Friday, December 31, 2010

A butterfly birth

To end off the year, I wanted to share a lovely birth story from one of my blog readers, Brieanne. She lives in rural California, is LDS, and has three children. This was her second unassisted birth and third unassisted pregnancy. 

A few hours after Annelise's birth, once it was light enough to take a picture
I woke up on the morning of August 16 feeling a bit sad, as this was my daughter's fifth birthday. How time flies! This particular day I was also 12 days past my due date. This was not uncommon for me, as my first was 16 days late and my second was 17 days. We started the day by asking the birthday girl what she would like me to cook for her birthday dinner. She said she wanted a roasted chicken and potatoes, with loads of gravy, and an apple crisp.

After I made my shopping list we all packed into the truck and went to the chiropractor for my bi-monthly adjustment. The chiro made a comment that he would "help me get things started." In my head I thought it was cute he could think he would make any of my babies be born if they weren't ready. Not in this family! I thanked him and told him I hoped I would not be back in two weeks. He agreed.

Our next stop was the grocery store. I picked up all the ingredients to make my daughter's dinner, and then we came home. I put groceries away and then Eric and I sat down to place our food co-op order. Eric was annoying me by opening every page of the website to look at every single item. I had a weird sense of urgency, but was having a hard time relaying this to him without thinking I would hurt his feelings. I finally went outside to call our landlord to see if I could borrow her oven to roast a chicken. She said it was fine, although it was over 100 degrees that day and would make her kitchen hot. I told her I would be up in a bit.

Once I gathered up my items we all piled in the truck again and drove the minute to her house. I preheated the oven, and started prepping things. As she and I were discussing the birth, I felt a click in my uterus and felt a trickle down my leg. I looked down at the white floor and noticed whatever came out of me was yellow. I am sure my face flushed red because for a second I thought I peed on myself. I must have gasped because she asked me what was wrong and I told her that I thought my water broke. We both went to the bathroom and I took off my pants and sniffed, but there was no odor. I knew then it must have been amniotic fluid.

Eric was upstairs fixing a toilet for the landlord, and just as I came out of the bathroom he was coming down the stairs. I told him my water broke, and he smiled really big and looked very happy. I told him I needed help because I anticipated a fast birth, and he agreed. Once we started cooking I had an enormous contraction, which was about 45 minutes later. The time was 7:45 at this point. I knew I had better get down to the house and start preparing for a baby, since my last birth was only 3 hours. We got everything in the oven and then Eric took the kids and I back to the house. He told the landlord he would come and get the food when his phone timer went off.

Back at our house I cleaned up the yard, had Eric set up my tent as this was an outside birth, and got blankets and my birth basket in the tent. At one point I looked out and saw my kids helping Eric put up the tent, and realized what a beautiful picture it was of the whole family helping prepare for our new baby. My daughter then came in and asked if I had put on my blessingway beads yet. I thanked her for reminding me, and then went to put them on. While I was placing them around my neck I dropped one side of the string and all the beads slipped off. My 3 year old scrambled around picking up each bead and then carefully placed each one in my hand with his chubby little fingers. I will never forget this little detail in all my life. It was so symbolic! Here is my former baby helping me prepare for the new one. It brings tears to my eyes every time I think of it.

It was around this time my contractions were pretty steady, but were not very painful nor did they require my attention. Eric left to get our food, and when he came back I fed everybody. After dinner we all gathered around holding hands while Eric gave me a blessing. I felt the Holy Spirit telling me all would be beautiful, and not to worry one bit. During my pregnancy I had butterflies follow me around whenever I thought about the upcoming birth. It started when there were 3 in my blessingway tent just weeks before, and then almost every day after, up until the birth. My husband's grandma even called one day to tell me a butterfly was following her around, and it made her think of me and the birth. She had known nothing of my similar experience prior to calling me. I could see my Heavenly Father's hand in all of this, and I was so at peace during the Priesthood blessing.

After the blessing I laid in bed with the kids and attempted to read them a book, but the contractions got too strong and I had to let Eric take over. After the kids fell asleep I stood in the front doorway looking out and my contractions got really strong and regular. I decided at this point to go outside in the tent. It was a beautiful summer night. The weather was really warm and the owls were flying around, like grey ghosts in the sky. We live on 22 acres, in a pretty rural part of California. Going outside was making the decision to join nature in something only nature does the best: giving birth. At this point I let go of all tension and entered my tent. This was a kitchen tent, which was just screen on all four corners, that zipped up so that flies and mosquitoes couldn't get in. Eric was in the shower, so I labored all alone for about 20 minutes. I really got into the flow of labor while he was gone, so when he came in the tent to tell me he was coming in and to ask if I wanted a chair, I felt a bit disturbed. I agreed to the chair, but couldn't bear to tell him I didn't want him coming into my space. When he came in he set my chair in front of me with a towel on the seat, to put my head on, I was on my knees so this was perfect for me. He then set his chair in a corner and just sat there, silent as a mouse. I could see him in the moonlight, and he looked so peaceful there, just watching me. I decided then it didn't bother me too much. Every time I focused on breathing through a contraction, I would look up and see exactly half a moon in the sky, and and then feel so centered.

After doing some pretty hefty labor dancing, I got back on my hands and knees and started pushing. I didn't feel "pushy" at all, but something deep inside told me to just push. When I did I felt the baby come down and then felt pushy. I ripped my shirt off and announced I was hot, so Eric grabbed a book out of my birth basket and started fanning me. I heard a pack of coyotes all howl in unison, and I felt so in touch with myself and with my Heavenly Father's creations. Finally I felt her head crowning, and after screaming at the top of my lungs into a towel, I lifted up one leg and our baby slipped out. The time was 12:41 am. Oh how easily I forget how painful the crowning part is!

Since Eric had made the decision to fan me instead of catching the baby, it gently unfolded onto the blanket. We had only the light of the moon by which to see, so when I turned around to pick up the baby, I swept my hand over it's bottom and didn't feel some parts I expected to feel, since I thought for sure it was another boy. I told Eric she was a girl, and he said he had known all along. I held her close expecting to hear her cry, but she just kind of made some little tiny noises. I felt in the dark and realized the cord was wrapped around her neck, so I gently unwrapped it. She then let out a tiny cry, but not much more than before. She was perfect in every way, but just didn't feel like crying I guess. In the moonlight I could see she looked exactly like my daughter! She was also born 41 minutes after her birthday.

About a minute after she came out, I felt what I thought was the placenta come sliding out, so I immediately wondered why the placenta came out so fast. I had Eric get his headlamp and shine it on the mass. It turned out to be a huge bunch of blood clots! I was confused about this part, but obviously we were both fine, so I didn't worry. I am still a bit curious to know exactly what these were and why they were so big. I didn't experience this with my previous births. About 20 minutes later I tried to push out the placenta, but it only partly came out, so I left it alone for a bit longer.

The baby started to vigorously suck her fist, so I nursed her thinking I would take a shower when she was through, but every time I tried to unlatch her to quickly clean myself off, she would start crying. I ended up sitting there cross-legged, nursing her in the dark, for almost three hours straight! Finally she was through, and so I had Eric cut the cord and pushed out the rest of the placenta. I "rushed" to the shower inside to get clean, and then got dressed and took the baby. All this time the kids had been asleep, so it was actually pretty romantic spending time with my husband, and now just the three of us.

After a few days we decided to name her Annelise Farfalla. Farfalla means "butterfly" in Italian. I want her to always remember how much her Heavenly Father watched over the two of us on our journey through the pregnancy, and then the birth, and how spiritual and wonderful her birth was.
Annelise with her two siblings
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Wednesday, December 29, 2010

Belly pictures: 32 weeks

32 weeks pregnant with baby #3 (really similar to Dio's pregnancy, except this pose makes my belly stick way out!)
pregnant with Dio
pregnant with Zari
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Tuesday, December 28, 2010

Pregnancy update: 32 weeks

Both kids are sleeping and I have some internet time finally. Eric is picking up more sheetrock and plumbing supplies this evening. I have sheetrock dust and wood splinters all over my clothes from working on the bathroom today.

The baby is squirming and sticking its foot right below my solar plexus. Like during Dio's pregnancy, I'm feeling almost all movements in the front. Lots of squirms and punches near my lower abdomen and hipbones and pubic bone, bigger kicks and stretches up near my ribs.

For those of you who are curious, I chose the prental Rhogam shot. I kept going back and forth on it, and finally I decided to do it  for a number of reasons: First off, my mind kept coming back to it, unlike other pregnancies. I also will be doing a lot of physical labor during the next few weeks of renovations. Of course I'm not planning on banging on my stomach with a 2x4! I also haven't had any sort of reaction to the postpartum shots. I feel like I could really have gone either way, and finally it was time to just make a choice and move on.

About blood sugar levels: I've implemented nutritional and exercise changes and spoken with a dietitian--the one who teaches GD classes recommended by my midwife--over the phone about ideas for lowering my fasting BG levels. She agreed that before fretting any further about my levels, it would be wise to check the calibration of the glucometer and to get new test strips. I picked those supplies up at the pharmacy last week and might test fasting levels next week for 4-5 days to see how I'm doing. Here is a summary of the changes I've made:

  • Increased my protein intake, trying to ensure every meal or snack has some protein-rich food. I have to say, though, that I feel like I'm always eating nuts, fish, eggs, chicken, &/or cheese and am getting a bit tired of them! 
  • Decreased my carbohydrate intake somewhat, cut out all simple carbs (which I didn't eat much of anyway) and focused on eating only complex carbs 
  • Continued eating moderate amounts of fruits and generous amounts of vegetables, especially non-starchy ones (my favorites are dark leafy greens, green beans, and broccoli)
  • Continued eating 3 meals & 3 snacks a day. When I'm pregnant or breastfeeding, I have to eat every few hours. Which is probably a good thing for keeping blood sugars more stable. 
  • Added a 20-min walk after lunch & about an hour before bedtime (I originally was going after dinner, but the dietitian said pushing the walk a bit later would help my fasting levels more). In the mornings, I often go to the gym, bring the kids to the indoor track, or run errands on foot with the kids. 
  • Okay, I admit: I do eat dark chocolate (85%), maybe 1/2 to 1 rectangle a day. A rectangle has 8 grams of carbs--4 of which are sugar and 3 of which are fiber. Not terrible, and enough to keep me sane! It's funny--70% dark chocolate now tastes too sweet. Okay, I also fess up to eating the occasional piece of marzipan during the Christmas season...

I've been enjoying my frequent walks. Not the trudging through snow and ice part--the temperatures haven't gone above freezing for the past month now--but the twice-daily segments of quiet, alone time. I've listened my way through all of the Motherwear Breastfeeding Blog podcasts and am now listening to the Momotics radio shows. Today I heard Dr. Stuart Fischbein discuss VBAC and preventing cesarean sections.

I really, really want to finish our bathroom renovation before Eric starts teaching again in mid-January. This baby could realistically come any time in February (although I'm not holding my breath for the first two weeks of that month) and I want to have a totally finished bathroom ready for when the baby arrives. Not to mention a jacuzzi tub to relax in while I'm still pregnant!

I still feel like I haven't given this pregnancy/baby enough attention, but what can you do with two little children and normal life to live? I just converted my Hypnobabies CDs to mp3s and am uploading them onto my mp3 player as I type. Listening every evening will give me more time to focus on this new baby (if I can actually stay awake!).

Speaking of sleeping...it's been a real challenge. Last week I had two nights in a row where I woke up in the middle of the night--4 am the first night and 2 am the next--and simply couldn't get back to sleep. At all. Despite having taken a Unisom both nights. This has happened on and off during this pregnancy (but never before). I was desperate after the second night of very little sleep: sobbing over my breakfast cereal, crying inconsolably at night when I was trying to sleep. Zari was quite disturbed. It's not like me at all. I mean, I didn't cry at my wedding or even when my kids were born. So it's really, really serious when I start randomly sobbing all over the place.

Thankfully I've been sleeping better since those two horrible nights. As an experiment, Eric started sleeping upstairs in the spare bed in Zari's room. Wow--what an amazing difference that made! He is a really restless sleeper starting around 4 am. Every time he rolls over or pulls on the blankets (often every 10-15 minutes), I wake up. And then I'm so uncomfortable with the aching pressure points on my hips that I have to move around and fluff up my pillows and roll to the other side. With Eric gone, I sleep almost as well the second half of the night as the first half. So I don't think he'll be sleeping in our bed until the baby is born. Sad but true--my sleep takes first priority.

Belly pictures coming tomorrow!
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Sunday, December 26, 2010

Early skin-to-skin contact after birth: the more, the better

A new study in the Journal of Human Lactation, available online in advance of the print edition, examined the effect of early skin-to-skin (S2S) contact on exclusive breastfeeding rates at hospital discharge. In Effect of Early Skin-to-Skin Mother—Infant Contact During the First 3 Hours Following Birth on Exclusive Breastfeeding During the Maternity Hospital Stay, Leslie Bramson and co-authors examined several variables correlated with exclusive breastfeeding. One of these was early S2S contact during the first 3 hours after birth. This relationship was dose-dependent; in other words, the longer the S2S contact, the higher the rates of exclusive breastfeeding. Below is the abstract:
This was a nurse-driven, hospital-based, prospective cohort study of data collected in 19 hospitals in San Bernardino and Riverside counties by California Perinatal Services Network on all mothers (n = 21 842) who delivered a singleton infant (37-40 weeks gestation) between July 2005 through June 2006. Multivariate ordinal logistic regression showed that maternal infant-feeding method intention (measured prior to birth), sociodemographic characteristics, intrapartum variables, and early skin-to-skin mother—infant contact during the first 3 hours following birth (controlling for delivery hospital) were correlated with exclusive breastfeeding during the maternity hospitalization. Compared with mothers with no early skin-to-skin contact, exclusive breastfeeding was higher in mothers who experienced skin-to-skin contact for 1 to 15 minutes (odds ratio [OR] 1.376; 95% confidence interval [CI], 1.189-1.593), 16 to 30 minutes (OR 1.665; 95% CI, 1.468-1.888), 31 to 59 minutes (OR 2.357; 95% CI, 2.061-2.695), and more than 1 hour (OR 3.145; 95% CI, 2.905-3.405). The results demonstrate a dose—response relationship between early skin-to-skin contact and breastfeeding exclusivity.
This study is significant for several reasons. First, it was a prospective (rahter than retrospective) study with a large sample size of over 21,000 mother-infant pairs. It also teased out the true assocation between S2S contact and breastfeeding rates, independent of maternal intention, sociodemographic characteristics, and events occurring during labor (specifically, forms of analgesia/anesthesia used and method of delivery). From the article's introduction:
From July 2005 through June 2006, PSN (Perinatal Services Network of Loma Linda University Medical Center/Children’s Hospital) enacted a prospective cohort, nurse-driven, hospital-based quality assurance intervention (n = 21 842 mother–infant dyads) to promote, support, and improve the development of newborns through bonding and attachment and early mother–infant skin-to-skin contact during the first 3 hours following birth. Analysis of the PSN data provided the opportunity to fill a gap in the early skin-to-skin literature. It was our intention to include in one study maternal infant-feeding intention, sociodemographic characteristics, intrapartum variables, and the length of time spent in early skin-to-skin mother–infant contact during the first 3 hours following birth (controlling for the hospital of birth) to determine their association with exclusive breastfeeding during the maternity hospital stay. In addition, this program allowed us to examine a possible dose–response relationship between early skin-to-skin contact within the first 3 hours post birth and the likelihood of exclusive breastfeeding during the maternity hospital stay.
At the end of the article, the authors discuss the clinical implications of their findings:

The clinical implications for this study are numerous. The current study has provided data demonstrating that early skin-to-skin contact is clinically effective with respect to increasing exclusive breastfeeding during the maternity hospital stay. Results from our study imply that there is a need to increase the length of exposure to early skin-to-skin contact during the early postpartum period. These results provide important information that peripartum staff can include in their postpartum program planning, policies, and intervention. Maternity caregivers can specifically allocate resources to woman who may be less likely to breastfeed by encouraging skin-to-skin contact during the early postpartum period. Walters and colleagues surveyed their hospital peripartum nursing staff after their early skin-to-skin contact (birth kangaroo care) pilot study. The peripartum personnel surveyed after the study stated that implementing early skin-to-skin contact did not take them longer nor did its implementation add to their workload.

Numerous interfering events during the maternity hospital stay can cause problems for mothers who intend to breastfeed. Events that interfere with breastfeeding may be decreased by allowing the mother and infant uninterrupted early skin-to-skin contact. Programs such as PSN’s pave the way to reestablish breastfeeding as the gold standard. One way to accomplish this seems to be facilitating uninterrupted, extended, early skin-to-skin mother–infant contact. We agree with the suggestion by Moore and Anderson that “the ideal intervention would include the mother-infant dyad experiencing skin-to-skin contact not only as early as possible, but also as often as possible, and for as long as possible each time, at least during the entire postpartum stay.” Our findings, if incorporated into hospital-based practices and protocols, can strengthen maternal–infant bonding and attachment and early exclusive breastfeeding behaviors. This is the ultimate goal, but in the interim we recommend the continuation and expansion of programs such as PSN’s early skin-to-skin mother–infant contact, nurse-driven, hospital-based intervention for a minimum of 2 hours during the first 3 hours following birth.
Email me if you'd like to read the full text.
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Thursday, December 23, 2010

A proactive approach to breastfeeding

Desiree of Hitting My Stride, 6 months pregnant with her first baby and planning to breastfeed, recently asked me this question:
Do you know if there's a way to help my chances of being able to breastfeed?  Everything I'm reading says that it's not a problem until it's a problem and there's not a lot you can do proactively.
Great question! I would argue that there is a lot you can do proactively to ensure a successful breastfeeding relationship. A proactive approach to nursing your baby covers three main elements:

1. Individual choices
2. Institutional policies & care provider actions
3. Uncontrollable circumstances

Nursing my newborn son minutes after he was born
Individual Choices
Let's look at the first element, the one you have most control over: your individual choices. These can include your knowledge about and familiarity with breastfeeding, the use or avoidance of pain medications and certain interventions during labor, and your parenting choices.

First, let's discuss knowledge and preparation. Most of us grew up and live in a culture of bottlefeeding. Often, bottlefeeding norms become deeply embedded, without us even realizing it. For example, if we are used to seeing babies drink from a bottle, we might unconsciously hold our babies and position our breasts in their mouths as if we were feeding with a bottle. Bottlefed babies are held on their backs, facing the ceiling. The bottle's nipple is centered in their mouth. Breastfed babies, however, are held stomach-to-stomach, wrapped closely around their mother. They latch onto the breast asymmetrically, placing their chins deep into the breast and taking in a large amount of the lower areola. I love Laura Keegan's illustrations of how bottlefeeding norms affect breastfeeding in her book Breastfeeding With Comfort and Joy.

Unless we have grown up surrounded by nursing mothers, we might lack essential knowledge about breastfeeding: how to get a baby latched on, how to help the baby empty the breast efficiently, normal newborn eating and sleeping patterns, and solutions or preventive remedies for common breastfeeding challenges (plugged ducts, sore nipples, etc). Books, websites, videos, lactation consultants, and breastfeeding support groups fill this role today.

As I mentioned in a Breastfeeding Carnival post about "What I didn't expect when I was expecting", when I was pregnant with my first baby, I read extensively about breastfeeding. My favorite book was Dr. Jack Newman's Ultimate Breastfeeding Book of Answers. I read the book several times and watched the videos on his website. By time I was full-term with my daughter, I knew what a good latch should look and felt like, how to position the baby properly in relation to the breast, how to identify and solve common breastfeeding problems, and when to get help for more serious issues. There are many fantastic breastfeeding resources, too many for me to list here; please refer to my top birth and breastfeeding books or browse through my book reviews.

Next, there are many choices we can make during labor and in the immediate postpartum period. Our choices about pain medications, timing of the birth (i.e., elective induction or cesarean), place of birth, and care provider can influence breastfeeding outcomes. For example, both intravenous and epidural/spinal pain medications during labor negatively affect breastfeeding rates, even among mothers who intended to breastfeed and/or who had already successfully breastfed a previous baby. The amount of skin-to-skin contact right after birth affects breastfeeding success; the more skin-to-skin, the higher the rate of exclusive breastfeeding upon hospital discharge. Breastfeeding rates are also higher in Baby-Friendly institutions; if you are lucky enough to have access to Baby-Friendly care (whether officially recognized or not), this might influence where you decide to give birth. I won't go into detail here about how various labor interventions & practices affect breastfeeding. For more information, read Linda Smith's book Impact of Birthing Practices on Breastfeeding.

Finally, there are the choices we make as we parent our babies: Do we nurse on cue? Do we feed on a strict schedule? Do we sleep close to our infants, either in the same bed or the same room? Do we use pacifiers or introduce bottles, especially in the first several weeks? Some of these choices will help establish a successful breastfeeding experience; some may negatively impact breastfeeding. Take the time to think about and research these options.

Institutional Policies & Care Provider Actions
A second element of breastfeeding success depends on institutional policies and care provider preferences. We have less control over these factors than we do our individual choices. For example, if you give birth in a hospital with a policy of routine nursery observation for healthy newborns, keeping your baby at your side may be an enormous challenge. This is where careful decision-making in the prenatal period is key--to the extent that you have choices, of course. Many of us are constrained by insurance restrictions (only X hospital is covered, not Y or Z), state regulations (whether home birth or birth centers are legally allowed), or care provider preferences (in some areas, no physicians will attend VBACs or vaginal breech births).

Labor management and postpartum routines can influence breastfeeding success. For example, going into labor spontaneously, using non-pharmaceutical pain relief during labor, and having immediate, uninterrupted skin-to-skin contact after the birth all contribute positively to breastfeeding rates. This is not to say that you will not be able to breastfeed if you have an epidural or a cesarean, just that those circumstances can lead to more breastfeeding challenges. Educate yourself about which birth practices or postpartum policies are most likely to enhance your ability to breastfeed and how to overcome challenges that may arise if certain interventions become necessary. Make wise, thoughtful choices--as much as you can given your geographical location, your financial situation, and your insurance coverage--about where and with whom you will give birth.

Uncontrollable Circumstances
Sometimes breastfeeding is challenging due to circumstances beyond our control, no matter how carefully we planned and prepared. Some of these factors might include tongue tie or cleft lip/palate, prematurity, Down's Syndrome, NICU stay, low supply due to hormonal imbalances or insufficient glandular tissue, overactive letdown, and so on. We might have a baby who just won't latch on well, despite all the right techniques! A proactive approach to breastfeeding means knowing how and where to get help if these challenges arise. For example, knowing about tongue tie might help you identify that as a potential culprit if breastfeeding is unexpectedly difficult and painful, despite doing everything right.

Before you have your baby, be sure you know who your local IBCLCs are and if insurance covers their services. Know when and where your local LLL or other breastfeeding support group meets. Ask around about breastfeeding-friendly family physicians or pediatricians, so if your baby has certain medical complications that affect breastfeeding, you'll have someone on your side. Gather together a supportive network of friends or family members who can help if you encounter breastfeeding challenges.

In sum, can you take a proactive approach to breastfeeding? Yes you can!
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Tuesday, December 21, 2010

Birth Around the World: European Court of Human Rights rules home birth legal in Hungary

From The Wall Street Journal blogs: European Court Makes Home Birth Legal in Hungary
Last year, Budapest resident Anna Ternovszky was looking forward to giving birth to her second child at home. Like elsewhere in the world, Hungarian women can be discouraged by the unfriendly sterility of hospitals and like the idea of their children arriving into a warm, welcoming home environment instead.

Ms. Ternovszky soon realized, however, that in Hungary a hospital birth was her only option as any doctor who would have assisted her with home birth risked facing criminal charges. She turned to the European Court of Human Rights in Strasbourg, which last week ruled that Hungarian women must be allowed to give birth at home if they choose to....

In its ruling, the Strasbourg court said that the Hungarian state was violating the right to respect private life guaranteed by the European Convention on Human Rights. This right encompasses the right to choose the circumstances of giving birth, the court said.

A basic human right in the rest of central and eastern Europe, home birth is thus getting the green light in Hungary. Hungarian legislation seems to be catching up: the Ministry of National Resources — and the state secretary responsible for health issues within the ministry — prepared and published Monday a long-awaited set of draft regulations for births outside health institutions.
From the Hungarian Civil Liberties Union: Victory in Strasbourg for the cause of home birth!
Today, the European Court of Human Rights in Strasbourg handed down a judgment in which it holds that the Hungarian state has violated the “right to respect for private life” guaranteed by the European Convention on Human Rights.

Exactly one year ago today, a pregnant Hungarian woman applied to the European Court of Human Rights. In her claim, the complainant alleged that the Hungarian state had violated her right to the respect of her private life by threatening midwives with sanctions and thus effectively preventing her from choosing to give birth at home. The complainant was represented by the HCLU’s attorney, Dr. Tamás Fazekas.

In its decision announced on 14 December 2010, the Court, in a decision of 6 against 1, held that the failure of the Hungarian state to regulate the issue results in a violation of the right to privacy guaranteed by Article 8 of the European Convention on Human Rights. A joint concurring judgment was submitted by Judges Sajó and Tulkens, while Judge Popovic wrote a dissenting opinion.

(1) The Court held that the right to respect for private life includes the right to choose the circumstances of birth.

(2) The Judges argued that the section of the Government Decree that imposes fines on midwives assisting at home births constitutes an interference in the exercise of the rights of the complainant and of similarly situated pregnant mothers.

(3) According to the Court’s opinion, the threat of sanctions – along with the absence of a specialised, comprehensive regulation in this area – are detrimental to the complainant’s ability to choose home birth. This in turn constitutes a violation of the legal security for the exercise of privacy rights, and in particular, violates the principle of legal certainty.

“We find this judgment to be very important”, stated Dr. Tamás Fazekas, attorney for HCLU, “because this means that, so long as Hungary fails to enact legislation regulating home birth, and so long as professionals assisting at out-of-institution births are unable to obtain a license for their work, Hungary is in violation of the European Convention on Human Rights”.
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Monday, December 20, 2010

Bathroom renovation: before & tearout pictures

Before pictures:
We had a very small full bathroom between the two downstairs bedroom. Each bedroom door opened into this hallway; the door to the bathroom is on the right.
The 2 doors on the left are for a linen cupboard & a second door to our walk-in closet.
The bathroom was really cramped--you had to squeeze in between the shower & sink to get to the toilet. 
Renovation plans: I love drawing up plans and rearranging walls & fixtures...we actually won't have the wall bump-out shown in the plans. When we tore out the wall behind the sink, we discovered it was a double width (double-framed) wall; we left the original thickness where the jacuzzi goes, but bumped the wall out to a single thickness to make more room for the new sink.

Before
After
The main changes entail:
  • turning the hallway & bathroom into one big room by removing the wall between the two
  • moving the ceiling joists up from 8' to the original 10' (for some reason, the bathroom had been built with lower ceilings than the rest of the house)
  • putting a shower into part of our walk-in closet--we lose some closet space, but it's definitely worth it. 
  • adding an extra-long, extra-wide jacuzzi tub
Day 4 pictures:
We've completed the tear-out, run most of the new wiring, opened up the closet for the new shower, raised the ceiling joists, and torn out a section of rotted sub-floor. It might look super scary, but if you've done renovations, you know how to look past it and envision the final product.

View into what used to be the hallway. We've removed the second door to the walk-in closet to make room for the shower
Looking inside the closet from the other door in our bedroom, you can see the framing for the shower enclosure
Standing inside the new shower area, looking toward the window. The toilet used to be where the piece of pink insulation is sitting. You can see where the old ceiling ended right above the window.
Standing by the window, looking toward the new shower. 
After tearout. We'll Freecycle anything useble and dispose of the rest.
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Saturday, December 18, 2010

Christmas sling giveaway winners

The Wizzle and navagating are the lucky winners! Please email me your preferred sling length (I have one M and one L) and your mailing address.
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Thursday, December 16, 2010

Birth Around the World: A Tale of Two Births in Canada

Joanne is a software engineer in Ontario, Canada. Her first child was born in 2007 at Kitchener Ontario's Grand River Hospital, which sees about 4,000 births per year. She chose a midwife-attended homebirth in 2010. This post is lengthy, but it’s really two birth stories in one! It shows two contrasting styles of maternity care available in present-day Canada.

When I became pregnant with my first child in 2007, I had no reasons to distrust the latest technology and knowledge of the Western medical establishment. My family doctor referred me to an obstetrician, who are in short supply in my area, so I “got who I got.” My pregnancy was highly normal and my care was fine (sparse but sufficient) up until the time my due date came and passed, and I waited... waited... waited to go into labour. My OB scheduled me for an induction at +10 days (a Friday--coincidence?) without discussion. I was worried about how I’d be able to handle an induced labour and thus mentally felt increasingly desperate as the fateful day approached.

The night before, I awoke with increasingly strong and regular contractions which I was pretty sure was finally it. When I arrived at hospital the next morning on schedule, the nurses confirmed I was 4 cm dilated and cleared me for continuing since I was in labour already. At noon my OB showed up and was quite annoyed with the nurses (and me) for not following his induction orders.

"We've got to get this baby out now."

"Why?"

"Because it's been long enough."

"I'm concerned about the pain with Pitocin contractions."

"It's called LABOUR for a reason; it's going to be painful. Look, you don't have to do it but I highly recommend it."

Seeing as I was contracting strongly, in pain, I wasn't expecting this, and I didn't have experience going against my primary care provider, I reluctantly agreed to let him break my water and start the Pitocin drip. Of course then I required continuous fetal monitoring, which made every little movement quite an event. The contractions quickly grew stronger, stronger, and more painful. I lasted another 4 hours and with such pain, the tension in my body hadn't actually let me progress past 4 cm. Discouraged, I agreed to an epidural. Admittedly it was a tremendous relief and I wanted to hug the anesthesiologist. Now that I could relax some, I actually progressed to 10 cm in a couple of hours. I also found out something I didn't know about epidurals--i.e. they don't provide total pain relief, at least not for me. Much of the time I could feel most of one side of my body, and the nurse would regularly have to call for permission to top it up.

Naturally I was confined to the bed, so I couldn't move around to deal with the pain. So pushing HURT. I was a good pusher and the baby descended steadily. At some point, the head nurse came in to say "she's got to stop pushing." It turns out (since it was now Friday evening) there was only one OB on the floor and she was busy performing an emergency C-section. And of course, my baby couldn't be born without a doc present. So they turned the Pitocin and lights off and rolled me on my side. What utter agony--I thought my body was going to push out the baby whether we were ready or not!!

There was some meconium in the fluid by this point (likely from the stress) although we could "hear" on the fetal monitor that baby's heartbeat was still reacting well. I was whimpering and at this point my partner secretly believed I was headed for a C-section too. He whispered to me "think of the other family" and I tried to. But eventually the OB and staff appeared, and another 2 pushes, and Alice was out. What relief--I simply cried tears of joy and relief.

The pediatrics team pumped the meconium out of baby’s stomach and luckily she was fine to stay in the room with me. So, in the end, despite all the "help" from the medical establishment, my body did what it was supposed to and I pushed my baby out. Looking back now, I realize I was probably lucky: this combination of Pitocin, epidural, and baby-stress can doom many a woman to an unwanted C-section.

I learned a few more things. I bled heavily after this birth and became anemic.... I learned later this can be a side effect of all the interventions. My tear/episiotomy site became infected, and I can’t rule out the possibility that the cause was from being in a hospital. But: my birth went well, didn't it? I had a healthy 8 lb. 10 oz. baby, delivered vaginally, no NICU visit, and all the nurses were really nice and helpful with breastfeeding. So, I should be satisfied, right? Right?? I had myself convinced for a while.

When I became pregnant with my second child I knew I wanted to try something different for care, so I called a local office of registered midwives. At first, I assumed I would go to the hospital again for delivery because that was just what people did. After processing some of the materials in the lending library, to our surprise, my partner and I independently came to the conclusion that we wanted to try a homebirth. Some of the stories about actively-managed labour with OBs in a hospital setting were simply eye-opening--this is exactly what had happened to us!! I don't know if we would have believed them had we not gone through the experience, but we had. So all of a sudden we were committed to a different kind of birth.

homebirth by reading what natural childbirth subjectively feels like. All these stories, including Rixa’s own birth stories, helped me overcome the knowledge deficit and gain confidence in my body's own ability to give birth naturally. I drank these up in my quest to "reverse" society's notion that childbirth is necessarily a medical event to be managed medically.

So, my second due date came and went with no baby in sight. Even with a midwife supportive of natural birth at home, her guidelines dictate repeated non-stress tests and ultrasounds to check on an overdue baby, as well as a "plan" for what would happen should two weeks past due date come and go. I was starting to feel increasingly desperate again as I saw my dream for a simple homebirth, at risk.

But, eventually at +10 days (again) those pesky prodromal labour contractions finally (finally!) became strong and regular enough to push out my baby. I laboured quietly at night in my bed from 2:00-6:00 a.m. which was nice actually--I could relax sleepily between contractions, which I knew was important for dilation. It was just so great knowing I didn't have to deal with going anywhere. By 6:00 am contractions were too difficult to lay through so I woke up my partner and told him it was time to call our midwife. She took her time getting ready and arrived at 8:30 am to find me 6-7 cm dilated ("and your body did it all on its own," she encouraged me). I was anxiously awaiting her arrival so I could get in the bath tub, post cervix check, for a change of pace.

I laboured alone as the others got the bed ready and brought in all the midwife's equipment. I got on all fours for each contraction (couldn't have done that in the hospital!) and actually found a semi-sitting position that was comfortable for relaxing in between. (I found that was key for me in both labours--I felt a lot of pain in between contractions if I couldn't find a good resting position, and those were elusive.)

I was off in labourland when Nicole came rushing in with "do you feel like you need to push?" Apparently my vocalizations had changed to what they often sound like when the baby is descending during second stage. It was all involuntary, which was awesome--my body was doing it all and I was just along for the ride!! My water spontaneously broke with thankfully only a bit of vernix to see. After 2-3 pushes on my hands and knees (still in the tub--not my midwife's idea of a convenient position but I wasn't willing to move anywhere!), Claire was born, nuchal hand and all. Finally I understood what I had read about it being a relief to push--on my hands and knees, it did feel better to push, almost like applying counterpressure to the contraction. (This was a definite contrast from being confined on my back in the hospital.) I didn't feel a ring of fire or any tearing, although I did receive a second-degree tear again. In fact, comparing the two births, I would say the pain levels were similar, although the first one was with an epidural and the second was obviously much shorter in duration.

It was 9:30 a.m. by this point--all the birthing and emergency equipment was barely in from the car and the backup midwives hadn't even had time to arrive yet. The tub had had to be drained (since it wasn't deep enough for a water birth, unplanned anyway) so I knelt on the floor of the empty wet tub, clutching my slippery newborn. I couldn't believe it had really happened!! A birth at home, just the way we had planned. I cut the cord myself.

Out of the tub and back to the bed for the delivery of the placenta, stitches, and initiating breastfeeding. Another healthy girl, 8 lbs 11 oz. So THAT is what birth is supposed to be like! What a privilege to have been able to experience a safe, natural childbirth at home. This is an experience I would wish for more women. It was so perfect and meaningful and to this day it’s still hard to believe it actually happened all the way we planned!! It was an empowering achievement in the way that my first birth, amazing in its own way since it was my first, just wasn't.

So yes, I join the ranks of moms who had one undesirable hospital birth experience and, as a result, experienced a beautiful homebirth subsequently. 2-5+ years ago, I would have never believed I’d be one of these women!! I try to not be judgmental of other people's birth choices, but now I encourage others to at least call a midwife early in their pregnancy to give themselves some birth choices. I remember my grad school supervisor telling me that if you knew at the beginning what you had learned by the end, it wouldn’t have been a learning and growing journey.... It’s not an end by any means, but the beginning to parenting my two girls!
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Wednesday, December 15, 2010

Pregnancy update: 30 weeks

We're starting our bathroom renovation tomorrow, so I wanted to get this written before the craziness beings. My dad drove over from Minnesota today. He's the best--willing to take a week off work and travel a long distance to help us redo our bathroom.

I'm still mulling over the prenatal Rhogam and blood sugar issues I wrote about last week. I've tweaked my nutrition--adopting a gestation diabetes-type diet (more proteins, fewer & higher quality carbs, etc)--and added additional light exercise in the evenings. Sometimes I walk at the indoor track, sometimes I vacuum or mop floors. I am going to have the world's cleanest floors this pregnancy!

My body has responded nicely to these adjustments, with 2-hour PP levels under 110. The only thing still an issue--assuming the glucometer is accurately calibrated--are my fasting levels, which are around 105-110. I checked once in the middle of the night to see if I was dipping and then spiking, but my 2 am reading was ~104. I am going back and forth between two options:

1) Test the glucometer for accuracy and track my fasting levels for a week. If they're still consistently at the same levels, I would attend a nutritional class at a large hospital an hour away. The class is supposed to be really good--it's run by a diabetes center and the people are really knowledgeable about helping you with nutrition & exercise. On the other hand, this would entail a lot of hassle (finding childcare for the class, traveling to & from, testing blood sugars multiple times a day). And I don't relish all the mental energy this would take.

2) Continue with my same nutrition & exercise modifications and stop fretting. The blood sugar question has been on my mind almost constantly. I feel super conflicted about what I should do, how much I should worry about it, and whether or not it's really a problem in my case. I don't like the stress that this has added. I was re-reading an article on gestational diabetes by Michel Odent last night, and I can attest to the power of the nocebo effect. I definitely have a lot more empathy for women facing various choices & health challenges during pregnancy. It's so much harder to make these decisions in reality than in theory!

It's about time to start listening to Hypnobabies. I liked both Hypnobabies & Hypnobirthing for their calming effect during pregnancy. It's a great way to end the day. Usually I fall asleep listening and wake up at the end of the track, which indicates that at least my subconscious is paying attention. Right?

I finished Dio's birth quilt! Pictures coming soon...I did all of the quilting by machine. Most was straight stitching with a walking foot. Then I did some freehand stippling on the squares that needed a more organic look. Now I'm ready to start on the next birth quilt. I gave fabric pieces to several friends & family members. Remember to get them back to me ASAP--you know who you are! If anyone else would like to contribute a square, especially those of you who helped out with Dio's quilt, send me an email. I have enough fabric scraps for a few more squares.

For the next few weeks, my life will be filled with hammer drills and prybars, plaster dust and vermiculite, tiling and drywall. And at the end of that time, I should have a beautiful new bathroom with a large Jacuzzi tub to soak in. And maybe give birth in...
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Tuesday, December 14, 2010

Christmas sling giveaway!

I am giving away two pink & green polyester jacquard slings, one size M and one size L. The pink & green threads are interwoven, giving the fabric a shimmery appearance. On the tail, you see the reverse pattern (green on pink background).

Contest rules:
Open to residents of US or Canada
Giveaway ends Friday, December 17 at midnight EST

How to enter (one comment per entry, please)
Entry #1: Tell me how long you've been reading and how you first found my blog
Entry #2: Link to this giveaway and share the link here
Entry #3: Add a Stand and Deliver button to your blog or website
Entry #4: Add a Second Womb Slings button to your blog or website
Entry #5: If you aren't already, follow my blog (via RSS feed, Google follower, Facebook fan, etc).

Stand and Deliver button code:
<a href="http://rixarixa.blogspot.com"target="_blank"><img src="https://dl.getdropbox.com/u/238755/blog-square-words-150x150.jpg" /></a>

Second Womb Slings button code:
<a href="http://www.secondwomb.com"target="_blank"><img src="http://2.bp.blogspot.com/_PttOM1y19hs/TNtDUQoQ4OI/AAAAAAAAEjI/K6Au96cZUYQ/s1600/second+womb.jpg" /></a>
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Sunday, December 12, 2010

Don't ask, just do

How often do we give authority to other people when it rightfully belongs to us? 

My friend--the one who had a cesarean for her second baby (breech) and whose third baby was breech until a successful ECV--had her third baby several weeks ago. It was a precipitous labor, and she made it to the hospital just minutes before her baby was born. I was hoping to drive out for the birth, but when she called me in the middle of the night with contractions that were 1-2 minutes apart, I knew there was no way I'd make the 3-hour drive before her baby was born.

She told me me her story later on that day, and a few things jumped out at me. Once she made it to the birth room, the nurse said, "now let's get you on the monitor." She said, "no way!" and went to the bathroom, where her water broke with a dramatic gush . She started feeling really pushy, so she headed back into the room. The nurse said, "let's get you on the bed." She said, "no way I'm lying down!" Instead, she grabbed a Chux pad, knelt on the floor next to the bed, and pushed her baby out a few minutes later.

I was present when she had her second (breech) baby. She went into labor when the one OB who did vaginal breeches was out of town, so she knew she was heading for a cesarean. She labored for several hours at the hospital before consenting to the surgery. During that time, if she didn't want to be on the monitors, she'd simply unplug herself and march into the bathroom. When she was done laboring in the bathroom, she'd go plug herself back in, standing up and swaying next to the bed. She didn't ask permission to get off the monitors--she just did it. Because of her "I know what I'm doing; don't mess with me!" attitude, the nurses didn't bother her. 

This is the same woman who, during her first birth, gave birth kneeling. It was the first time her OB had ever seen an upright birth. My friend had tried to lie down as requested but found it impossibly painful, so she got up on her knees and stayed there. She would have preferred to give birth standing up, but knelt as a concession to the OB, who was nonplussed enough as it was with my friend's unconventional birth position.

How many times have we read stories where laboring women weren't "allowed" to get out of bed, where the nurses wouldn't "let" them get off the monitors, or where the doctor said they "had" to lie down to push and couldn't change positions? This has happened to many, many people I know both personally and through my blog.

I don't want to minimize the enormous power institutional and medical authority have over laboring women. Nor am I implying that it was a failure of the individual laboring woman when she was told she couldn't do X or Y. Not at all.

But...

What if we simply stopped asking permission? What if we simply did what we wanted to? What if the mantra of laboring women became "don't ask, just do"?

Don't ask if you can eat or drink. Just do it. Don't ask if you can get out of bed or walk around or go to the bathroom. Don't ask if you can change positions or give birth kneeling or squatting. Just do it.

Do it with confidence. Do it with an "I know what I'm doing, and please don't mess with me!" attitude.

Just do it.

Let's join Dr. Michelle Harrison's vision of a new womanly revolution, from her book A Woman in Residence:

I used to have fantasies at Doctors Hospital about women in a state of revolution. I saw them getting up out of their beds and refusing the knife, refusing to be tied down, refusing to submit – whether they are in childbirth or when they were forty and having a hysterectomy for a uterus no longer considered useful. Women’s health care will not improve until women reject the present system and begin instead to develop less destructive means of creating and maintaining a state of wellness.
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Friday, December 10, 2010

Reminder

Today is the last day for free shipping to the US or Canada at Second Womb Slings. Don't procrastinate any longer!
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Thursday, December 09, 2010

AHRQ invites public input on reducing cesarean sections

A message from Susan Hodges of Citizens for Midwifery:

~~~~~

Effective Health Care Program Update: 
New Draft Key Questions and a Draft Review Are Now Available for Comment

Dear Friends,

The federal Agency for Healthcare Research and Quality (AHRQ) is preparing a review document about “interventions” that are effective in reducing cesarean sections, and all of us have a chance to give input!

ARHQ has drafted 4 key questions for members of the public to answer on-line, plus you can also upload a document.

Scroll down below the questions to read the draft review (not too long). This will help you to see where they are starting from. For example, the word “intervention” is really used to denote any action (or non-action) that is being studied for its effect on reducing cesarean rates, even if you don’t normally think of it as an intervention. Also, it is apparent that routine hospital practices (that we know can interfere with labor) aren’t really mentioned in the list of “interventions”…

NOTE: The deadline for comments is December 29!

Wonderful that AHRQ is looking seriously at the topic of how to reduce the cesarean section rate, and that they are inviting comments from the public! I would encourage you to be respectful and informative in your comments, so that they are helpful and useful for the purpose of this review.

Please feel free to pass this on to other relevant lists you may be on!

Sincerely,
Susan Hodges
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Wednesday, December 08, 2010

Birth Around the World: Training Medics in Burma

One of the midwife blogs I follow is Missionary Midwife Mama. She lives in Thailand and is a mother of four. She occasionally travels to other parts of the world doing midwifery training & clinicals. She recently came back from training medics in Burma. Here is her account:
I was able to teach for about 4 days. We started out by taking a survey of all the local birth practices and labeled them as "helpful" "harmless" or "harmful." I learned so much about this that I am considering writing an article about it for Midwifery Today. The next classes were about taking a prenatal history, doing a basic prenatal exam, the stages of labor, hemorrhage, breast exam, breastfeeding (importance of colostrum; not how, but dealing with mastitis, etc.), fertility awareness method (some access to condoms but not much else), and cord burning.

There were 2 main things that I emphasized through out. First, that what I was teaching was practical for attending births in the jungle. They had been taught some about birth already but so much of it was over-medicalized and appropriate only for hospital. For example, how can someone go in and teach about a "managed 3rd stage" when there is NO PITOCIN AVAILABLE. Or how can someone teach about cutting a cord when there is NOTHING CLEAN to cut it with?? I know these medics will be getting all kinds of information, a lot not evidence-based, and not practical for birthing. Hopefully what I taught will make them think and know that they have other options. Dealing with hemorrhage with only having been taught what to do using pharmaceuticals is dangerous... they needed other options, which I gave.

The second thing I emphasized was working with TBAs (Traditional Birth Attendants). I started by asking a question: "who knows more about birth? TBAs or medics?" They all answered: MEDICS. And so I said, "Oh really? If you have seen 5 births, and a TBA has seen 200 births, who knows more about birth?" Lightbulb moments for all of them, and this opened up a discussion. The medics cannot be at every birth all over their area of northern B-Land. TBAs will continue to be the main source of birth attendants. By working together, they can teach each other. The medics can learn more about normal birth and complications from TBAs while the TBAs can learn about some complications and sanitary birth from the medics.
You can read more on her original post Beautiful B...urm...a. She has several pictures up there as well. I'll just share the best one--a wooden delivery table. Doesn't that look comfy? She wrote about the picture: "The ... birth... bed.... (we had long discussions about this one and we all agreed the floor with a clean mat was a way better option!)"
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Tuesday, December 07, 2010

Elective induction, patient choice, and physician preference

The CNM I am seeing recently wrote about how both patient choice and physician preference play into elective inductions. While she was doing her CNM clinicals a few years ago, she worked at a small community hospital that had two obstetricians (now there are four). At the time, it was common practice to do elective inductions at 37 or 38 weeks.
While working at Witham Hospital, I became well aware of how good physicians can obtain bad reputations from the natural birth community simply based on their induction rate. At the time, Dr. Winkler and Dr. McCarty were the two obstetrical providers in the practice and both held stern ground in not inducing labor without a genuine medical indication prior to 39 weeks. However, once reaching 39 weeks, most all moms were lining up for their induction, leading to a fairly high induction rate by World Health Organization standards.

It is quite common in obstetrical units for nurses to triage phone calls of clients sharing concerns that are nothing more than normal discomforts of pregnancy, yet they aren't seeking reassurance that their pregnancy is healthy and normal, but instead the perfect complaint that will justify an early end to their miserable pregnancy.

I distinctly remember being told by a pregnant mother that if the on-call physician did not induce her labor (at 37 weeks), then she would be happy to take her business elsewhere. The truth was she could go to any other local hospital and her wish would be granted. These two doctors declined her request and risked losing her as a client. They refused to put her baby and herself at risk, for the sake of her own convenience.

Not one of these physician's peers would fault them for inducing women earlier. They all did it in their own practice. Women want early inductions, and we're all about women's rights. However, they would have failed to withhold the oath, "do no harm." These physicians stood firm in the face of persecution and I was quite impressed.

Around the same time, one of the physicians discontinued his routine practice of artificially rupturing the amniotic sac in elective inductions. This would otherwise commit the client to birth, or more specifically, cesarean section because too often mom or baby simply wasn't ready. If the attempt to induce failed, this physician was comfortable telling mom after a day or two's effort to induce, "Sorry, we need to discharge you home as your induction was not successful. We can reschedule you in a few days." The nurses gave this physician a round of applause and many of us began to choose him as our own provider.
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Monday, December 06, 2010

Decisions...

I have two decisions I'm mulling over right now.

#1: prenatal RhoGAM. I am Rh- and have had the RhoGAM shot after both babies, although I chose not to have the 28-week shot. I'm one day shy of 29 weeks and need to make up my mind ASAP about the prenatal shot. I've read pretty much all there is to read and still feel undecided. My mother became sensitized some time before or during her fifth (and hence last) pregnancy, so there is a small but real risk with sensitization. My brother was induced at 37 weeks and was fine, except for being quite jaundiced. But the increasing risks of pregnancies after sensitization made her decide to stop having children at that point.

On the other hand, I am concerned the risks with the prenatal shot. I'm adding risks to my current baby, in the hopes of benefiting a hypothetical future baby. I'm fine taking the postpartum shot; the evidence is a lot clearer, the benefits are more substantial, and any possible risks fall on me alone.

#2: High-ish blood sugars and GTT. A few days ago, I tested my blood sugars over the course of 24 hours. They came back higher than we'd like to see...which makes me wonder if I should do the 3-hour GTT and see what's really going on. Here are the numbers (possibly complicated by the fact that I got a really high reading once immediately after swabbing with an alcohol wipe. 10 seconds later, it was 100 points lower once the alcohol had evaporated. I did use alcohol wipes before all of my tests. If I do any more finger sticks, I'll forgo the wipes and just wash with water):
am fasting: 121
2 hours after breakfast: 98
2 hours after brunch: 131
2 hours after dinner: 140
next am fasting: 105
If my sugars really are wonky this pregnancy, I'm more than fine with modifying my diet, etc to keep them in line. My midwife said that often just rearranging what you eat & when can make a huge difference, especially for women like me who already eat well (lots of fruits & vegetables, complex carbs, & proteins, little if any simple carbs or processed foods). At my prenatal appointment today, she gave me the drinks & blood sugar testing equipment for doing the 1-hour or 3-hour GTTs. It's up to me if I want to test, if I want to do nothing further, or if I want to go ahead and do some dietary modifications without further testing. If I decide to test and come back with not-so-good results, there's a GD class at a large tertiary hospital that my midwife said is excellent.

My biggest concern with testing is ingesting such a huge amount of glucose. Yuck-o.
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Saturday, December 04, 2010

Sprout Change Giveaway Winner...

...entry #19, "Jen." Congrats and thanks to everyone for entering!
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Friday, December 03, 2010

Physician/midwife recommendations in central Illinois

A blog reader recently asked me for physician/midwife recommendations for a friend in central Illinois:
A friend of mine who lives in central Illinois (Shelbyville, about an hour from Springfield and an hour from Champagne) recently learned she is pregnant, and she's hoping for a "natural" birth. I don't know that she has a really specific idea of what she wants or is necessarily interested in home birth, though I don't think she's ruled that out either. In my experience, it seems more important to get the right provider than to have the right birth plan. I was wondering if you'd happen to know a "Dr. Wonderful" or any midwives in central IL.
I gave her a few suggestions (talk with local doulas, ask around at birth/mothering forums, etc). I'd also recommend visiting The Birth Survey.

Can anyone recommend specific providers in the Shelbyville IL area? If so, leave it in a comment or send me an email. Thanks!
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Wednesday, December 01, 2010

Feminism & Mormonism: A Conversation with Kathryn Soper

We're having a great conversation over at Patheos about Mormonism & Feminism. On the heels of Kathryn Soper's essay As Sisters in Zion: Mormon Feminism and Sisterhood, several people were invited to submit short-essay responses. I've included mine below. (Not surprisingly, I couldn't resist mentioning birth & breastfeeding.)

Come join the discussions!


~~~~~

by Rixa Freeze

Woman #1: Married at age 20, she is the mother of two young children and pregnant with her third baby. She is a wife and stay-at-home mother. She breastfed her children through toddlerhood and beyond, often nursing one baby while pregnant with the next. She sews baby slings as a side job and enjoys cooking and gardening. Her husband works full-time while she is home with the children, so most of the household responsibilities (meal planning, shopping, cooking, cleaning, laundry) fall to her unless she specifically requests help. In her free time, she blogs about pregnancy, birth, and mothering.

Woman #2: A scholar and musician, she studied violin from age 5 and planned a career in music until an overuse injury made her change paths. She was accepted into Harvard, Princeton, and other undergraduate schools with full tuition scholarships and won presidential fellowships for both her master's and Ph.D. programs. During her graduate student years, she and her husband -- a fellow Ph.D. student -- renovated a historic Victorian house, doing almost all the work themselves. They also worked for nine summers in France directing study abroad programs. She does the family's finances and tax returns. She continues to conduct research, publish, and attend conferences.

Which of these women is a feminist? And which is a faithful Latter-day Saint?

You might be surprised to know that woman #1 is a feminist and is married to a man who considers himself a feminist. You might also be surprised to learn that woman #2 is a life-long, faithful member of the [LDS] Church who is passionate about motherhood, childbirth, and breastfeeding.

You'd probably be most surprised to learn that woman #1 and woman #2 are the same person:

Me.

I've never fit any of the typecasts that come with being an LDS woman and mother, with being a feminist, or with pursing advanced education. In academic settings, my husband's colleagues shy away from my (increasingly visible) role as mother and seem relieved when we turn the conversation to my scholarship. At church, my multiple degrees and later entry into motherhood (at the old age of 28!) make me the odd woman out at times.

But I like these contradictions. I like living with one foot in both worlds. In fact, I don't see these two "women" as living separate or conflicting roles. And thanks to the efforts of my feminist foremothers, I have the freedom to choose my life's path -- or rather, paths.

I love that my academic interests and my commitment to mothering mesh together seamlessly. My main areas of graduate study were childbirth, maternity care, and breastfeeding. At the same time, I was actively involved in these fields outside of school as a doula, as a home birth midwife's assistant, and then as a childbearing and lactating woman.

Like the two "women" who comprise myself, my childbearing experiences could be seen as both ultra-traditional or ultra-radical. I gave birth to my first child at home unassisted, with no midwife or doctor present. My second child was born again at home, this time with a nurse-midwife in the background. I experienced the empowerment of stepping outside the medical system to have a baby -- no arbitrary rules or timelines, no one telling me what I could or could not do, the freedom and autonomy to follow my body's inner wisdom.

Kathryn Soper's comment resonated strongly with me: "It's a good time to stop worrying so much about who's a feminist and who's not, and instead focus on how women who care about gender issues can better cooperate by emphasizing similarities and respecting differences." I have found a remarkable degree of cooperation among those dedicated to supporting freedom of choice in childbearing -- freedom to birth at home (or any place of women's choosing), freedom from coercion or manipulation during prenatal care and childbirth, and freedom to breastfeed anytime, anywhere without harassment. Conservative Christian moms, lesbian moms, working moms and stay-at-home moms -- even Democratic and Republican legislators -- have united to protect the rights of pregnant & breastfeeding women.

Giving birth and nurturing my children at the breast are the most empowering, fulfilling, and radically transformative acts I have ever engaged in. It doesn't really matter whether these choices are feminist or traditional, conservative or radical. What matters is that I could choose.

For more responses to Kathryn Soper's As Sisters in Zion, click here.
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Tuesday, November 30, 2010

Pregnancy update: 28 weeks

I haven't taken any belly shots since I was 20 weeks along. Today I rigged up an elaborate tower with the camera on top and asked Zari to push the button.
Here's me 28 weeks with Dio...
27 weeks with Zari:
30 weeks with Zari:
How much bigger will I get this time???

This pregnancy's theme is "get things done." I've nearly finished Dio's birth quilt. I machine quilted most of the squares; the rest will need hand quilting because of the designs. I definitely plan to have it finished and hanging up before the next baby comes.

We've also decided to entirely renovate our downstairs bathroom. Demolition begins in mid-December, and we HAVE to get it finished quickly. A) because I have to pee in the middle of the night and it's a long, long trek all the way across the house and up a very steep staircase to our other bathroom, and B) because, after all, I'm having a baby in February and won't be able to work on it after the baby is born. I'm really excited about the renovation. Right now it's a cramped, poorly designed room with ugly, cheap fixtures and no tub at all, just a shower. I drew up plans that make a much larger, open space with an oversize whirlpool tub plus a shower, sink, and toilet and higher ceilings (our bathroom's ceilings were dropped to 8', but they could go back up to the original 10' height). All without moving any walls, except for a small bumpout into our master bedroom for the sink. I bought a jacuzzi tub on Craiglist (exactly the size & style I was looking for, 72"x42") for $100, including a nice faucet. Because we saved so much on the tub, we decided to hire a plumber to help us get the bathroom done faster. We'll do everything else ourselves, with some help from my dad.

I read a lot of pregnancy/birth/breastfeeding books during my other pregnancies, but this time around I haven't read any, except ones I'm reviewing. I have practically memorized all of the birth books I own, so it's just not as interesting reading them again for the fourth or fifth time.

I've been leaving this baby alone more than my other pregnancies. (Or should I say neglecting?) Because I had such a hard time locating heart tones earlier on, I stopped trying for a while. Two days ago, I listened again and found the heartbeat quickly and easily. I guess the baby is big enough now that it can't hide any longer! I'm not going to worry about the baby's position until at least 34 weeks or later; I had too much self-inflicted stress when I was pregnant with Dio over whether he was breech or transverse.

I had about 2 months of fairly decent sleep, but now my hips are starting to ache more and more at night. It's not the pelvis or joints, just a muscle/pressure point ache on the outside of my hip/leg from sleeping on my side. The last few hours of sleep are really fitful, because both sides ache equally bad by that point and I can only stay on one side for a few minutes at a time. What I really need is a mattress or mattress topper with a bowl-shaped hole right where my hips go...I've seen inflatable maternity mattresses that do this, but never anything designed for a real bed.

I'm just reaching that threshhold where, instead of the birth seeming far off in the future, it's coming up almost too quickly. Am I ready for another baby? Another labor and birth?
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Friday, November 26, 2010

Sprout Change giveaway!

I am excited to host a giveaway from a Sprout Change cloth diaper! If you're new to my blog, you can review review of the diaper here. The winner will receive:
  • a Sprout Change shell in the color combination of her choice, AND
  • an insert of her choice: organic hemp/cotton fleece topped with organic cotton fleece OR microfiber topped with wicking microfleece
To enter (new comment per entry, please)
  • Entry #1: Leave a comment with your favorite color combination & insert
  • Entry #2: Follow The Willow Store on Facebook, Twitter, or blogger
  • Entry #3: Mention my Sprout Change review and this giveaway on a blog, website, Facebook, Twitter or discussion forum. Please include the link in your comment.
Giveaway rules:
Contest open to residents of US or Canada
Giveaway ends Friday, December 3, 2010

Happy cloth diapering!
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Wednesday, November 24, 2010

Sprout Change cloth diaper review

A month ago, I contacted the Willow Store to see if I could review their Sprout Change diapers. I first heard about them at Baby Makin(g) Machine and was intrigued. A fluffy package soon arrived in the mail!

So what exactly is a Sprout Change cloth diaper? I've heard it called an all-in-two system or a hybrid diaper combining the best of AIOs, pockets, and covers. I would describe it as a cover + absorbent inside...but unlike any other cover system.

One of my favorite features of the Sprout Change diaper is that the cover or "shell" is fully reversible. You get two colors for the price of one! My diaper was a BlueBerry: medium blue on one side and aqua on the other. There are 12 different color combinations, from chili pepper (fiery red/olive green) to sweet corn (sage green/pale yellow) to grapefruit (lavender/pale pink). As with all diaper covers, you can re-use them multiple times and just change the wet insert. Once the diaper is soiled, you change both the cover and insert.

The diaper shell is made of 2 layers of PUL (polyurethane laminate, the waterproof, breathable fabric used in most cloth diapers). To keep the diaper from trapping water between the two layers during a wash cycle, there is a small opening left unstitched in the front. This allows excess water to exit the diaper when the washing machine begins to spin.

Another great feature is that the Sprout Change system is one-size-fits-all, from 5-40 lbs. How does this work? The legs and waist both have buttonhole elastic that cinches as tight or as loose as you need it. At the edge of each snap tab, there's a small access pocket. You simply open it up, pull the elastic to the right length, and fasten it to the hidden button. Tuck the extra elastic back inside and you're done! You'll probably need to adjust the diaper 3-4 times from your baby's birth until she is potty trained.

I wasn't able to try out the diaper on a real newborn; I'll have to wait for a few more months for that! But it fit Dio quite well right out of the package.

So now onto the inside of the diaper. You can buy a huge variety of absorbent insides: one-size serged inserts, one-size organic hemp "insides" that fold either horizontally or vertically to fit any size baby, traditional organic hemp sized prefolds, and more. You can also buy Soft Sleeves that you insert other absorbent insides into--great for re-using really worn, but still functional, prefolds.

My Sprout Change Shell v2 came with an organic cotton fleece Super Saver insert: several layers or organic cotton/hemp fleece, topped with a layer of organic cotton fleece. It's really absorbent--great for holding lots of moisture, but definitely the longest to dry in my entire diaper stash. For faster drying, you could choose the microfiber/microfleece Super Saver insert. This insert mimics the feel & function of a stay-dry pocket diaper, since the microfleece wicks moisture away into the microfiber layer.

You can also buy just the shells and use your own inserts or prefolds.

My only critique is that the diaper is sewn with white thread, rather than matching thread on each side. This reveals even the slightest imperfections in stitching.

I lent the diaper to a friend who has cloth diapered her 18-month-old since birth. She has used a wide range of diaper brands and systems. She really liked the Sprout Change as well. Her only suggestion for improvement would be adding snap-in liners; she's used to those and almost tossed the insert into the toilet when she was shaking off the soiled diaper!

I also tested the Sprout Change shell and insert several times (plus more of my own inserts, since you can re-use the shell several times until it gets soiled). I had no problems with any leaks, even when I double stuffed and put it on for overnight. The shell dries very quickly while, as I mentioned earlier, the organic insert takes a while to dry. Using a foldable insert (either the one-size inside or the prefold) would cut down on drying time.

Because the Sprout Change shell fits any size baby or toddler, you only need to buy 6-8 shells, plus 24-36 insides, for a lifetime of cloth diapering. The upfront cost of cloth diapering can turn many parents away, especially if they have to buy 24 diapers in 3 or more sizes. With the Sprout Change system, your initial investment is much more modest, and there's nothing else to buy as your baby grows. If you bought 8 shells and 24 Super Saver inserts, it would cost $270. If you bought just the shells ($16.95 each) and used your own inserts or prefolds, it would cost $136. And because the shells are reversible, buying 8 shells gives you 16 different colors to choose from.

Want to a Sprout Change diaper for yourself? Stay tuned for a Sprout Change Giveaway!
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