It is confirmed...I'm carrying a mini Homer Simpson

The "big" ultrasound was yesterday. For each of my kids, I've left the 20-week ultrasound feeling like the baby looked like something specific on the ultrasound screen. With my first, she looked like a turtle...it was something about the placenta resting against her back. With my second he looked like a duck. This baby looked strikingly like Homer Simpson. There was a particular shot when they measure the distance between the eyes that really brought out the Homer image with eyes bugging out and big round forehead. Anyway, I'm hoping the kid is a bit cuter in 4 months.

We don't have the official report yet, but everything looked good from my eyes. Baby was extremely uncooperative for most of the measurements. Even if we had wanted to know the gender, they would not have been able to tell. I guess that is the way it is supposed to be. We truly weren't meant to know. I still have this feeling about a boy, and my daughter is convinced it is a boy...but we'll see. We're definitely coming up with girl names too, just in case.

Otherwise, things are going well. I'm STILL gagging and vomitting on certain food items and when I brush my teeth. Almost 21 weeks...sheesh. Between the sickness and the uncooperative behavior for doppler and ultrasound, I'm still thinking this baby might be a handful when he/she emerges on the outside. Contractions are getting more regular. I've always had lots of "practice" contractions very early on, so this is nothing new for me. It is exciting though.

Last week I attended my last doula birth for probably the rest of the winter and spring, and it just got me soooo excited to be in labor again. Birth went very well, though it was long. But mom got exactly what she was hoping for - it was about as close to a homebirth in a hospital that you could hope for. And the neat thing, at least from a doula perspective, was to really see how as the baby's position changed from posterior to anterior, it really changed the contractions. Had this mother had an epidural, I feel certain she may have needed a cesarean. This baby liked to be posterior, and only turned with extended time on hands and knees (which an epidural would have prevented). Anyway, it was a beautiful experience.

Otherwise life is very busy. I'm teaching two university classes this fall, plus doing a bit of research work. I was offered a teaching position for winter term too, which I had to turn down because of the baby. And I now have one lined up for spring, as well as 2 research proposals to work on and a proposal to work on some e-courses for quite a bit of money. Though getting the PhD was a major pain in the arse, I'm sooo happy to have it now. Pay is more than quadruple what I was making before (which obviously wasn't much), and I feel this invisible measure of respect coming from the other faculty. Pretty sweet.

Boy or Girl?

We've decided not to find out this time. I kinda can't believe it. I was so sure I wanted to know with both of my previous pregnancies, and though we told the ultrasound technician not to waste time hunting for it, we were relieved when baby made it really easy to guess their gender. But this time, the ultrasound instructions will be to steer clear of the goods! And we are totally comfortable with that plan.

I still think it is a boy though. I've just felt that way from a few weeks in. We didn't try for a boy or girl this time, so it really could be either. But I just feel boyish. Plus I've been sicker than sick (still puking about every other day...at 18 weeks!), and though I wasn't THIS sick with my son, I was certainly sicker with him than I was with my daughter. Each pregnancy has just gotten sicker and harder. We have plans for a 4th after this, but for the first time I'm actually dreading the whole pregnancy part of it. I just don't enjoy pregnancy very much. I like the idea of it, but my pregnancies have been very hard on me. Guess I'll never grow up to be a surrogate.

Baby is safe

It took a while, but baby is making him/herself known now. I've been pretty certain I'm feeling movement, and then today we FINALLY found the heartbeat on a doppler. Whew! Coming up on 16 weeks and all is well.

When it hits the fan

A week ago, we were on top of the world. We'd just sold our house for a very sweet price. We'd just bought a new house for a very sweet price. We were moving in just a few weeks, and were VERY excited about it. Then Thursday hit.

On Thursday we had our inspection. Nothing really scary came up, but definitely a few annoying things. However, the buyer obviously saw something that terrified him because he went running. His reason? He said he didn't think any bank would give him a loan. Not sure where he got that, cause there was nothing that serious in the inspection. Regardless, he's gone. Our new house deal is gone. And we are back on the market. NOT. HAPPY.

And, on that same day, we had an appointment with our midwives. At 14 weeks, they were unable to find a heartbeat. I'm trying not to be too worried about it since I'm still pretty sick and we had that ultrasound just 2 weeks ago. Plus I think I'm starting to feel movement. But still, I'd think there would be a loud heartbeat by 14 weeks. Next appointment isn't until 18 weeks, but I may go back next week just to check unless I start getting some majorly reassuring kicks this week.

Bleh. I'd like some good news now.

How Many of Me?

HowManyOfMe.com

There are 116 people with my name in the U.S.A. How many have your name?

Not too bad. Only 116, out of 300,000,000+. How common is your name?

Confirmation of life

Those first few months of pregnancy are rough, when you are sick and feel bloated, but haven't heard a heartbeat or felt the baby move yet. There's just no confirmation you feel like ass for a reason. These months have been dragging on since I've been feeling so badly, more than any of my pregnancies before. I was pretty nervous going into our ultrasound last week, just hoping to see a healthy fetus. I knew being sick was probably a good sign, but there's nothing like seeing your baby flip you off to know things are going well.

All's well with this one (nicknamed P3). At 12 weeks exactly, we went in for an Ultrascreen (combination ultrasound and blood test that looks for Down's Syndrome and Trisomy 13 and 18). We hadn't heard the heartbeat yet, so this was our first glimpse of life. And that little bugger was wiggling! Everything looked really healthy. The baby had a great heartbeat and was extremely active. We got to watch some hiccups for a while. And our test results were fabulous too - chance of Down's or Tri 13/18 is less than 1 in 8000 and 1 in 10000, respectively. And best of all, baby was measuring perfectly. I love to see that when it happens, because I always set my due dates according to my ovulation date. My ovulation date is the most accurate, and I know this (and my midwife trusts this). Had we used my date of last menstural period, my due date would be nearly a week off. So hooray for knowing your body!

Happy Birthday Ava!

My oldest turned 3 years old today. I can't believe she's soooo grown-up. Pics soon perhaps, if our computer doesn't go up in smoke.

This baby is gonna be trouble

I've never been this sick before. I blaim that for my extended absense in blogworld, and it probably isn't over yet. I'm still sick, though having occasional moments of normalness that tell me perhaps the end is near (in a month maybe). It is bad enough to make me wonder why I wanted to get pregnant again, and to seriously question our plan to have one more baby after this one. I'm sure I'll see things differently when I feel better, but damn...this sucks.

Pregnancy seems to be going well. Just over 11 weeks now. Haven't heard or seen the baby yet, but we have an Ultrascreen (includes an ultrasound) scheduled for next Thursday. Heartburn started about a month ago, but is treatable with papaya so far. Tired as hell, but that doesn't surprise me. My belly is growing quickly and I can easily find my fundus nearly halfway to my umbilicus. Guess third babies push your body out quickly.

Our 3 year-old (birthday tomorrow!) is SUPER excited about the baby. I'm really looking forward to having her conscious and present throughout this pregnancy and birth.

1930s wifedom

Good think I'm not a wife of the 30s.

18 As a 1930s wife, I am Very Poor (Failure) Take the test!

Blehhhhhhhhhhhhhhh

Morning sickness sucks. I know I remember morning sickness once it is over, but I don't remember who crappy I feel really. This stinks. :( All day bleh.

In other much more exciting news, we made a bid on a house today. :) :) :) It is a contingent offer, so even if it is accepted, we still have to sell our place. But it is a great house!

How much worse can they make themselves look?

The AMA is really making themselves look pretty bad here. Open mouth and insert foot. They've joined ACOG's movement with recent resolutions (Resolutions 204 and 205) both to completely BAN all homebirths AND births in freestanding birth centers and criminalize mothers who choose to continue doing this, plus they are going after the entire midwifery model of maternity care by suggesting all non-nurse midwives be OUTLAWED, and nurse midwives come under even greater levels of OB control. Um, what? And, to make it even better, these resolutions are made with absolutely no medical basis. They don't mention a single study, a single statistic, or even a promise that this would be good for mothers and babies. Nope. Their resolutions read more like, "I'm scared for my job and Ricki Lake has made this powerful movie that makes us look really bad so now we better just throw everyone in jail and make it a law that all pregnant women must pay us directly...no other options."

Reaction in the normal birth world is mixed. Some are scared, just because it does suggest there will be a fight ahead and the AMA is waaaaay more powerful than any midwife group (the AMA controls the entire insurance industry, for example). Others think this is good publicity for midwifery and for homebirths. Because their statements are sooo outrageous and have no medical basis, they do seem rather ridiculous. Kinda like shooting guns with no bullets. I have a difficult time seeing how this could ever become a real law...given there is NO medical research supporting the AMA and ACOG's statements (quite the opposite actually).

Well, I'll tell you how much this has changed my mind. I had a very nice talk with my HOMEBIRTH-ONLY, NON-NURSE MIDWIFE yesterday. I'll be seeing her apprentice as my primary midwife, so not only is she NOT a nurse, she isn't even certified OR licensed. HA! And thankfully, my right to do this is completely protected by the fabulous state of Oregon.

Doctor Firefly Mama

Dead cat, open house, and sharing the news

That was my day. Well, there were some other things thrown in there too, but this is the part I choose to share.

We're taking care of a neighbors cats, and this morning husband returned to say he thought one of the cats was dead. Poor kitty. Sure enough, "Yoda" was curled up in a tiny box under the sink in the laundry room, and was stiff as a board. He was still warm, but definitely not with us anymore. I've never had to wrap a cat in a garbage bag and stick them in a freezer before. The owners will return tomorrow to a sympathy card taped to their door. Don't want to surprise them when they open their freezer to find a frozen kitty...

Just after finding the cat, and just before placing kitty in the freezer, we jumped in the car to go look at a house. It is the first house we've actually gone to see...and turns out it is owned by someone we work with. House needs work, but is livable and has EXCELLENT potential. Location is great too. But if we buy it and want to make some upgrades, it would be more than we can afford.

A few hours later, my folks arrived for tomorrow's graduation ceremony. They haven't been here in a year, haven't seen daughter in a year, and haven't seen son in 9 months. It is really great to have them around. And...I got to actually tell them in person that we are expecting another baby. This is the first time I've gotten to tell them in person, though I think they kinda suspected since we mentioned we were looking at bigger houses. Still, it was great to see their faces as the comprehension sunk in. I had one of those digital pregnancy tests that just says "Pregnant" and I asked daughter to carry it in and hand it to grandma. It was pretty sweet.

Now tomorrow I get all dressed up and receive my PhD. It feels a bit surreal.

By the way, I was in Vermont for most of the week at a conference. Nearly saw a tornado while there, and I've got pics. Hope to get those up soon.

Recent kid pics

In Praise of Telling Too Soon...

You may be surprised to hear I'm pregnant, when really I'm not even 4 weeks pregnant yet. Lots of folks wait until 8...10...12 weeks to tell, and I'm just not like that anymore. I am happy to be pregnant right now, and if something happens and this pregnancy does not make it all the way, I want to share that and receive support too.

One of my friends sent this message to me not long ago, after her own miscarriage. From Mothering.com:

In Praise of Telling Too Soon
By Katie Silberman
Web Exclusive, January 28, 2008

That thing they warn you about: it happened to me. I got pregnant. I was thrilled. I told a bunch of family and friends—and then I lost the baby in my second month. I had to untell a whole lot of people. That story was swirling around in my head. You know the one. The one "They" always say about how you're "not supposed to tell people too soon."

I always hated that one. I hated it when my sister would whisper that her friends were pregnant, and then warn me, "...they're not telling people yet." It seemed so negative and scardey-cat to me. I always swore that when I got pregnant, I'd tell the whole world.

Well, I did (practically). And it was great. I got the most wonderful responses, full of excitement and anticipation and appreciation for my husband Bryan and me. We had a great two months—it was fun when my clothes started not to fit; it was fun when my husband had to go out at night and get me ginger ale, just like in the stories. We even got a few cards and gifts.

Then we went for our first OB appointment. The doctor saw the baby on the ultrasound, but she could not detect the heartbeat. "I think your baby has died," she said. The words didn't even sink in. My husband and I are pretty optimistic people—it truly had not even occurred to either one of us that the baby might not be okay. When we finally registered what she had said, the news was crushing; it was devastating; I felt like a balloon had been popped.

Any loss can surely be utterly distressing, painful and sad. What seemed different about this particular loss, besides the fact that it was happening to us (this wasn't supposed to happen!!!), is that when I was pregnant I was coming from a place of such elation. It wasn't just normal life—it was flying high, excitement, euphoria, anticipation. And then the crash. The distance to fall seemed farther—the chasm between zenith and nadir more vast.

That's where "in praise of telling people too soon" came in. My husband and I were crushed with grief and disappointment. All I wanted to do was to lay on the couch in my bathrobe all day (sometimes Bryan would gently inquire around 4 o'clock in the afternoon whether I wanted to get dressed. I would scowl at him and say no.) Not up to talking on the phone, I sent out an email message to my friends and family briefly explaining what happened. Along with "untelling," I explained that I did not much feel like receiving calls. We were inundated with caring replies, and reading the messages that poured back in was all I felt like doing those few weeks. Bryan smiled that every time I checked my email, tears rolled down my cheeks as I was touched by the waves of support from the people who loved us, recognized what we were going through, and offered us their kindness. If we had not had the outpouring of care and support from our friends and family, I am certain that couch-laying phase would have lasted a lot longer than it did.

The thing about miscarriage that I most feared was that it seemed so invisible. I hadn't really looked pregnant yet; the baby was just a tiny thing (the size of a raspberry, the books said). With the code of secrecy surrounding the "don't tell too early" story, there did seem to be a residual sense of shame about what was happening; as though it should be kept in the realm of women's maladies that happen "down there," in the dark, that we're not allowed to talk about. But I knew that something real had happened to me; it was not invisible.

If I had kept my pregnancy and miscarriage a secret, if I had bought the shame story, then I would not have been real. I can't even imagine having to fake it with the most important people in my life: to pretend that nothing was wrong, during one of the most heartbreaking experiences of my life. That, to me, seems much more traumatic than having to "untell" and then tell the people who love you that you could use a little love and support. And then let them give it.

Cesareans may mean you lose health insurance?

Interesting article. I'm not surprised, but it really sucks that moms are left in the middle. Docs pressure them into cesareans that are often unnecessary, and then their insurance drops them over something they generally feel they had no control over. Perhaps in the long-run this will lead to an overall drop in the number of cesareans, but in the meantime, it is painful for innocent families who get screwed over.

#3

Notice tickers on the left. :)

PA Court tells State Medical Board to shove it

Big news in the midwifery world on Friday. I know lots of people across the country were tuned in to hear the outcome of this one. Thankfully, the humans came to their senses and an innocent midwife pervailed!

Diane Goslin has been a practicing midwife for like 25 years, and she's attended over 3,000 births. In that time, she has received one (ONE!) complaint against her - and it wasn't even by a parent or family she was serving. It was by a coroner, who examined an infant's body from a birth she had attended. You see, the coroner found the infant's death had nothing to do with the birth or the midwife, but he didn't like that the midwife had attended the birth at all so he complained to the PA Medical Board. What a kind fellow.

So Diane was ordered to cease and desist her midwifery practice and was brought up on numerous charges, including practicing medicine without a license, and given $11,000 in fines. Diane is a Certified Professional Midwife (CPM), an internationally-recognized certification for midwives. But silly Pennsylvania doesn't recognize them and therefore won't give them licenses of any kind. There were a bunch of rulings, and it looked like homebirth midwifery was about to be shutdown in Pennsylvania. But Diane fought hard, and she had thousands of supporters along the way. Save Homebirth joined the fight. The Amish and Mennonite (Diane's primary customers) came out in full force to support her. You can see some amazing pictures here.

Well, it all worked. Diane won. The court decided that practicing midwifery was not the same as practicing medicine, and therefore Diane wasn't guilty of practicing medicine without a license. AND, the court gave the PA Medical Board a slap on the wrist for trying to claim she was practicing as a nurse-midwife, because the Board is only allowed to police women who are trying to do this, and at no time did Diane advertise or call herself a CNM. PLUS, the court decided Diane was denied due process in these charges. Wow. You can read the final ruling here.

This is amazing news for all supporters of midwifery and homebirth. Midwifery is not "practicing medicine" and it should never be judged as such. Midwives should never be prevented from practicing because of misunderstandings about what they do. If states are afraid of midwifery (and that is what it comes down to here - FEAR), they need to take the time to learn what a midwife does and what a midwife doesn't do. If they would open their minds just a little, they would realize that supporting midwifery (and specifically homebirth midwifery) is not only cheaper, but better for the health of mother and baby.

Man, I'm so glad Pennsylvania saw the light. And now onto the local fight - whether or not Oregon will begin mandatory licensure for all practicing midwives (it is currently optional). OMC (Oregon Midwifery Council) is debating how to coordinate a unified front and what they should be arguing for. More to come...

Pushing pedals

We took our inaugural bike ride around town this morning. We've had our Burley for over a year, and my bike is brand new but has collected dust for a year. We got both while I was immensely pregnant, and the Burley isn't fit for infants, so we knew it would be a while before we hit the streets. But we made it out today and it was great! Both kids loved it and wore their helmets without a peep. We cruised the neighborhood in search of "For Sale" signs...yep, we're kinda sorta house-hunting.

Homebirth montage

I linked to this before but want to imbed it now so I can find it easily in the future. Amazing photos...

Vaginal Birth of Twins and Triplets!

This is awesome inspiration for those not interested in an automatic cesarean with multiples. The lady named Lindsey has been my friend for years, and the lady named Lisa is an online aquaintance.

D-O-N-E!!

This morning I turned my final revisions into the graduate school for my dissertation. It almost required a degree just to turn it in and meet all the requirements (10x13 inch manila envelope with metal clasp with 2 flyleafs, 3 extra title pages, 1 extra signed abstract, taped title page on front, receipt for archiving fee, etc etc). My revisions were pretty simple - took about 3 days. As of this afternoon, my online transcript says "Doctor of Philosophy degree requirements met on May 8, 2008." DONE DONE DONE DONE!!!

In other news, I've attended two births in the last two weeks too. Birth stories coming soon. One was a 92-hour marathon birth (I was only present for the last 25 hours). The other was an induction with hx of embolism complications that ended well with 4 hours of pushing. Both were good. Can't believe I fit them in there with all the defense stuff going on.

So now I'm taking a little time off from school. Gonna work on relaxing and reclaiming my sanity and health, develop my childbirth classes a bit, go see a movie, and go meet some new babies...

FREEDOM!!!!!!

Welcome Baby D!!

Super-duper happy for Franny and Dave as they welcomed Baby D at 2:24 this morning. :) Can't wait to see him! Congrats guys!

Doctor

Firefly Mama, PhD

I think I like the ring to that.

Defense went well today. First I presented my research in a quick 30-minute seminar, which was followed by a brief Q&A from the public. Then I had 2 hours of grilling from the profs. They excused me for 30 minutes, then brought me back in to shake my hand. Pretty good feeling being part of the club. Finally. Now I'm tired. Got a birth coming up in the next few hours too.

T-minus 6 days

Life is crazy as I prepare to defend my PhD next Thursday. I can't barely keep up with things. Plus, I attended a marathon 92-hour birth earlier this week (I was only there for 25 of those hours). And I've got another mama due tomorrow too. How did all this stuff end up happening at the same time?

Cool thing this week was picking up my cap and gown. When you become a Dr, they give you very fancy robes.

Honda Odyssey ad

Merck is evil

Merck, makers of the infamous Vioxx, as well as a suite of pediatric and adult vaccines, has not only been marketing drugs they knew were dangerous, they've also been covering up death in drug trials and hiring prominent physicians to sign their name on research that Merck was doing in-house (to make it look legit, so it could prove the safety of their drugs). JAMA has been so kind as to allow free access to these two important articles. You can read about ghostwriting here and death cover-ups here.

Sadly, I am not surprised. I would bet all the drug companies are into this practice. It makes me sick though.

For vaccines, Merck makes Varicella, MMR, one of the HepBs, one of the Hibs (which was recently recalled for other problems), the Hib/HepB combo, one of the HepAs, and one of the Pneumococcals. Wonder much foulplay was involved in the studies proving the "safety" of these vaccines...

Sweet rides and happy days

Picked up the new minivan last night. It is soooooo nice. I'm in love! It feels so big and luxurious compared to our past vehicles. And now today it is GORGEOUS outside, and I got my final comments back from my professor on my dissertation, and he LIKES it! This are looking good today. I think this afternoon we're gonna go out for a joy ride.

Big Blue

We bought a new car today. :) Got a good deal too...over $1000 under invoice. We get it on Wednesday or Thursday. I can't wait!

Can you find Barack in this picture?

Barack, I think I love you

I'm only a week late in sharing this news...but hey, I've been busy lately.

I saw Barack Obama. In person. Not from the nosebleed section at a rally, no. On the street. Shaking hands (he didn't get to mine though). Standing in front of the pizza restaurant (American Dream) I was trying to get into to. I was close enough to see his skim blemishes. Ten feet maybe? He's kinda like a drug...makes you want to do stupid shit for him. I wanted to run up and throw my arms and legs around him in a great big hug, but I was pretty sure my kids would miss me while I spent the night in jail. I can't believe how electrifying I feel in his presence. It is pretty freaky. For the first time, I feel like I understand the power behind some of the major political movements of the past...such as for JFK and RFK. And I think I am beginning to understand how devasting it would be to lose some as strong as say...MLK. I feel it in my heart that Obama will be our next President, but I also can't shake the feeling he will face more than a few assassination attempts. Thankfully, he travels with an army of secret service types. I saw far more of them than I did of him on the street that day. I'd show you my hastily-snapped cell phone pic, but it is a blurry mob of suits, coats, and the backs of people's heads.

Simon's Cat 'Let Me In!'

More fun with Simon's cat

Simon's Cat 'Cat Man Do'

Simon has obviously been spying on my cat Terri

Bicycle Awareness Test

This is just too funny. And it has a point.

May 1st, 2008

Okay, just kidding in that last post.

I will be defending on Thursday, May 1st. It is official now. I've submitted the paperwork to set things rolling. From 10 am till 1 pm on May 1st, I'll be sweating buckets. Hopefully by 2 pm, I'll have successfully defended my dissertation. Whew.

April 24, 2008

I will be defending my dissertation on Thursday, April 24, 2008. Time TBA.

I can't freakin' believe this is going to happen. I will then have 15 days to complete all my revisions and turn everything in to the Graduate School.

Then, on Sunday, June 15, I will become Dr. Olsen. hehehehe

She was meant to be a midwife

SageFemme is definitely in the right profession. Kudos to her for handling a 13 MINUTE shoulder dystocia of a nearly 13 lb baby girl. At home. With no broken bones. And full resuscitation. Oh. My. God.

Baby girl is doing well.

SafeFemme is also an amazing photographer of the births she attends, and has created this gorgeous montage of some of her homebirths. Beware - not for office viewing.

Reality

As if it weren't obvious, I'm taking a break from blogging for a bit. Life is just too much right now. School and life are taking over. I hope to rejoin the blogging world soon. I'm still around and reading, just saving myself the pressure of feeling I need to make posts.

A great response to ACOG's stupidity

This is an awesome, honest, and accurate response to ACOG's statement on homebirths.

I couldn't have said it better. And I agree whole-heartedly with her point that ACOG's statement was defensive, insulting, and paternalistic.

Citizens for Midwivery offers facts as talking points

This is a really nice collection of talking points (in no particular order) from Citizens for Midwifery (CfM):

• Twenty-four states license direct entry midwives, several for more than twenty years. Twenty-two use or recognize the Certified Professional Midwife (CPM) credential administered by the North American Registry of Midwives (NARM) as the basis for licensing, and two states have voluntary licensing. In all theseyears, no state has repealed their midwifery law for any reason. Furthermore, in 9 states licensed midwives receive Medicaid reimbursement for their services. These records demonstrate that CPMs do not pose any threat to the health and safety of pregnant women and newborns.
  
• An economic analysis of the cost benefits of a licensed midwife program (Washington State) indicate that the cost savings to the health care system (public and private) is estimated to be ten times the cost of the program, even with this licensing program being the most expensive in the country. (Midwifery Licensure and Discipline Program in Washington State: Economic Costs and Benefits, (A report to the Washington Department of Health), Health Management Associates, October, 2007)
  
• Contrary to ACOG’s uninformed assertion, many rigorous scientific studies, published in leading medical journals, have found that for a healthy woman having a normal pregnancy, a planned, midwife-attended home birth is as safe as a hospital birth and with far lower rates of medical interventions. The most recent is also the largest study, based on prospective reporting for all the births attended by Certified Professional Midwives in 2000, published in 2005 in the British Medical Journal . ("Outcomes of planned home births with certified professional midwives: large prospective study in North America." Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager. BMJ 2005;330:1416 (18 June). Also see CfM’s summary fact sheet.
  
• About 99% of births in the US take place in hospitals. If standard obstetric practice is so good, why does the US rank so abysmally when it comes to maternal mortality and neonatal mortality?
  
• The Complete Mothers’ Index 2007 shows that mothers in the US have a higher lifetime risk of maternal mortality than the mothers in 27 other developed countries.
  
• The World Health Report (from the World Health Organization) indicates that the neonatal death rate (death in the first 28 days of life) is greater in the United States than in 35 other countries.
  
• ACOG claims that "complications can arise with little or no warning even among women with low-risk pregnancies". However, complications seen in low-risk women laboring in hospitals are often related to the many routine practices and interventions that disturb the birth process and cause or lead to complications and more interventions. In fact, most of these practices were adopted without being studied for safety, and many are still routine even after being studied and found to be either worthless or harmful or both. (Enkin et al. A Guide to Effective Care in Pregnancy and Childbirth) Midwives attending home births avoid unnecessary interventions and the use of drugs, allowing normal birth to proceed. They are trained and experienced in noticing any signs of problems and taking appropriate action, including transfer to medical care in a hospital when necessary, which is rarely. (see the BMJ article cited above)
  
• The press release states "ACOG acknowledges a woman’s right to make informed decisions regarding her delivery…" but goes on to say that ACOG does not support any of the alternatives to a doctor-controlled birth in hospital or birth center, or anyone who provide or supports home birth. So how is ACOG supporting informed decisions?
  
• ACOG claims that an "emerging contributor" to the rise in cesarean section rates is "maternal choice." However, there is no evidence for this claim. In fact, recent surveys of mothers found that less than 0.08% of pregnant women request a C-section. Applying these numbers to a recent figure for annual births, a scant 2,600 out of 4.1 million pregnant women actually requested a C-section. (Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences. New York: Childbirth Connection, October 2006.) Clearly, this number is so small it could not possibly explain the doubling of cesarean section rates in the last decade. Furthermore, when he was President of ACOG, Benjamin Harer publicly promoted maternal choice cesarean sections on popular TV news and talk shows, for reasons for which there was not evidence. (for example: Benjamin Harer on Good Morning America, 2000. Having actively worked to create a market for cesarean sections for no medical reason, based on lies and misinformation, ACOG is now blaming women for the increased cesarean rate??
  
• When attending births outside the hospital, both Certified Nurse Midwives and Certified Professional Midwives referred fewer than 5% of mothers for cesarean sections, while obstetricians were performing cesarean sections on nearly 20% of low risk mothers in hospitals. (see CfM fact sheet with references)
  
• Some women are going to choose to deliver their baby at home, for a variety of very legitimate religious, social, health or economic reasons. These women deserve to have the best care available the care of a well-trained midwife with experience in out-of-hospital settings. (Firefly Mama thinks this is the most important point!)
  
• While ACOG states that childbirth is a normal physiologic process, today’s obstetrical profession performs cesarean sections for nearly one third of births, induces labor in nearly half of births, and administers drugs of one kind or another to more than two thirds drugs that pass through the placenta and harm the baby. In fact, almost the only women who give birth with no interventions are those who give birth at home. (Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences. New York: Maternity Center Association, October 2002.)
  
• Apparently obstetricians are not trained to support normal birth, but oppose the very health care providers who are: midwives who are trained and experienced in attending births outside the hospital. The Certified Professional Midwife credential is the only maternity are credential that requires experience in out-of- hospital settings.

Childbirth Connection addresses ACOG's policy

From Childbirth Connection:

ACOG Place of Birth Policies Limit Women's Choices Without Justification and Contrary to the Evidence

In October 2006, the American College of Obstetricians and Gynecologists (ACOG) released a Statement of Policy on "Out-of-Hospital Births in the United States." Following feedback from ACOG members and from Childbirth Connection and many other concerned organizations, ACOG issued a revised Statement of Policy on "Home Births in the United States" in May 2007. This Alert and Response describes Childbirth Connection's concerns with the statements and their implications for mothers and babies.

What place of birth policy did ACOG set in "Out-of-Hospital Births in the United States" (October 2006)?
The earlier statement asserted that "studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous." ACOG also claimed that the hospital "is the safest setting for labor, delivery, and the immediate postpartum period." Consequently, it concluded, ACOG "strongly opposes out-of-hospital births" and "does not support programs or individuals that advocate for or who provide out-of-hospital births." However, the statement failed to cite any evidence to support the assertions and failed to acknowledge impressive existing evidence regarding the safety of planned home birth and out-of-hospital birth center birth.

What place of birth policy did ACOG set in its revised statement, "Home Births in the United States" (May 2007)?
The revised statement was identical to the previous statement with the exception of limiting the focus to home births rather than to all out-of-hospital births and acknowledging the safety of birth in out-of-hospital birth centers that meet standards of relevant accreditation organizations. The revised statement concluded by stating that "ACOG strongly opposes home births" and "does not support programs or individuals that advocate for or who provide home births." Again, no study was cited to support this position, and existing research in support of planned home birth was overlooked.

What was the response to the earlier statement?
Some ACOG members objected to the policy, and numerous organizations submitted letters of concern and posted the letters online. These included American Association of Birth Centers, American College of Nurse-Midwives, Consumers United for Evidence-based Healthcare, Lamaze International, and White Ribbon Alliance for Safe Motherhood. In addition, Childbirth Connection and other consumer advocacy organizations together sent a letter identifying special concerns from a consumer perspective. Joining together with Childbirth Connection were Center for Medical Consumers; National Partnership for Women and Families; National Women's Health Network; and Our Bodies, Ourselves, as well as the Executive Director of Families U.S.A. signing as an individual. In general, the letters asked ACOG leaders to review the policy in light of the plethora of high-quality scientific evidence supporting the safety of planned out-of-hospital birth.

What were the major concerns of the consumer groups?
The joint letter from organizations writing from the perspective of best interests of mothers and babies expressed several concerns. First, the groups were troubled that the policy would undermine women's choices and legal right to informed consent about where to give birth and noted that ACOG's own document, Ethics in Obstetrics and Gynecology (2004), strongly supports women's right to informed consent.

Moreover, the groups were troubled by the complete lack of evidence to support the statement's assertions and its failure to acknowledge impressive existing evidence. With respect to home birth, they noted a large prospective study of 5,418 American women planning home births with Certified Professional Midwives (Johnson and Daviss 2005), and a systematic review of home birth (Olsen 1997). With respect to birth in out-of-hospital birth centers, they pointed to the large prospective National Birth Center Study of 11,814 mothers who began labor in out-of-hospital birth centers (Rooks et al. 1989) and a systematic review of care in out-of-hospital birth centers (Walsh and Downe 2004). Notably, both of the large studies achieved 4% c-section rates whereas about one mother in three now gives birth by major surgery in the United States. All four studies found very low rates of many widely used obstetric interventions and no sign that the settings or conservative use of obstetrical procedures involved extra risk when out-of-hospital births were compared with low-risk women giving birth in hospitals. The systematic reviews concluded that there is no a priori basis for denying planned out-of-hospital birth. The large prospective studies were published in the most prestigious general medical journals, New England Journal of Medicine and BMJ.

The letter from the consumer groups also pointed out that in rejecting the strong available evidence ACOG displayed a double standard. The letter referenced an analysis of ACOG's recent obstetric practice recommendations that found that just 23% are Level A, that is, "based on good and consistent scientific evidence," whereas 35% are Level B -- "based on limited or inconsistent scientific evidence," and fully 43% are Level C, "based primarily on consensus and expert opinion" (Chauhan et al. 2005). In evidence-based medicine, expert opinion when not backed by sound research is the lowest and least reliable level of evidence (Oxford University 2001). Despite the weak scientific evidence for over three-quarters of ACOG’s professional practice recommendations, some obstetricians feel that they are vulnerable to malpractice claims and suits if they deviate from ACOG policies, and recent research supports this (Ransom et al. 2003). Finally, the letter to ACOG from the consumer groups pointed out that the policy endangers the health and well being of mothers and babies in two ways. First, in opposing those who support out-of-hospital birth, ACOG could jeopardize appropriate physician back-up for the considerable number of women who will continue to choose out-of-hospital births. All health professionals need to be able to call on other health professionals for specialized services that are beyond their expertise and scope of practice. Obstruction of such professional collaboration jeopardizes the welfare of mothers and babies and is of grave concern. Second, in taking the position that all women should give birth in hospitals, the statement would consign low-risk women to the high rates of invasive procedures and other interventions that are now the norm in U.S. hospitals, as measured in Childbirth Connection’s Listening to Mothers II survey (Declercq et al. 2006).

Did the revised policy statement address concerns of the consumer groups?
The revised policy statement reflects the best available evidence about planned birth in out-of-hospital birth centers, but continues to reject home birth without justification and contrary to the best evidence. After describing results of the best available research and concern about typical maternity care in U.S. hospitals, the consumer groups wrote:

"These major [out-of-hospital] studies set a standard for what is attainable among healthy low-risk pregnant women in North America and raise troubling questions about current practice trends. Care in these settings should be emulated rather than denigrated."

Another available research review is consistent with the studies and systematic reviews cited above: Stotland and Declercq (2002).The current ACOG policy statement about place of birth continues to raise troubling questions about: current standards of maternity care in the United States, ACOG's disregard for best available evidence, and ACOG's infringement on rights of childbearing women.

References:

American College of Obstetricians and Gynecologists. Ethics in Obstetrics and Gynecology, 2nd ed. Washington, DC: ACOG, 2004.

American College of Obstetricians and Gynecologists Executive Board. ACOG Statement of Policy: Home births in the United States. Washington, DC: ACOG, May 2007.

American College of Obstetricians and Gynecologists Executive Board. ACOG Statement of Policy: Out-of-Hospital Births in the United States. Washington, DC: ACOG, October 2006.

Chauhan SP, Berghella V, Sanderson M, Magann EF, Morrison JC. American College of Obstetricians and Gynecologists practice bulletins: An overview. American Journal of Obstetrics and Gynecology 2006;194:1564-75.

Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences. New York: Childbirth Connection, October 2006.

Johnson KE, Daviss B-A. Outcomes of planned home births with Certified Professional Midwives: Large prospective study in North America. BMJ 2005;330:1416.

Olsen O. Meta-analysis of the safety of home birth. Birth 1997;24:4-16.Oxford University, Centre for Evidence-Based Medicine.

Oxford Centre for Evidence-Based Medicine levels of evidence, 2001. Available at http://www.cebm.net/index.aspx?o=1025 (accessed June 20, 2007).

Ransom SB, Studdert DM, Dombrowski MP, Mello MM, Brennan TA. Reduced medicolegal risk by compliance with obstetrical clinical pathways: A case-control study. Obstetrics & Gynecology 2003;101:751-5.

Rooks JP, Weatherby NL, Ernst EK, Stapleton S, Rosen D, Rosenfield A. Outcomes of care in birth centers: The National Birth Center Study. New England Journal of Medicine 1989;321(26):1804-11.

Stotland NE, Declercq ER. Safety of out-of-hospital birth in industrialized nations: A review. Current Problems in Obstetrics, Gynecology and Fertility 2002;25:134-44.

Walsh D, Downe SM. Outcomes of free-standing, midwife-led birth centers: A structured review. Birth 2004;31:222-9.

ICAN responds

ICAN’s Response to ACOG AND AABC Statements on VBAC and Homebirth
Redondo Beach, CA, February 7, 2008:

The International Cesarean Awareness Network would like to publicly condemn both the AABC (American Association of Birth Centers) and the ACOG (The American College of Obstetricians and Gynecologists) for their statements this week that limit not only women’s choices in birth but imply that birth is a fashion trend rather than a safety concern.

Since VBAC is the biological normal outcome of a pregnancy after cesarean, ICAN encourages women to get all of the facts about vaginal birth and elective repeat cesarean before making a choice. This decision should not include weighing the choices of your doctor’s malpractice payments but only be a concern of the mother, her baby and their health and safety.

Since some mothers will make the choice to give birth outside of the hospital, we encourage the AABC to not cave into ACOG’s demands that all women give birth in a hospital facility with a surgical specialist, but instead allow women to make their own choices about care providers, birth settings and risk factors. ICAN respects the intelligence of modern women and accepts that the amount of information available about VBAC and elective cesarean should serve as informed consent.

ICAN further encourages the governments of individual states to look closely at their cesarean rates (31.1% national cesarean rate as of 2006) and the informed consent laws that apply and help women to reach a standard of care that lowers the risks of major surgery and the risks of elective or coerced cesarean without medical indication. Women and children should not bear the brunt of malpractice risks being conveyed into physical, mental, emotional and spiritual health risks in order to protect their physicians.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are more than 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.

AABC statement

ACOG statement

Big Push for Midwives fights back

This is the first (of many, I'm sure) responses to ACOG's statement.


PushNews from The Big Push for Midwives Campaign
CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill@kc.rr.com
FOR IMMEDIATE RELEASE: Thursday, February 7, 2008

ACOG: Out of Touch with Needs of Childbearing Families

Trade Union claims out-of-hospital birth is “trendy;” tries to play the “bad mother” card

(February 7, 2008) — The American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, has issued the latest in a series of statements condemning families who choose home birth and calling on policy makers to deny them access to Certified Professional Midwives. CPMs are trained as experts in out-of-hospital delivery and as specialists in risk assessment and preventative care.

“It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they’re simply being ‘trendy’ or ‘fashionable,’” said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008. “The fact is, families deliver their babies at home for a variety of very valid reasons, either because they’re exercising their religious freedom, following their cultural traditions or because of financial need. These families deserve access to safe, quality and affordable maternity care, just like everyone else.”

Besides referring to home birth as a fashionable “trend” and a “cause célèbre” that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth “experience” over the safety of their babies.

“ACOG has it backwards,” said Steff Hedenkamp, Communications Coordinator of The Big Push and the mother of two children born at home. “I delivered my babies with a trained, skilled professional midwife because I wanted the safest out-of-hospital care possible. If every state were to follow ACOG’s recommendations and outlaw CPMs, families who choose home birth will be left with no care providers at all. I think we can all agree that this is an irresponsible policy that puts mothers and babies at risk.”

The Big Push for Midwives calls on ACOG to abandon these outdated policies and work with CPMs to reduce the cesarean rate and to take meaningful steps towards reducing racial and ethnic disparities in birth outcomes in all regions of the United States. CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality.

Moreover, their training as specialists in out-of-hospital maternity care qualifies CPMs as essential firstresponders during disasters in which hospitals become inaccessible or unsafe for laboring mothers. In addition, CPMs work to ensure that all babies born outside of the hospital undergo state-mandated newborn screenings and are provided with legal and secure birth certificates.

Currently, Certified Nurse-Midwives, who work predominantly in hospital settings, are licensed and regulated in all 50 states, while Certified Professional Midwives, who work in out-of-hospital settings, are licensed and regulated in 24 states, with legislation pending in an additional 20 states.

The Big Push for Midwives (http://www.TheBigPushforMidwives.org) is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.

Media inquiries should be directed to Steff Hedenkamp (816) 506-4630, RedQuill@kc.rr.com.

ACOG declares war

The American College of Obstetricians and Gynecologists (ACOG) has declared war against all non-nurse midwives and homebirth. We've known their stance on the issue, but now it is public and in a press release. And, they've tossed in a number of lies to help make their point.

Deep down, I really do believe that someday they will be sorry they fought so hard for inferior care.

The full text of the press release:

ACOG NEWS RELEASE
For Release:
February 6, 2008
Contact:
ACOG Office of Communications
(202) 484-3321
communications@acog.org

ACOG Statement on Home Births

Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.

ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).

Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.

Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, but there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.

The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.

It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.

ACOG encourages all pregnant women to get prenatal care and to make a birth plan. The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.

# # #

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

Democrats

So I couldn't have been more wrong. I really thought we were going to see a clear leader after yesterday's elections. I thought it was going to be Obama. But alas, he's trailing just a little right now. I can't believe how close this is. I both love it, and hate it, as I fear it will cause voters who are currently rooting for the eventual loser to have difficulty voting for the candidate in the general election. I hope I'm wrong. Anyway, I've got my ear glued to the news and can't wait for the next round of elections (Saturday we have Washington, Nebraska, and Louisiana for the Dems). Oregon's election isn't until May 20th. I've been assured that by that time, we'll know who the candidate will be.

Updates

I haven't posted in a while. I know. I think my blog is going to suffer a little in the coming months as I near the end of my school career. My stress and anxiety are just overwhelming sometimes, and it leaves me wanting to lurk more than post on the internet. So I will try to speak up when I can, but know that if I'm MIA, its cause I'm buuuuuuuuusy.

So updates...

Last weekend I attended Neonatal Resuscitation Program with Karen Strange, and it was an AMAZING class. We learned far more than just resuscitation of newborns. We learned about newborn physiology and some techniques to encourage a peaceful transition from intrauterine to extrauterine life. And, I got to meet Sage Femme, someone I've admired for a while and hope to interact with more frequently.

Alder is coming up on 9 months now. He still isn't crawling, and has no teeth. He's been on the verge of crawling for about 2 months, so I'm starting to wonder if he'll skip crawling all together. He's doing okay with standing if propped up in that position.

The life-after-school question is still up in the air. A big job came up but I've decided to pass because it is: 1) in Eugene, 2) full-time, and 3) research focused, and I want none of these things. My advisor has remained noncommital about whether I can work for him after graduation, so I'm starting to assume that means no. He's sending some hints that it is no, though I think if he really KNEW it was no, he'd just tell me no. Anyway, I'm definitely not counting on that. Right now I'm excited about developing my doula and childbirth education business, and possibly getting the opportunity to do some assisting at homebirths in the near future (Pssst...any area MWs reading this...I'm available!).

School is coming along, but pissing me off too. I'm still revising my final chapter, and time just keeps passing. My advisor is being tough on some of the revisions, so we aren't setting a defense date yet. Now it looks like I may stray into spring term. If so, at least my advisor has offered to pay me (a teeny, tiny amount) for spring term too. But dammit, I gotta finish!!

What else...

We got a new tv today. (grin) Finally...my piece o' junk tv can be retired, in favor of the nice, new, CLEAR imagine of our LCD flatscreen. As a LOST junkie, I can't wait to see my favorite characters on the big screen.

I've been doing a draft of our taxes, and it looks like we're going to get quite a little refund this year. Thank goodness...cause we're shopping for a minivan this summer and need more for that downpayment.

Not much else really. Just busy...and stressed.

Super Duper Tuesday!!!

You can taste the electricity in the air. There is no voting in Oregon today, but most everyone I know will be tuning in tonight to hear the results of the various caucuses and primaries. I'm really feeling like we will have a clear leader in the Democratic race after today. And because I feel the country just HAS HAS HAS to swing to the Dems this year, I feel that the leader after today will be our new President come 2009.

So who do I want? Well, my first choice was Kucinich. I've always matched very well with his politics and am sad he'll never have a real shot at getting elected. Between Clinton and Obama, I'm quite torn. They aren't terribly different in policies. Each has some strong qualities they could bring to the Office. I've always wanted a woman in office, and I've always wanted an African-American in office. I can't believe we have to choose. When it comes down to it, I feel Obama is more electable and has a better shot against McCain. So in interest of getting a Dem in the Office in '09, I am hoping Obama is the leader after tonight.

Penny and Me

I had a FABULOUS time in Seattle at Penny Simkin's workshop on attending laboring mothers who've experienced early childhood sexual abuse or previous birth trauma. It was really phenomenal, and should be required training for all birth attendants. Among the attendees was Karen Strange, CPM, instructor for neonatal resuscitation program, which she's teaching in Corvallis in a week. I'll be in on that class too.

More soon. I've got some catching up to do at home. It was a long 2.5 days away from the kids.

Busy

Sorry...I know I've been slacking about posting lately. And I feel like there has been a lot going on to post about...but I'm just not finding the time. I'm racing to finish this dissertation. I'm battling a little cold right now. I've had doula engagements right and left lately (fun meeting with doulas in neighboring town, interview, prenatal, book club, etc). Tomorrow I head to Seattle Midwifery School to take a class from Penny Simkin on working with moms who are sexual abuse and birth trauma survivors. I just decided I'm going for childbirth educator training in March. And I'm trying to figure out what happens after my last paycheck. SO yeah, just a lot going on lately. Oh, and I've been hanging out a lot with a friend who is 5 days overdue now. She's trying to be patient, but is not a happy camper at the moment.

Anyway, hope to be back to more regular posting soon. Will certainly try to blog about Seattle, cause it will be awesome.

Freaking out

The end of my life in school is near, and it has me thinking constantly about what I will do next. If all goes well, I'll be defending my dissertation in as little as six weeks. My last (little tiny) paycheck as a graduate research assistant comes at the end of March. Then what? The answer is...I still don't know. My advisor may have work for me. I've asked him about it in the past, but he's been unwilling to discuss it until we knew when I would finally finish the degree. I think we could discuss it now...I just need to get up the guts. There is also a chance he won't have anything for me, as I recently learned he hired another friend (who is significantly cheaper than I would be). If I can't work for him, then what? Perhaps another professor will have work, but it is unlikely. Ideally I'd like 10-20 hours per week and I don't really need benefits, so I'm really not THAT expensive, but my field is not funded as much as it should be.

If I don't work at school, then I really don't know what I'd do. Stay home with the kids while I search for something else? I'd like to avoid pulling the kids out of daycare if I can help it, as it was hard enough to get them in that place. I definitely don't want something full-time, and it shouldn't be too permanent, as we plan on me needing another maternity leave or two in the next couple of years. I've been browsing tenure-track faculty positions around the country, and a few things have caught my eye. But I'm just not ready for that yet. I hope I can find something come spring though. I like to have my mind challenged a few hours a week, by something other than playing Scrabble I mean.

Best Thai food ever...in America

What do you think? Does this look like an exquisite Thai dining establishment? It is called "The Woodsman" if you can't read that sign, and apparently they have fried chicken on Wednesday nights. It is in the thriving metropolis of Philomath (population ~4,000). It looks like a bar. It has a bar, and they serve Coors Light (among other things). It is decorated in chainsaws and cross saws and pictures of large trees that were cut down. And it is the best darn Thai food I've had since being in Thailand. We ventured there last night for a belated birthday dinner sans kids (thank you in-laws!) after getting a tip from a friend that we might find good Thai food there. Wow. What a great jewel to find right under our noses.

Doula meeting

Night before last I attended our monthly doula meeting here, and it was a really great night. We alternate locations for the meetings, and this time it was at our hospital in one of the L&D rooms. We always extend the invitation to the L&D nurses, CNMs, and OBs, but have had few attend before (and no OBs). This time we had an L&D nurse (who is also a doula), a homebirth midwife and her assistant, a CNM, and an OB! It was awesome! Feedback continues to be very positive for doulas in our community, though most of us are working far less than we would like. In fact, there has been a significant lull in business lately for everyone, with some of the women having no births since early last summer. We are working on more marketing and getting ourselves out there.

In other doula news, I have one client due in April. I recently had an interview for one due in February, which I was secretly hoping I wouldn't get because it just feels like too much on my plate with finishing school and all. So I didn't get them, but they chose me as back-up. Perfect! I also had a contact about someone due in March, but referred them to other doulas because I don't want to take a birth on during the same month I think I will be defending. Beyond April, I have nothing though there are two hopefuls in May. Hoping to get some more births lined up.

Night pottying update

Definitely NOT NOT NOT done with diapers here, at least at night. Ava did well for the start of the night, getting up to pee a half-dozen times. But once she is asleep, she has difficulty waking enough to get up and make it to the bathroom before peeing. I heard her up in the bathroom at 2:30 am, so I went to check on things. She was cold and wet, as was the bed, so she'd obviously peed sometime earlier in the night. At that point I just pulled the wet stuff off the bed (had clean, dry sheets underneath), changed her pjs, and put a new diaper on her (with no protests this time). And last night she didn't protest at all either. I think she knows she isn't ready to go diaper-less at night.

Nap training continues to go well though. Yesterday she kept her bed dry by managing to get up after waking and walking all the way into the bathroom before letting lose. So she soaked her pants, but at least it wasn't the bed. I was proud she woke up and got up before going. That is a huge forward step. :)

The Business of Being Born comes to Corvallis

Ricki Lake's wonderful film, The Business of Being Born, will be playing in Corvallis as part of V-week on Wednesday, February 13th from 4-6 pm on the OSU campus in the MU Main Lounge. There will be a panel Q&A afterwards with a homebirth midwife, a certified nurse midwife, an OB (hopefully), an RN, a birth doula, a postpartum doula, and a family doctor. Vagina Monologues goes on stage in LaSalles Stewart that night from 7-9, and again the next night (V-Day) too. There will be several other events that week as well. Sounds like it is going to great fun!

Goodbye to diapers?

One certain not-yet-2.5-year-old refused to put on a diaper at bedtime tonight. FLAT OUT REFUSED. Hmmm... She's very well trained during the day. We're working on naptime, and she doesn't wear a diaper then anymore (but still has accidents maybe 50% of the time). But this was a first at night. I didn't think we'd tackle night training for a while. We'll have to see how this works out. I'm fairly certain she's going to be soaked at some point in the middle of the night, and again in the morning if she still refuses a diaper after getting changes. But maybe she'll surprise me.

Hysterectomy and cesareans

More bad news about cesareans: moms who've been cut are more likely to lose their wombs in future pregnancies. Ouch!

With all the negative outcomes that research has recently linked to cesareans, I just can't fathom HOW the cesarean rate continues to climb. The liability argument just doesn't fly for me anymore if the surgery just increases all these risks.

Thanks to Doulicia for pointing out this new information.

Happy Birthday to me!

Today I turn 32. It has been a low key day really. I slept moderately last night. This morning I took the kids to daycare, as usual. Then I went to the gym. I was bummed I didn't get on my favorite machine, but it felt good to move my body regardless. Then I came home, played some Scrabulous, and took a loooooong shower. Then I got Keith for a lunch date. We enjoyed pizza slices from a new restaurant here in Corvallis that has the closest thing I've tasted to REAL New York pizza. We also dropped in a framing shop to get a painting framed that used to hang in my aunt's home (the one who died 2 months ago). Getting the painting professionaly framed is my birthday present (plus the awesome massage that I got yesterday). Then I took Keith back to work and went to a movie. BY MYSELF. I've never done that before, and it was pretty awesome. I love going to the movies. I need to do that more often. I saw I AM LEGEND and boy...it was spooky. As someone trained in the biological sciences, the concept of a super-virus (that we engineered, no less) wiping out the human population is pretty terrifying. And now, I'm home and relaxing with the kids. I'm going to pick something yummy for Keith to pick-up for dinner (Indian maybe?) and then I'm going to start baking my birthday cake, which will be shared this weekend when some friends come over to celebrate.

Yeah, it has been a pretty nice day. 32 feels a little different than 31 because I can vididly remember when my Mom was 32 (I was 10) and she seemed old. Guess I'm getting up there.

Waterbirth International needs to stay alive!

Please help Barbara Harper keep waterbirth alive

Waterbirth International may close doors. Here is a note from Barbara Harper of Waterbirth International

Barbara Harper wrote: I cannot yet imagine a world without the voice and work of Waterbirth International - we get calls and emails every day from women who need help convincing one hospital or another to let them labor or birth in water. If we die - a big part of the movement dies. Waterbirth has shown us all that women know how to give birth and babies know how to be born. Waterbirth gave us "hands-off", sit back and let the baby out. I see waterbirth mentioned on Blogs every single day, not to mention Baby Story on the TV. I took Waterbirth International to ACOG two years in a row - and was the ONLY booth showing birth films to obstetricians and especially to student physicians. There were tears, laughter and outrage - just the thing to stir up those young crop of doctors. I am finally realizing a life's dream. But now I am faced with letting this dream go. Perhaps I have done enough. Perhaps it is time to quit.

About 18 years ago, maybe it was longer, when Mothering Magazine was facing bankruptcy Peggy did a heartfelt plea asking their readers to consider ordering a Life-time subscription. I think the subscriptions were $1000 or $1200, I can't remember now. I do remember that I couldn't imagine not reading my Mothering. So, I bought two and gave one to my obstetrician's office. How can you help us stay open to take the next phone call? - to convince the next obstetrician to incorporate waterbirth into his/her practice - to work with the nurse midwives to install pools in their facilities? To educate an entire hospital on the benefits of allowing women freedom of movement in the water. How much is it worth to see waterbirth become the norm in the US, like it is in the UK? I think we only need a few more years to make that happen. Do women really want waterbirth to be an available choice in every hospital? I think so.

Can you help us by getting the word out on blogs and lists? I had to let go of all of the staff except one person to process orders. Miraculously, we made payroll today, but we can't hang on much longer. We need a miracle. If I need to call every single waterbirth parent personally, I will. I don't want 25 years of work to end over a measly $200,000. The work that we have done the last few years has been phenomenal. How God arranged for me to teach in hospitals and medical schools around the planet - Taiwan, Venezuela, Turkey, Mexico, Canada, Holland, Portugal, China, Trinidad, Croatia - I'll never figure that out. I laugh out loud sometimes when I get up in front of an audience of physicians in a medical school overseas - who all want to hear about waterbirth and the incorporation of Gentle Birth practices and principles into their routines. Think about what you can do and call me if you want to chat or if you have some great ideas on how we can quickly move into the black and keep waterbirth alive and thriving. We need your help. Barbara Harper needs your help. The waterbirth/gentlebirth movement needs your help.

Blessings,

Barbara

Barbara Harper, RN, CLD, CCE Founder/Director Waterbirth International
www.waterbirth.org
503-673-0026 - office (out of US or in Portland)
800-641-2229 - toll free
503-710-7975 - cell phone

We LOVE helping women get into Hot Water!! And have been doing it for 24 years!!

Mama!

Alder's first word: Mama. He's not even 8 months old, but it is crystal clear that he is trying to talk to me. It sounds more like mamamamammaamammama, but he ONLY does it when he WANTS me and it is really obvious he's trying to get me to come pick him up. If Keith picks him up instead, he continues to say mamamamama. I just love it. Ava wasn't identifyably saying mama until like 12-14 months, so this just really speaks to my heart.

Yep, Alder is a mama's boy.

"I don't want to!"

This is how my 2.5-year old says NO. We rarely ever hear the word NO around here. Is that weird? A toddler-near-preschooler who doesn't say NO? "I don't want to!" I absolutely love the way she says this. It sounds so polite, so mature (at least compared to screaming NO!). Ask her if she wants toast for dinner and she says, "I don't want to." I have no clue how we grew a child who doesn't say NO, but I love it and hope Alder follows in her footsteps.

Year in review

My buddy Amanda did a year in review like this, and I like the idea so much I'm stealing it for myself.

2008 In Review

January - I was 4-5 months pregnant and I turned 31. Keith and I rented a yurt for the weekend to celebrate and went there ALONE. As in, Ava stayed home with Grandma and Grandpa. It was a first, and it went really well. We also (on my birthday) learned that we were going to be having a little boy. And, though a strange twist of fate involving the death of a friend's dog, we realized this little boy would be named Alder.

February - One of my very dear friends committed suicide. This was a hard blow and to this day, I still see her ghost ALL OVER campus. We were workout buddies so her presence is especially strong in the gym. I missed her memorial service because we (the family) flew to Virginia to visit my folks during this time. We all got extremely sick the second we stepped off the plane, so the entire week-long visit was spent just trying to survive. Ava met my Grandmother for the first (and probably last) time, though she was in a feverish haze and probably had no idea what was going on.

March - Sinus infection hell for me. I finally give in to antiobiotics - something I prefer to avoid when pregnant (well, I prefer to avoid them at all times actually). I finished my final term as a full-time student (because it was the last term I had an assistantship for). I attended an awesome birth for a dear friend.

April - I'm writing writing writing and trying to finish as much of my dissertation as possible before the baby comes. This is the final month we have Ava in daycare as well. The house gets rearranged in prep for the new baby. Keith turns 35 and I throw him a party, despite feeling like a giant whale with my growing belly. We decide to tile the backsplash in the kitchen as one list big project before life gets crazier.

May - We spend Cinco de Mayo in a yurt on the coast when I am 36 weeks pregnant. It is not the most comfortable experience of my life. Ava loves the beach, as always. My Blessingway happens on Mother's Day at 37 weeks pregnant. Five days later, Alder comes blasting into the world. It was a fantastic birth and is the highlight of the year.

June - My parents come visit to meet their new grandson. It is wonderful to have them here to help with the kids. Most of the month passes in a blur as we adjust to living as a family of four.

July - Ava potty trains at just under two years old. We brave the wilds on a camping trip WITH BOTH KIDS to Sunset Bay. It was tiring, but fun. Ava looooooooves camping. Ava turns two at the end of the month and bawls at the candle smoking on her cake.

August - I get myself back at school more frequently now, back on the track to finishing. My wonderfully generous in-laws agree to watch both kids for half-days three times a week. Wow. I attend a surprise premature birth on the very same night Alder sleeps straight through for the first time, so he didn't even know I was gone. I am struck by a terrible case of tendonitis in my right foot and can only limp short distances. I We brave another camping trip, this time down a looooong and nearly impassable (for Honda Civics anyway) primitive road at Olallie Lake. It was another great trip.

September - We cram in one more camping trip before the weather turns fowl, this time to Ice Cap Creek. We've got camping down to a science now, so this is the most enjoyable one of the summer. We actually get to relax a little. At the end of the month, Keith and I celebrate our 3rd anniversary with a nice dinner out ALONE. I attend a really awesome midwife assistant's training. And as always, I'm working hard at school.

October - We head out to the Wallowa Mountains for a "deluxe" cabin trip. It is glorious out there, and since it is late in the season, almost no one is around. On the drive out, I get a call from my brother that my aunt and godmother is dieing. Our vacation is cut short so I can fly out to Virginia to be with her. On Sunday, October 14th, after four days of providing hospice care alongside my mother and brother, I hold my aunt's hand as she passes away. At the age of 58, she died of liver and kidney failure after decades of depression and alcoholism. I brought Alder with me on the trip, so she got to meet him before she died. We return to Oregon and proceed to do nothing for the next several weeks as I process this loss.

November - Back at school, trudging along. I finish my dissertation (a draft anyway). I attend another amazing birth for a good friend. Alder turns six months old and gets his first taste of food, which coincides exactly with him starting to sleep through the night almost all the time. And I finally admit to both an eating disorder (and I'm not ready to say anything more about that right now) and long-standing depression. I find myself a good shrink.

December - Constant work on the dissertation. I'm very near the end now. Just revising based on comments I've gotten on the final chapter. But it is still a slow process. Both kids start attending daycare two days a week again, and the in-laws drop their care down to two days a week. So now I have four days to work. We spend a little holiday time up at a cabin in the snowy mountains. Ava loooooves to dig in the snow. We all get sick this month, for pretty much the entire month. Ava gets croup, Alder gets an ear infection that bursts. I have a sinus infection. Keith gets food poisoning. And when those things weren't happening, we all had colds. I ring in the new year with just Keith as company, as our guests for the evening left before the ball dropped.

Midwife gift

It is customary to give your midwife a gift if you have appreciated your services after a homebirth. I always knew I wanted to give my midwife something handmade. After Ava's birth, we hoped I would have time to make some stained glass, or that Keith would have time to do some pottery. But that didn't happen, so her gift ended up being a check (which is always welcome, as homebirth midwifery does not make you rich!). But this time I really wanted to find the time to make a special gift. And somehow, even though I've got two kids and am finishing my PhD and work as a birth doula, I managed to make it happen. The piece above was actually quite easy to make compared to my previous pieces. There were far less curves to grind out on this one. The lead came and solder are silver in color, though you can't tell from the picture. I like this pattern quite a bit. I think I'll be making another one for myself.

Oh, and the really cool thing about this - the week before I gave my midwife this piece, she was at my house for the Blessingway of another expectant mommy and she commented on the large fish and turtle glass piece I have in my bathroom window. She said it was really gorgeous and remembered that I used to do glass work and was glad to see I'd gotten back to it. :) I didn't tell her at the time I had this gift for her, because it wasn't finished yet. But it made me feel really good to know she was going to appreciate my gift. And she did.

Peas

I know it is normal for kids to be picky eaters at times. But what about an infant that doesn't want to eat anything but peas? Alder is just nuts about peas. He won't touch fruit. He is not a fan of cereal. He doesn't even like sweet potatoes. But peas? He'll chow 3 jars for every meal. (no, we don't give him 3 jars of peas for every meal) I'm hoping this phase passes soon, or else my kid is going to turn into a pea.