal that subsidized formula be available by prescription or application only. Others claim that by taking away free formula from low-income women, they will resort to giving their babies plain milk, or other such inferior substitute. This article, posted in the International Breastfeeding Journal, has something to say about this argument. The author says,

It might be argued that if they were not supplied with infant formula, some WIC clients might instead use juice, cow's milk, evaporated milk, or over-diluted formula. There is that risk, but it is likely to be overcome with proper breastfeeding support, from WIC, employers, and others. Moreover, those who feel that they must use infant formula would remain free to purchase infant formula. It does not seem sensible to promote an inferior product simply because one can imagine something that is even worse.

Finally, the WIC program does seem to recognize the effect they are having on breastfeeding rates among the poor. In this USDA publication detailing the costs of the WIC program, it is admitted,

WIC officials recognize the numerous health benefits of breastfeeding. WIC, through its nutrition education and breastfeeding promotion programs, encourages mothers to breastfeed their infants. Breastfeeding women get higher priority for certification into the program than nonbreastfeeding postpartum women, and they are eligible to participate in WIC longer than nonbreastfeeding mothers. Mothers who exclusively breastfeed their infants receive vouchers for more foods and larger quantities for some authorized foods than nonbreastfeeding postpartum women. Breastfeeding mothers can also receive breast pumps and other breastfeeding aids to help support the initiation and continuation of breastfeeding.

Although breastfeeding rates are increasing among women participating in WIC—both while in the hospital immediately after giving birth, and 6 months after giving birth—the rates continue to be lower than those of non-WIC women. Although some have questioned whether WIC provides a disincentive to breastfeeding by supplying free infant formula, the women most likely to participate in WIC, including mothers who are poor and have low education levels, are less likely to breastfeed their children in general.

So I guess the fact that they are poor and under-educated means we shouldn't bother trying to encourage them to breastfeed? Perhaps more effort needs to be spent in examining class conflict when working on improving breastfeeding rates. Paid maternity leave * would be an excellent place to start.

In any case, there is clearly more going on the breastfeeding vs. formula feeding debate than just worrying about who can make which choices. For some, their choice is already made for them.

*For more perspectives on paid maternity leave and breastfeeding, you can visit this blog and that blog.

The illusion of choice

2009-03-31T08:00:00.000-06:00

The buzz word for today’s women is “choice.” Every woman demands the right to choose: the right to choose to keep a pregnancy or abort it. The right to work or stay home. The right to be married or stay single. That’s one of the many positive things to have come out of the women’s liberation movement; women are given more choices than ever.

At the same time as the women’s lib movement, another movement was brewing: the natural childbirth movement. Along with a woman’s right to choose what to do at the beginning of her pregnancy, many women felt that they should have a right to choose what to do at the end of her pregnancy. The only problem was, there was no choice in the hospital. Women at that time were routinely administered pain medication that rendered them unconscious and physically unaware of what was going on at the time of delivery. The natural birth movement’s answer to that was to encourage women to birth outside the hospital, so that they could choose to participate in their own labors.

But like many forces of nature, every action has an equal and opposite reaction. The medical industry responded by providing a new, more “humane” form of pain relief: the epidural. Once again, the woman was provided with her freedom of choice, and she could safely reenter the hospital, knowing she had a better option of pain relief, which still enabled her to participate in her labor.

The problem women now face is not lack of choice: it is the illusion of choice. After the epidural was introduced, whatever steam the natural birth movement had gained was slowly petering out. And combined with the advent of continuous electronic fetal monitoring, and safer techniques of cesarean section, the movement was effectively quashed, and women flocked to hospitals in higher numbers than ever.

But what about this illusion of choice? Women believe they have more choices now than ever in their labor and delivery, but the truth is, they are being offered conditional choices. They have less freedom in labor than they had before, only now, they simply feel better about it because they have the illusion of choice.

When women are presented with the option of an epidural, they are frequently unaware of the strings that literally come attached with it. Before a woman receives an epidural she must have an IV to properly hydrate her and stabilize her blood pressure, since epidurals have a lowering effect on the blood pressure. Once she receives an IV, she must stay in bed. She must also get a catheter inserted into her bladder, since she will be unable to get up and move around. And usually, an internal fetal monitor is placed in her uterus, in order to monitor the baby’s heart rate more closely, since epidurals have an adverse effect on baby’s heart rate as well. Once the epidural is administered, it often has the effect of slowing down, which must then be sped back up by administering pitocin. The combination of all these drugs, monitors, and forced immobility often results in either fetal distress, or failure to progress, which inevitably leads to a c-section. So much for being an active participant in one’s labor.

We've gone back to the same philosophy as the days of twilight sleep: strap women to the bed (with IVs, monitors, epidurals, and catheters, instead of wrist restraints), drug them up (with pitocin, narcotics, and epidurals, instead of scopolamine) and cut the baby out of them (only now with c-sections, in addition to episiotomies and instrumental delivery).

Another current fashion is the birth plan. Women write a birth plan with the promise of having a choice in their labors. But there are several things fundamentally flawed with this concept. First of all, when a woman has to ask specifically not to be violated, taken advantage of, and asked permission before procedures are performed, that’s not a true choice: that’s making a deal with the devil. Second of all, there is absolutely no guarantee that her wishes will be honored.

The birth plan is typically addressed to the doctor, who will not be one she will have to answer to in labor. The doctor will typically not show up until the woman is ready to push, so she has no real ally in him (or her) throughout the rest of her labor. And as is standard practice in many large practices today, there is not even the guarantee that her doctor will be the one on rotation that day. Even if it is her doctor that appears throughout her labor, there are literally hundreds of different scenarios that a doctor can present that will negate her original birth plan. For some reason or another, the doctor WILL find a reason to insist she has some procedure or test performed contrary to her birth plan. The sad fact is, a woman cannot reasonably expect to enter a doctor’s territory and then presume to tell him/her how to do their job. But the medical establishment still wants you to believe you have a choice.

What choices do you really have when you enter a hospital? You must submit to their policies and you must defer to their judgments. Many women have told me that they were successful in having everything they wanted in the hospital without ever having to fight for it. I don’t believe it. Some concession had to made somewhere along the way, be it writing a birth plan, finding a doctor sympathetic to their philosophy, or some “small” concession, like a hep lock IV instead of a continuous line.

And the illusion of choice doesn’t exist only in the hospital. Where else will you give birth if not in the hospital? The medical system today has virtually eliminated women’s right to even choose the location of their birth. In many states, midwives are illegal. In other states, midwives are licensed and legal, but have so many restrictions placed on who they can accept as patients, that they are severely limited in the type of clients they can accept.

Women who have breech babies and twins have almost no choice in the matter. Women who have had a previous c-section have almost no choice. In most states where midwives are legal, they are prohibited from attending those births. Doctors and hospitals refuse to allow these women to give birth vaginally. So what real choice do they have? A c-section, or a home birth either attended by an unlicensed midwife or no midwife at all.

What boggles my mind in all of this is that the women’s liberation movement has not taken a more vocal opposition to this trend. Women who argue and fight for women’s rights, particularly reproductive rights, seem to completely overlook the fact that pregnant women have no rights. The legal and medical systems are quietly and slowly narrowing women’s choices, and soon they will be left with none.

Sure, women have a choice between this pain reliever and that pain reliever. They can choose which hospital or which doctor. But is this true freedom of choice? No. It is tantamount to our helping our toddlers get dressed in the morning; they don’t get carte blanche to select their clothes, they get a couple of choices from those that we select for them. As long as women are being offered a choice, they will continue to be complacent in those choices, forgetting that there is a bigger picture, a bigger issue concerning their rights as human beings.

Many natural birth advocates today are pushing the birth plan, and encouraging women to be proactive in advocating for themselves in the hospital. I don’t think this is the answer. Piecemeal demands will only be met with piecemeal advances. This is exactly what happened in the original natural birth movement. No, I think the system is too large and too entrenched to affect any meaningful change by addressing one intervention at a time. It’s like trying to fix an avalanche with five men with snow shovels.

I think the answer is to categorically refuse to enter the system at all. This is probably an unrealistic expectation in today’s current climate, when most women have almost no choices outside of the hospital. But if we can somehow, some way encourage women to take their births in their own hands, and out of the clutches of the medical establishment, then they would HAVE to notice. Now that’s true choice.

Monday Munchies

2009-03-30T08:09:00.003-06:00

This recipe is straight out of Betty Crocker. I think beef stroganoff suffers from the same cultural stigma as meatloaf - stodgy and boring. But both, when done right, are a delicious rich, savory meal that can easily qualify as comfort food. There are two ways to do stroganoff: the easy way, and the hard way. You can do the easy way, but it won't taste nearly as good. Here I list the long recipe, but it is well worth your time and effort.

Beef Stroganoff

1 1/2 lbs. beef (can be ground beef, stew meat, tenderloin bits, whatever you have)
2 T. butter
1 1/2 c. beef broth
2 T. ketchup
1 t. salt
1 clove garlic, chopped
3 c. mushrooms, sliced
1 med. onion, chopped
3 T. flour
1 c. sour cream (can sub. plain yogurt)

Melt butter in large skillet and brown the beef. Reserve 1/3 c. broth. Pour the rest of the broth, the ketchup, salt, and garlic into the skillet. Heat to boiling, reduce heat, and simmer 10 minutes, or until beef is tender. Stir in mushrooms and onions. Cover and simmer about 5 minutes, or until onion is tender. In a small bowl, combine the 1/3 c. reserved broth and flour, mixing until smooth. Gradually stir into beef mixture. Heat to boiling, stirring constantly. Boil and stir for 1 minute. Reduce heat to low, and stir in sour cream, just until warmed. Serve over rice or noodles.

Questions to ask your prenatal care provider

2009-03-28T14:51:00.008-06:00

Michelle Crouch, in this article, makes a list of 10 questions to ask your care provider in determining how willing they will be to work with you in achieving a natural birth. These questions are pretty standard, such as, Can I move around during labor? and, Do I have to push laying on my back? Unfortunately, many doctors are happy to talk about natural birth in their office, but once you enter the hospital in labor, they come up with all sorts of reasons why you can't do the things they once agreed upon.

I am of the opinion that asking permission to do things you, as an adult woman, should be fully capable of doing without any prompting or concession itself is unnatural. For that, and many other reasons, I don't believe low-risk pregnancy belongs in a hospital at all. However, many women have told me that their doctor is very supportive of their wish to deliver naturally, and for that reason, they feel perfectly comfortable being in the hospital. But how do you know your care provider won't pull the ol' bait and switch once you reach the end of your pregnancy?

Birthkeeper, over at Midwifery Ramblings, created this list of questions which I elaborate on, to ask your care provider, to find out their TRUE philosophy about birth. Do they see birth as an emergency waiting to happen? Or are they willing to let the process unfold itself, and only use intervention when absolutely necessary? Ask them these questions to find out:

1. How do you feel about unassisted birth?

This should be the most telling clue about your health care provider's attitude toward birth. Granted, most doctors won't be jumping at the bit to tell you to run off and have an unassisted birth. However, if they seem to have a "live and let live" attitude about those who choose unassisted birth, or concede that while they don't condone the practice itself, they can understand those who do it, it is a good sign that they don't view all labors as a destined tragedy. If the care provider says anything about wishing it would be illegal, calling state child protective services, or mentions "death warrant," it is a good sign that your care provider does not believe that labor is natural process, designed to mostly go right.

(This is not to say you ought to run off and have an unassisted childbirth. This question is just to test the reaction of your care provider to the idea that birth is normal.)

2. What is your policy for postdates? At what point do you consider a pregnancy postdates?

The correct answer should be, "We won't do anything until you are overdue, at 43 weeks. Then we may start doing some monitoring to check the baby's progress." Full term pregnancies are from 37-42 weeks. Not the day you hit 42 weeks, but through 42 weeks. But what about "old placenta?" A myth, to be busted in a future post. What about stillbirth? The rate of stillbirth does go up after 42 weeks, but there is often a good chance of being off on dates. Ultrasound can be off by as much as three weeks in either direction.

The point of this question is to see your care provider's reaction to the end of pregnancy. Do they push for induction at 40 w 1 d? Are they convinced all babies will die at 42 weeks? Will they respect your wish to avoid induction?

**ETA** I have explored this myth here.

3. What is your policy regarding large babies? Any fears surrounding them?

The ACOG itself does not support induction for suspected macrosomia ("big baby"). Induction of labor and birthing position is far more closely associated with shoulder dystocia than large babies, and in fact, shoulder dystocia occurs more often in average-sized babies. Ultrasound is inaccurate in predicting weight, and can be off by as much as 2 pounds in either direction, and is not recommended for use in considering induction. If your care provider shows *any* concern for the size of the baby, unless the baby appears to be 16 pounds (or not growing at all), you can be sure they will try to scare you into induction with horror stories about "big babies."

**ETA** I have since written a post about why big babies are no cause for concern.

4. Do you attend breech births? Do you feel breech vaginal births are safe?

Most doctors will not attend breech birth. I already answered the myth about why breech vaginal birth is not assumed to be safe. For most women in America, their choice in a breech birth will be to have a c-section in a hospital or birth unassisted at home. However, if your care provider seems to sympathize with your situation, or indicates that he/she believes breech birth is normal, but is legally unable to attend one, you might be able to get away with an "oops" breech vaginal birth. Under most circumstances though, you are better off staying home.

5. How often have you swept membranes to get labor going? Artificially ruptured membranes?

The answer should be never. However, you are unlikely to find an OB who has never done either of these things. Instead, your doctor should say "rarely" or "not anymore." "I only do it if necessary" is the WRONG answer. I can't think of a single instance that would be helped by doing either of these things. Also, beware if your doctor insists on doing vaginal exams at the end of your pregnancy, despite your request to avoid them. Some doctors may use the opportunity to sweep the membranes without permission.

6. In a typical labor, how often do you usually do vaginal exams?

If you are seeing a doctor, it is typically the nurses who do VEs while in labor. The answer should be "only upon request," but in a hospital you are unlikely to be left alone until you ask for one. Instead, look for the reaction when you say that you would prefer not to be checked at all. Dilation and station have nothing to do with when you will go into labor or how long the labor will last. Any care provider who insists on performing routine VEs without indication should be avoided.

7. What is your policy on prolonged rupture of membranes?

If your doctor insists you come into the hospital the second your water breaks, you should consider switching doctors. It is not uncommon at all for your water to break without labor starting immediately. The big fear with water breaking is the risk of infection. However, the risk is greatly increased as a result of vaginal exams. Without inserting anything into the vagina after water breaks, there is no need to do anything but wait until labor begins. According to this website, 94% of women will be in labor within 48-95 hours. That's up to 4 days between rupture of membranes and onset of labor. Rupture of membranes is not a reason for panic.

8. How do you handle posterior babies?

The answer should be that there is no special "handling" of posterior babies. Bonus points if they suggest a chiropractor to encourage anterior positioning. C-section is NEVER indicated for posterior babies.

9. What conditions do you consider high risk in pregnancy?

Conditions that should NOT be on this list include GBS positive, Rh factor (unless sensitized), diet-controlled gestational diabetes, advanced maternal age, borderline anemia, twins, breech, VBAC, or borderline high blood pressure, to name a few. In fact, the list of true high risk conditions is fairly short, and usually involves a congenital problem in the mother, or a rare pregnancy-related disease. If you are labeled "high-risk" for something, you would do well to research, and get a second opinion. And switch doctors.

10. How soon do you usually clamp/cut the cord after delivery?

The wrong answer is "immediately." Ideally, your care provider will say, "once the cord stops pulsing." Another red-flag answer is, "it depends on the situation." Unless the baby needs immediate resuscitation, there is almost never a need to cut the cord immediately.

**ETA** See Nursing Birth for a great discussion on this myth.

Some readers may be saying to themselves that meeting all these conditions would be almost impossible to achieve in a hospital birth. Bingo! If you happen to stumble upon one of those gem OBs who answered all of these satisfactorily, kudos! Otherwise, you should seriously consider staying at home, if you truly wish to have a happy and safe, and natural birth.

This blog post is not about the specific interventions themselves. Some of the statements I have made here I have not put the references to back up my claim. I plan to write blog posts on these topics in the future with full documentation.

Birth choices, then and now

2009-03-26T19:54:00.003-06:00

Over at Phd in Parenting, they are discussing the results of the Canadian Maternity Experiences Survey. Ann Douglas at The Mother of All Parenting Blogs was looking over the data collected in the survey, and wondered how much of the responses were influenced by the birthing climate in various communities. These ladies have gotten together a little questionnaire to find this out. I couldn't decide which of my births to use for this information, so I thought I would fill it out for two of my births, one a hospital birth, and the other an unassisted birth. (You can follow the link on the right to read my UC birth story.)

For the record, I live in the US.

How much choice did you have when it came to finding a prenatal care provider? Lots of choice? Or was the choice made for you?

Hospital birth: There was no choice. I lived in a small town (population about 3000), and there was one small county hospital and doctors' group. Some of the doctors were GPs and some were OBs, but most people just went to the person they knew. Midwives were not in that town, although I had heard that there was one midwife who came from 70 miles away to attend home births. Even if there was a midwife, I was on state medical insurance, which does not cover midwives, so I went to the doctors' group, which was paid for.

UC: I started this pregnancy in the same small town as the previous pregnancy. I went to the same OB. Then we moved to a relatively big city for this birth. There were plenty of choices, between doctors and midwives, including CNMs, DEMs, and CPMs. However, state medical insurance would only cover doctors or CNMs, so a home birth midwife would not have been paid for. I chose to visit with a CPM and pay out of pocket, but soon dropped out of care in order to pursue a UC (not for financial reasons.)

Where did you go for information when you were pregnant?

Hospital birth: Books mostly.

UC: Books and internet. I asked my health care provider but did not trust the information I was given. In some cases, I had researched it first, asked the care provider, and was given erroneous information.

Did you know about the importance of taking folic acid prior to conceiving? Had you heard about the new research about the role folic acid can play in preventing preterm birth (if you take it one year before becoming pregnant)?

I did know about the importance of folic acid, but had not heard about the whole preterm birth aspect of it.

Did you feel you had adequate choice in terms of a place to give birth? Did you wish you had more options?

Hospital birth: No choices at all. I wanted to see about a home birth, but as I said, the only midwife around came from 70 miles away, and was not covered under state insurance. The only place to birth in that town was the county hospital. There is one birth center in the entire state, and it is in the northern part. If you wanted a home birth, you had to pay for it out of pocket to have a midwife come in, or do an unassisted birth. That is pretty much the situation for most women in America. And in a lot of places, midwives are illegal altogether, so the choice is between a hospital birth, an illegal midwife, or an unassisted birth.

UC: Choices were still limited. I was on state insurance, which will only cover hospital births. The one birth center in the state was about 45 miles away. We still chose to pay for a home birth midwife out of pocket, but I decided I did not want a paid attendant at all, so I did a UC. In that case, my options were limitless.

Car seat safety

2009-03-24T07:42:00.004-06:00

Today I am featuring a guest blogger, Joy, from Eternal Granola Mama. I asked her to share her information regarding extended rear-facing, or keeping children rear-facing in car seats past the legal minimum of one year and 20 pounds. I turned my toddler around at 1 year, and once I learned more about ERF, I turned her back around. She is now 2 years old, and tall enough to almost outgrow her rear-facing convertible seat, but she is still very small, at 22 pounds. For this reason, I bought a more expensive rear-facing car seat that is taller. Not everyone can afford the more expensive seats, but if you can keep your child rear-facing as long as they still fit into their car seat, you are giving them the safest ride possible.

picture used by permission from vicki

This is a very important topic, so if someone you love has turned around their toddler before they are ready, please share this information with them.

Extended Rear Facing
Joy

Extended rear facing means keeping a child facing the rear of the car after the first year of life. Riding rear facing is 4 TIMES safer than riding forward facing according to this study. I take that very seriously since according to CDC data motor vehicle injuries are the number 1 killer for children ages 1-14.

The vast majority of crashes are front or side impact crashes as shown by this data from the National Highway Traffic Safety Administration. When the crash occurs occupants are almost always moved or thrown forward or sideways. When a child is forward facing they are thrown against the harness or seatbelt and the head flies forward putting a lot of strain of the neck. Children are especially at risk because their heads are much bigger in relation to their bodies than adults. This is a crash test video showing what happens to a forward facing child in a frontal impact, which is the most common type of crash:

When a child is rear facing the back and side of the car seat absorbs a lot of the crash force and supports the back, neck and spine. This video shows a crash test with a rear facing child:

If you had to pick, which video would you rather your child be in? This is why I kept my oldest daughter rear facing until she was almost 3 ½. I wish there were bigger rear facing car seats available in the US so that she could still ride that way. In Sweden the norm is for children to rear face until they are 55 lbs and they have car seats that are big enough to allow that. Here is an interesting report that deals with Sweden’s practices versus what is common in the US, UK and Australia. This report also discusses extended rear facing in Sweden.

One of the reasons often given to turn a child forward facing is that their legs are uncomfortable. My daughter and many other children just curled their legs up or rode cross legged, whichever was more comfortable. Considering how much safer rear facing is I would not turn my child forward facing for this reason. Also, many think the legs could be broken in a crash if the child is left rear facing. I was unable to find any documented cases of a broken leg due to rear facing. However, serious neck injuries from forward facing abound, think whiplash and worse. Even if rear facing increased the risk of a broken leg I would prefer that over a broken neck.

Many pediatricians tell parents that they have to turn their child around at 1 year of age because it would be dangerous to keep them rear facing. As Emily has proven so well in other blog posts many doctors are unfortunately not up to date on current research.

So, once a child outgrows an infant carrier what can be done? This is where convertible car seats come in. A convertible seat rear faces for longer than an infant seat and can then be turned forward facing when the child is too big to ride rear facing. In the US there are many convertible car seats that allow a child to rear face up to 35 lbs. These seats allow the vast majority of children to ride rear facing until they are at least 2 years old. Thus, age 2 would be a better minimum to ride forward facing and then as long as possible after that. Some examples of good convertible seats are: Britax Marathon, First Years True Fit, Recaro Como, and Costco Scenera. A good convertible car seat allows rear facing to 35 lbs and has a tall back. Many of the better seats are more expensive, but a Costco Scenera is about $40.

Ed. note: If you are unable to afford an appropriate car seat at all, please contact your local health department. Most states offer free or reduced-cost car seats to low-income families.

If you have questions feel free to post in the comments section or check out this great website: www.car-seat.org Its a great site to post questions about what seat would work best for your child and vehicle as well as learning more about car seat safety in general.

Here is a link to find a Child Passenger Safety Technician near you who can inspect your car seat installation and answer questions. At least 80 % of car seats are not installed correctly which puts children at risk. http://www.seatcheck.org/

Monday Munchies

2009-03-23T08:00:00.000-06:00

The other day I set out to make some hummus. I got down the ol' Betty Crocker and got to work. Once it was all mixed together, I went to taste it, and it tasted....blah. Completely uninteresting. So I added a little of this, a little of that, and what I got was out of this world. When I have made hummus in the past, we haven't eaten it fast enough before it gets funky. But this hummus was so good, we ate it in 3 days. Now, I will share this little bit of heaven with you:

As usual, all amounts are approximated, and may be tweaked to suit your own tastes. This recipe is vegan-friendly.

Emily's Spicy Garlic Hummus

1 pound garbanzo beans, cooked, liquid reserved (or 1 can, if you prefer not to cook your own)
1/2 c. bean liquid
3 cloves of garlic
1/4 c. tahini
2 T. lemon juice
3 T. olive oil
1 t. cumin
1 t. salt
1/2 t. black pepper
1/2 t. paprika
1/2 t. cayenne pepper

Soak the beans overnight. Drain liquid, cover beans with water and boil 2-3 hours, until soft. Put all ingredients in food processor or blender and mix until smooth. Serve with chips or pita bread.

C-section rates continue to rise

2009-03-19T15:02:00.004-06:00

The CDC has released their preliminary birth statistics from 2007.

The preliminary cesarean delivery rate rose 2 percent in 2007, to 31.8 percent of all births, marking the 11th consecutive year of increase and another record high for the United States (Table 8; Figure 3). This rate has climbed by more than 50 percent over the last decade (20.7 percent in 1996)...The rise in the total cesarean delivery rate in recent years has been shown to result from higher rates of both first and repeat cesareans (1).

This represents the average for all states. Some notable c-section rates for certain states and territories include:

Florida..................37.2%
New Jersey...............38.3%
Mississippi..............36.2%
Puerto Rico..............49.2%

If having a 1 in 3 chance (or in some areas, approaching 1 in 2) of walking out of the hospital with a major surgery scar isn't enough to encourage more women to look into out-of-hospital birth, I don't know what is.

Monday Munchies

2009-03-16T09:06:00.005-06:00

They say when you are trying to remove a bad habit you must replace it with a good habit. That way, the pain of the habit-void will not force you to pick the bad one back up. The bad habit I am trying to eliminate is sweets. Again. I think it was Mark Twain who said, "It's easy to quit smoking. I've done it hundreds of times."

The good habit I have chosen to replace my sweets with is smoothies. This was made possible by the über-cool present I got for Valentine's Day this year.

Smoothies are sweet, 100% natural, and even organic if you choose. The basic recipe for smoothies is this: fruit, fruit juice, plain yogurt, and ice. You can experiment with different fruits and fruit juices until you find the ones you like the best. This recipe turned out to be the most delicious smoothie I have made yet. It tastes better than milkshakes - I promise.

Plum-Berry Smoothie Heaven

1/2 can frozen pineapple-orange juice
1/2 plum
1/2 c. mixed frozen berries
1/2 c. plain yogurt
4-6 ice cubes

Combine in blender or food processor. Serves 2.

Response to "The Case Against Breast-Feeding"

2009-03-15T09:02:00.007-06:00

The latest installment from the "don't judge me" argument has been published in a new article, "The Case Against Breast-Feeding." In this article, the author sets out to describe the discrimination and social pressure that non-breastfeeders must face, and how the evidence that supports the health benefits of breastfeeding is exaggerated or non-existent.

Naturally, this has the breastfeeding community up in arms. Let me explain to you why.

Hanna Rosin begins her article talking about the cool reception she met from moms at the park when she mentioned weaning her child at one month old. She describes the other moms as trendy types, who breastfeed as a "signifier" of their trendy status. She also goes on to describe how she herself came to breastfeed her own child, after reading several magazine articles about how easy it would be, and the health benefits of it. Now on her third child, she has become disenchanted with the idea of breastfeeding, and wrote this article to show us why she doesn't want to breastfeed anymore, and why we should not judge her for doing so.

This time around, nirvana did not describe my state of mind; I was launching a new Web site and I had two other children to care for, and a husband I would occasionally like to talk to. Being stuck at home breast-feeding as he walked out the door for work just made me unreasonably furious, at him and everyone else...When I looked at the picture on the cover of Sears’s Breastfeeding Book—a lady lying down, gently smiling at her baby and still in her robe, although the sun is well up—the scales fell from my eyes: it was not the vacuum that was keeping me and my 21st-century sisters down, but another sucking sound.

Her primary motivating factor seems to have been the feeling of being shackled by the chains of motherhood. She spends a bit of time talking about the feminist movement, and how breastfeeding is the modern equivalent of indentured servitude. To women who want to have careers, who want to be liberated from our biological imperative, that sounds great! But there is an easier solution:

DON'T HAVE KIDS.

You don't want to "do" the wife and mother thing? Then don't get married and have kids. We are designed by God (or nature, if you prefer) to carry our young for 10 months, to birth them vaginally, and to suckle them at the breast. That is why we are classified as mammals. I will never understand why women want to have children, but don't want anything that goes along with having children: birthing them, nursing them, and being home to raise them. But I digress. Let's move on to the meat of the article.

The author's moment of "enlightenment" came while reading another magazine. The results of this study that she read about prompted her to do further research into the alleged benefits of breastfeeding, which caused her to conclude that the benefits were exaggerated, and that knowledge helped her to feel less guilty about not wanting to breastfeed.

One day, while nursing my baby in my pediatrician’s office, I noticed a 2001 issue of the Journal of the American Medical Association open to an article about breast-feeding: “Conclusions: There are inconsistent associations among breastfeeding, its duration, and the risk of being overweight in young children.” … The breast-feeding advocates’ dream—that something in the milk somehow reprograms appetite—is still a long shot.

This statement is just one of the many statements she makes about the benefits of breastfeeding, without looking at the comparison to formula. Yes, it is true there is no direct correlation between breastfeeding and its ability to prevent obesity, but why would there be? It's not a weight-loss drug or anything. It's just food. However, if one looks at formula:

A Scottish study concluded that formula feeding is associated with an increased risk of childhood obesity. (Armstrong, J. et al, 2002)

A German study found a 40% higher prevalence of obesity among children who were formula-fed, over children who had been breastfed. (Von Kries, R, 1999)

and so on. While breastfeeding by itself doesn't prevent obesity, when compared to formula feeding, the rates of obesity are significantly lower. So her statement about how breast milk doesn't "reprogram appetite" is not pertinent to the discussion, if her point is that formula is not necessarily worse than breast milk.

The author is a product of her generation, equating infant formula with scientific progress, and paying little heed to the history or science of formula creation itself. She states, "Formula grew out of a late-19th-century effort to combat atrocious rates of infant mortality by turning infant feeding into a controlled science." Infant feeding was NOT a controlled science in the late 19th century. The first infant formulas were just cow's milk. Period. It was considered a last-ditch attempt to save babies for whom human milk was not available. Most of the babies died anyway. Later on, someone developed the ability to condense and store milk for delivery and shelf-life, and hence mass-marketed infant formula was born. Infant formula was still just evaporated cow's milk. Infant formula did not become a "science" until it became marketable. (For more information about the history of infant formula, please read the book Milk, Money and Madness.)

She comes to this conclusion about all the "evidence:"

What does all the evidence add up to? We have clear indications that breast-feeding helps prevent an extra incident of gastrointestinal illness in some kids—an unpleasant few days of diarrhea or vomiting, but rarely life-threatening in developed countries. We have murky correlations with a whole bunch of long-term conditions. The evidence on IQs is intriguing but not all that compelling, and at best suggests a small advantage, perhaps five points...

Breast milk is not magical, no, but it doesn't cause any negative effects, which cannot be said for formula. And her conclusion also does not factor in that breastfeeding in comparison to formula feeding isn't just better - it saves lives. Her concluding statement illustrates this point perfectly: "So overall, yes, breast is probably best. But not so much better that formula deserves the label of “public health menace,” alongside smoking."

In fact, the author is careful to not include any studies about formula - maybe because studies about formula paint a much darker picture? The author neglects to put up any studies about the very real dangers of formula, including increased risk for asthma, allergy, respiratory disease, reduced cognitive development, infection from contaminated formulas, childhood cancers, nutrient deficiencies, chronic diseases, diabetes, ear infections, environmental contaminants, and death. (ref) How is it that a product that causes death does not deserve the label of public health menace?

Ay, there's the rub! The elephant in the room that no one wants to talk about. Formula causes death. Sure, most babies use formula and live. I formula fed my first child, and she grew up to be quite healthy and very intelligent. But then, George Burns smoked cigars until the day he died, at the ripe old age of 100 - does that mean that tobacco doesn't kill people?

According to this article,"between 1982 and 1994 alone, there were 22 significant recalls of infant formula in the United States due to health and safety problems. Seven of these recalls were classified by the FDA as "Class I" or potentially life threatening." In fact, powdered formula is not sterilized at all, and subject to contamination by any source. According to this article by the FDA:

As background information for health professionals, FDA wants to point out that powdered infant formulas are not commercially sterile products. Powdered milk-based infant formulas are heat-treated during processing, but unlike liquid formula products they are not subjected to high temperatures for sufficient time to make the final packaged product commercially sterile.

Google e. sakazakii, melamine contamination, or BPA.

This article finds that formula use doubles the US infant mortality rate.

A 1989 study conducted by the U.S. National Institue of Environmental Health Sciences estimated that four of every 1,000 infants born in the United States each year die because they are not breastfed. In 1992, 4.1 million American children were born. If half were bottle-fed (which is a conservative estimate), there would have been 8,168 unnecessary, preventable deaths.

And it doesn't just kill babies - it kills mothers. According to phdinparenting:

The Canadian Cancer Society reports that in 2008, an estimated 22,400 women in Canada will be diagnosed with breast cancer and 5,300 will die of it (source: Breast Cancer Stats). It has been well documented through research that breastfeeding lowers a woman’s chance of contracting breast cancer (for other ways of lowering your risk see It’s Your Health - Breast Cancer). In fact, studies have shown that if women breastfed for at least 16 months over their lifetime, the incidence of breast cancer might drop from 6% of women to 3% of women (source: CBC article “Breastfeeding protects against breast cancer, study confirms”).

So if infant formula kills babies, is subject to contamination, increases health risks, and harms mothers, why is it still marketed to women as their "right to choose?" As if choosing to breastfeed or use formula is no more important than choosing Coke over Pepsi?

...in any case, if a breast-feeding mother is miserable, or stressed out, or alienated by nursing, as many women are, if her marriage is under stress and breast-feeding is making things worse, surely that can have a greater effect on a kid’s future success than a few IQ points...The debate about breast-feeding takes place without any reference to its actual context in women’s lives. Breast-feeding exclusively is not like taking a prenatal vitamin. It is a serious time commitment that pretty much guarantees that you will not work in any meaningful way...
...Given what we know so far, it seems reasonable to put breast-feeding’s health benefits on the plus side of the ledger and other things—modesty, independence, career, sanity—on the minus side, and then tally them up and make a decision. But in this risk-averse age of parenting, that’s not how it’s done...
...We were raised to expect that co-parenting was an attainable goal. But who were we kidding?... Even in the best of marriages, the domestic burden shifts, in incremental, mostly unacknowledged ways, onto the woman. Breast-feeding plays a central role in the shift...
...In her critique of the awareness campaign, Joan Wolf, a women’s-studies professor at Texas A&M University, chalks up the overzealous ads to a new ethic of “total motherhood.” ...Choices are often presented as the mother’s selfish desires versus the baby’s needs. As an example, Wolf quotes What to Expect When You’re Expecting, from a section called the “Best-Odds Diet,” which I remember quite well: “Every bite counts. You’ve got only nine months of meals and snacks with which to give your baby the best possible start in life … Before you close your mouth on a forkful of food, consider, ‘Is this the best bite I can give my baby?’ If it will benefit your baby, chew away. If it’ll only benefit your sweet tooth or appease your appetite put your fork down.” To which any self-respecting pregnant woman should respond: “I am carrying 35 extra pounds and my ankles have swelled to the size of a life raft, and now I would like to eat some coconut-cream pie. So you know what you can do with this damned fork...”

It's all about M-E. This summarizes the tone of the whole article, and I would submit, the tone of our culture today. I don't want to breastfeed because I am too busy. Because it's uncomfortable for me. Because I want to work. Because I want to have an exclusive relationship with my husband. Because I want a life that does not include children in a significant portion of it. Because I don't want to be inconvenienced

Now, far be it from me to judge someone for not wanting to be a parent. If someone wants to live a life free of constraints, to be able to go wherever they want when they want to, to have a career to dedicate themselves to for their entire lives, more power to them. No one is forcing anyone to have kids. But once you have children, you have already chosen your life! You cannot have your cake and eat it too.

Most importantly, once you have children, you cannot take away THEIR right to choose. Your right to choose ends when another life is affected by your choices. Infant formula is potentially harmful to babies. Period. You cannot "choose" to use formula simply because it suits your lifestyle better - you must breastfeed because it won't kill your baby!

The final word today's culture is about being judgmental. The phrase "don't judge me" has the same weight in today's culture as calling someone a pinko in the 50s.

What’s most amazing is how, 50 years after La Leche League’s founding, “enlightenment from the laboratory”—judgmental and absolutist—has triumphed again. The seventh edition of The Womanly Art, published in 2004, has ballooned to more than 400 pages, and is filled with photographs in place of the original hand drawings. But what’s most noticeable is the shift in attitude… The experience of reading the 1958 edition is like talking with your bossy but charming neighbor, who has some motherly advice to share. Reading the latest edition is like being trapped in the office of a doctor who’s haranguing you about the choices you make.

The shift in attitude of which the author speaks isn't a change in the book; it's a shift in the attitude of today's women - that of entitlement. When the book was first published in 1958, women didn't need to "harangue" each other about breastfeeding. They only needed to educate and support each other, because they assumed that women would naturally want to assume their proper role as mothers to their children.

Make no mistake - this article is not about the health benefits of breastfeeding. This article is about women who don't want to breastfeed, despite knowing the benefits of it, and despite knowing the risks of formula, without reproach or judgment. You will have no such luck with me. I judge you. I judge you for choosing something dangerous for your children for your own convenience. I judge you for trying to make other women feel good about their choice not to breastfeed, so you don't feel alone in your selfishness. I judge you for making the commitment to have children without having the integrity to follow through with everything motherhood entails.

In the end, the author finds

I’m not really sure why I don’t stop entirely. I know it has nothing to do with the science...My best guess is something I can’t quite articulate. Breast-feeding does not belong in the realm of facts and hard numbers; it is much too intimate and elemental. It contains all of my awe about motherhood, and also my ambivalence. Right now, even part-time, it’s a strain. But I also know that this is probably my last chance to feel warm baby skin up against mine, and one day I will miss it.

Author: this is your biology calling. Please answer.

** I wish we were all adults and I didn't have to make this disclaimer, but such as it is...I obviously don't judge anyone for whom formula feeding is not a choice, such as adoption and those with certain medical conditions. That is why formula was invented, after all.