My kids are so funny!

Eating popsicles:

Autumn: "Oh nooooo... now I have a HUGE ice-cream head-aaaaaaaaycccccchhhhheeee"

Explaining the world:
Madeline: "Autumn did you know that when your blood is in your body, its blue?"
Autumn: "Really?"
Madeline: "Yes, when it comes out of your body it turns red because of the air temperature".

LOL

In honor of Madeline's sixth birthday... HER birthstory

NOTE: This story is virtually unchanged since I wrote it nearly six years ago. It does nothing to capture the heartache and sadness I experienced from all the interventions. It also doesn't say anything regarding the terrible side-effects Madeline and I suffered from the epidural, or from having my waters ruptured at what ended-up being 35/36 weeks gestation not 37 weeks as they had thought. I have very little sensory memory of her birth, its more like watching a movie based on information from Hal, my medical file and reading this story that I wrote a few days later.

Early labor began on Wednesday November 19th at night. I was having uncomfortable contractions that made it hard to sleep. On Thursday, they began to get somewhat painful. I spent the whole day laying on the couch, timing. I took baths and a long walk with Keyser in the rain. By 3pm they were getting seriously uncomfortable and I decided to call the doctor. They told me to go to the hospital where I was assessed. My contractions stopped, of course and my cervix was doing NOTHING! They had me walk around the hospital for two hours and rechecked me- STILL NOTHING! So I was sent home.

Friday brought more of the same and worse. When I got up I took a long, hot shower which helped a bit. I lay on the couch for awhile and then we took a walk. The contractions became more regular and were finally too painful to walk and talk through. After suffering until nearly 2 am on Saturday we decided it was time to go in. When we finally got there, I was checked and to my suprise, I was 90% effaced and 3 cm dilated! The doctor told me to walk for two hours and they would check me again for progress.

So we walked and walked. As the contractions became stronger and stronger, I could not walk through them and was getting very irritated by Hal's coaching. By the time 4 am rolled around, I was seriously getting exhausted. I started crying, because I thought they were planning to send me home again. The doctor came back and I was told they were going to break my water. At this time I was also offered an epidural, which I steadfastly refused. The breathing was working very well and I wanted to keep my birth as natural as possible. But the breaking of my bag of waters was too painful and I ended up with an epidural.

We slept for nearly an hour. I was wearing oxygen as well, so it was all very surreal. I woke just as the doctor came in. He checked me and found that I was fully dilated and began explaining to me how to push. I woke Hal up and he called everyone and told them to hit the road- Madeline was coming!!! At 7:30 am we began pushing. It was a piece of cake- after thirty minutes of pushing Madeline was crowning. Fifteen more minutes and she was born!

Madeline was still covered with vernix and her head totally covered in dark hair. When her eyes opened, we saw they were a beautiful shade of slate blue. When they took Madeline to the warming table to be weighed and wrapped, she began crying with a sweet little girl cry that you only hear on television. Hal went with her and began singing, "You Are My Sunshine" using the same voice he had sang to her with when I was pregnant. Madeline immediately stopped crying and looked up at him.

Dissing the birth plan?

I've read and heard a an increasing amount of chatter against the birth plan. L&D nurses feel that the moms who come in with a "plan" have a higher chance of having their birth go in the other direction. Doulas and midwives have questioned the wisdom of having a birth plan at a hospital birth. I feel very strongly in the power of the birth plan as a discussion tool for everyone involved in the birth.

A birth plan should not be a list of demands.
That's right, in fact I don't even think it is a "plan" per se. I see it as a list of preferences (that's why I encourage my clients to call them "Birth Preferences". One cannot plan birth! But it is important for a mother to be treated with respect and not be subject to touch or exam that she is not comfortable with and she needs a way to communicate this to her care providers that is succinct and to the point.

A birth plan should be agreed to by all parties involved in the birth.
This is where the biggest benefit of the birth plan comes into play. The birth plan is above all a discussion tool. Its real power lies in having it finished as the third trimester begins and bringing it to every prenatal visit the mother has (usually weekly by 36 weeks.) Discussing it with every OB/Midwife/Nurse/Doula the mother has and asking them for their input. And of course, having things that might go against protocol put into the mother's chart! The CPs don't have to "sign off" on the birth plan necessarily (they're usually reluctant to sign off on anything that isn't theirs) but putting it into the chart essentially means that even if that person isn't present at the birth- the attending CPs will follow these preferences, even if they are unorthodox.

This also means that the birth plan is subject to revision, again and again and again... However, if a mother feels that she is being asked to change and compromise on issues that are important to her, perhaps it is time to look for a new care provider. Childbirth Connection has a great article on choosing a care provider and choosing a place of birth and why they are so important.

A birth plan helps define your CP's view of an emergency.
Most birth plans start out with something like, "In the absence of complications". And most CPs will agree to many of the items on the birth plan by saying things like, "That's fine, as long as everything is okay." But this should not be the end of the discussion. Most of the time CPs have a very different view of emergency than parents. Parents imagine alarms going off, mom and baby clearly in distress with no time or room for discussion. This is a crash-emergency and very, very rare. CPs know that emergencies in birth happen quietly and can be mysterious, unfolding unseen for the most part- and feel that they are preventable if monitored and graphed for every flutter and fluctuation.

So mothers should be prodding, asking what the CP views as not-okay or abnormal. And this will flush out exactly how much arguing, delaying and resisting the mother will have to do in her birthing time. Even with the strongest birth partner and most experienced doula, the last thing a mother should be doing is fighting to have her wishes respected. This is the time to gauge if you can trust that CP to be a lifeguard, stepping in only when truly necessary. And if that isn't the case, see the section above for those articles from Childbirth Connection.

In the broader picture, birth plans will change childbirth.
Yes, I know that many care providers dismiss birth plans as crazy-hippy-unreasonable barriers to providing life saving care. But I also know that as care providers begin to see more and more mothers with birth preferences backed by evidenced-based care rather than hospital protocols and see mothers leaving their care if the CPs refuse to provide it they will be forced to re-examine their "protocols" and consider change or lose market share. Certainly, there will also be a large number of mothers who simply agree to go with the flow and not prefer otherwise. But for those who are interested in consumer-driven care the birth plan is a powerful tool to create change.

"THE" question of homebirth

It is inevitable. In every single childbirth education class and doula prenatal meeting I lead, I am asked THE question. It never fails. Sometimes a particularly well-read mother or partner asks it at our first meeting before we even start getting “down to business”. Other times it does not come up until the last meeting, after we have watched videos of particularly beautiful births and we are saying good bye, “Until the baby comes”. But most often THE question is asked when we are talking about all the interventions offered at births in hospitals and discussing the evidence supporting the interventions and their benefits and risks.

So what is THE question? No, it is NOT, “Can I hire you to be my doula?”. The question is, in some way, shape or form, “Can I have a homebirth?”. And sadly my response is always along the lines of, “What county do you live in?” Because where I live, teach and doula homebirth midwives are no longer attending births or at least not advertising their services as such. You have to know someone, who knows someone, who can put you in touch with someone… you get the point. Basically, my answer is a qualified, “no” while my heart is screaming, “Yes! Yes! Yes!”

As an hypnosis for childbirth instructor and a doula, the majority of my students and clients are seeking a natural birth experience. They are also mostly low-risk, under 40 and somewhat knowledgeable about birth. They come to me because they want a different experience than they have had with prior births or than the horror stories they have encountered in the media or from friends. I teach them about all the terminology, the tests and ways to negotiate to get what they want. I talk to them about strategies to get care providers to slow down and listen to them and when all else fails to bring a man in a suit (the father or grandfather of the baby) to intimidate their care providers into taking them seriously. I also ask them to seriously consider where they are birthing and with whom and explain the midwife’s model of care. During all this I know, that the best chance they have to achieve their desire of a gentle, natural birth is giving birth at home and living in Pittsburgh, they do not have that option.

When I am with a birthing mother, in her home, helping her to relax and “nest”, watching her go from uncertain to confident and comfortable in her temporary role, I cannot help but think about what is to come. How, at some point ,we are going to have to decide to interrupt the wonderful birthing dance and move her to a new place with new people, bright lights and invasive exams and monitors. We are going to ask her to let go of her inward focus and answer questions about her pain level, contraction frequency and duration and many other things so that “we” can figure out what her body is doing and how“fix it” or make it go faster and “better”. How, when we arrive and check in, there is very little I, as the doula, can do to stop the cascade of interventions if for some reason, her body takes longer than average to dilate, her baby descends more slowly than desired or if her urge to push is delayed or takes longer than “necessary”. It feels like a crime that this mother is not allowed to just remain in her own space, with a watchful and respectful birth attendant.

As a doula, the best solution I have found is encouraging my clients and students to stay at home as long as possible. However, this strategy has several flaws. One, if a mom has tested positive for Group Beta Strep and her bag of waters has ruptured, the current accepted model of care for GBS+ is repeated doses of antibiotics to prevent infection in the baby. Since many births, especially first births, last over 12 hours this means that the mother would have to leave her home repeatedly during the course of her birth to be administered antibiotics and then return home. This back-and-forth can cause unnecessary stress and aggravation to the mother and take a toll on birth progress.

Another drawback is the expectation of having to move. This can prolong a labor because the mother is “holding back” or has fears about her comfort during the transition to a new place. So while, it is in the mother’s best interest to remain at home, the anticipation of a move causes tension, which interferes with cervical changes. Then when the mother arrives at her birthing location, she finds that she is not as far along as she had hoped and the cascade of interventions begins.
Especially with first time mothers and in cases of prodromal labor, it can be hard to tell “where” a mother is in her birth and whether we should go or I should encourage her to wait through another contraction or period of time. Women can experience “transition-like” sensations at different times during their births and it can be hard to gauge where she is without the luxury of additional time. And while precipitous births in cars are rare, it is still something that can happen if the couple waits “too long”. And what doula wants to bear the responsibility of having suggested they wait longer?

The irrational “illegality” of homebirth robs women of the opportunity to birth unmolested, it robs babies of the opportunity to have a truly natural birth and it robs families of the empowerment that comes from taking charge of their care. As a doula, I teach the contradiction: The parents have the ultimate right and power to make decisions about their and their child’s care BUT they do not have the option to give birth in their own homes. As I get that question more often and families begin to stand up for their rights in hospital settings, hopefully they will also demand their right to birth at home.

Hospitals are banning certain types of births in Massachusetts

In a February 20, 2009 report by the International Cesarean Awareness Network some 821 hospitals in the country are banning a certain type of birth, while another 612 simply don't have doctors practicing that would support it.

VBAC (pronounced vee-back), stands for Vaginal Birth After Cesarean. Studies show that risks exist for both VBAC deliveries and elective repeat cesearan sections or ERCS. According to a 2008 study review published in the September edition of American Journal of Obstetrics and Gynecology the outcomes of successful VBACs were more favorable than ERCS. Most studies recommend the decision for a trial of labor after cesarean section to be made on a case by case basis. This decision should involve input from both the patient and the care provider and observe risk factors for both forms of birth. Read On...

AAN: Breast-Feeding Benefits Multiple Sclerosis Patients

FRIDAY, Feb. 20 (HealthDay News) -- In new mothers with multiple sclerosis,
exclusive breast-feeding may significantly reduce the risk of postpartum
relapses, according to research that will be presented April 25-May 2 at the
annual meeting of the American Academy of Neurology in Seattle.

Annette Langer-Gould, M.D., of Stanford University in Palo Alto,
Calif., and colleagues studied 32 pregnant women with multiple sclerosis and 29 age-matched pregnant controls who were assessed during each trimester and at two, four, six, nine and 12 months postpartum.

Among the multiple sclerosis patients, the researchers found that the rate
of postpartum relapse was significantly lower among those who breast-fed
exclusively for at least two months compared to those who did not breast-feed or began regular supplemental feedings within two months postpartum (36 percent versus 87 percent). Although most of the women who avoided breast-feeding did so in order to resume multiple sclerosis therapy, the researchers found that the risk of relapse was significantly higher among those who restarted therapy within two months postpartum than in those who did not, regardless of breast-feeding status. They also found that exclusive breast-feeding was associated with a later return of menses.

"Our findings call into question the benefit of foregoing breast-feeding in
order to start multiple sclerosis therapies and should be confirmed in a larger
study," the authors conclude. Read On...

The Trouble With Repeat Cesareans

For many pregnant women in America, it is easier today to walk into a hospital and request major abdominal surgery than it is to give birth as nature intended. Jessica Barton knows this all too well. At 33, the curriculum developer in Santa Barbara, Calif., is expecting her second child in June. But since her first child ended up being delivered by cesarean section, she can't find an obstetrician in her county who will let her even try to push this go-round. And she could locate only one doctor in nearby Ventura County who allows the option of vaginal birth after cesarean (VBAC). But what if he's not on call the day she goes into labor? That's why, in order to give birth the old-fashioned way, Barton is planning to go to UCLA Medical Center in Los Angeles. "One of my biggest worries is the 100-mile drive to the hospital," she says. "It can take from 2 to 3 1/2 hours. I know it will be uncomfortable, and I worry about waiting too long and giving birth in the car." Read On...

In celebration!

Of this AMAZING day, that I never allowed myself to imagine would come... I am re-posting my blog posts from when I was working on the Obama Primary Campaign. I was neighborhood captain for Franklin Park and we won our district by 100 votes! While he lost PA, it was the most amazing and life changing experience of my life and I am so grateful to have had it.

In her own words... (ORIG 8/25/08)

And as I tuck that little girl and her little sister into bed at night, I think about how one day, they'll have families of their own. And one day, they - and your sons and daughters - will tell their own children about what we did together in this election. They'll tell them how this time, we listened to our hopes, instead of our fears. How this time, we decided to stop doubting and to start dreaming. How this time, in this great country - where a girl from the South Side of Chicago can go to college and law school, and the son of a single mother from Hawaii can go all the way to the White House - we committed ourselves to building the world as it should be.

So tonight, in honor of my father's memory and my daughters' future - out of gratitude to those whose triumphs we mark this week, and those whose everyday sacrifices have brought us to this moment - let us devote ourselves to finishing their work; let us work together to fulfill their hopes; and let us stand together to elect Barack Obama President of the United States of America.

-Michelle Obama, August 25, 2008, Democratic National Convention

Thank you Michelle. This IS why we're working so hard to elect Barack. Thank you.

Wow, a really special suprise! (ORIG 4/12/08)

Yesterday, David Plouffe (yes, the national director for the Obama campaign!) was in Greensburg to speak with the press and undecided Western PA delegates about Barack Obama. He also took time to speak with representatives of the top Western PA neighborhood teams and I had the privilege of representing Franklin Park/Marshall/Brad Woods! He acknowledged the tremendous progress we've made both with weekend canvasses and weeknight phone banks- to the tune of 1000 doors last weekend and countless calls this week alone. Because David has Barack's ear directly, this is the same as reporting directly to the man, himself. So you all should feel incredibly proud and recognized for your accomplishments since we met two weeks ago at the YWCA. Senator Obama now knows specifically how hard we are working for him in our neighborhood.

Since I told my story I feel like now Barack Obama is accountably... while he has always known that people like me were working for him... now I've had a chance to tell him my personal story and he'll feel all the more accountable once he is president.

Wow, what an AMAZING night... (ORIG 4/9/08)

Tonight we held a Women for Obama Wednesday phone bank... what great night! Five strong women calling voters and volunteers to build support in our community for Barack.

We started our with some delicious dinner of pizza and salad (Thanks Terri!)... then had an unbelievably inspiring conference call with... Michelle Obama! (yes, that's right! the lady herself took time to talk with us about the campaign!) Then... well, let's just say we really kicked butt! Approximately 300 calls later we have 4 more GOTV volunteers and a number of identified Obama supporters and undecideds! AWESOME work ladies... those are amazing numbers. It is this work that is building Barack's support in PA.

But as Michelle said tonight, the bar is constantly being raised and we still have some serious work to do before April 22nd. So please, help get out the vote in Pennsylvania by logging onto http://pateams.barackobama.com and creating your account. THE, come to one of our many events and be sure to sign up for the exciting GOTV weekend events. This campaign is about me and you and it will not succeed unless we get out there and make it happen!

From the mouth of my baby... (ORIG 4/8/08)

I just wanted to share an inspirational story...

Today my daughter (4 yo) was helping me stuff envelopes with invites to my Women for Obama party this weekend. She told me (As she has many times) that she is going to vote for Barack Obama. I said, "Oh honey, you know that you have to be 18 to vote." And she replied, "Well, I'm voting for him by stuffing these envelopes. I'm doing it my own way."

For me, working on the campaign is truly about her, my younger daughter and everyone elses' kids... They don't get a voice, we have to be their voice in this election. If we are going to get America back on track and give them chance at a future that is peaceful and secure with even better opportunities for them (and the world) we need Barack elected as President this year... not in four or eight years.

Sometimes you hit it out of the ballpark... (ORIG date 3/19/08)

I am really struggling to express how this speech made me feel... Over the past week, I have struggled with my sadness over the reaction of the pundits, people I know and people I don't know over the issue of race in this primary. It has made me angry, sad, hopeless, desperate and enraged. And how I hoped for Senator Obama to address us, to tell us his story and give me back my hope that we can work towards healing... and he did.
and so much more than that. When I listen to this speech (and I have three or four times) it truly makes me want to believe in the best in ourselves, myself. It makes me want to BE the imperfect human always working towards making myself better and to make better choices and judgments... and it reminds me that this imperfection and good exists in EVERYONE I see... whether I can see it or not.
This speech also gave me hope that my children have a real good chance of living in a better world than we do right now. That they will have the chance to take this to the next step... a world without prejudice towards anyone's difference. A place where we all work to bring out the best in each other and where we help each other overcome our weaknesses.
This speech could mark the start of a new kind of liberalism, where no one has to be ashamed for having a "soft heart" or to ask for help. Where the desire to use one's strengths to help another overcome their own weaknesses is celebrated rather than ridiculed and where the phrase "tough love" doesn't have a place.

YES, WE CAN! (Original post 3/16/08)

we're going! i'll have to take dh's smart phone to take pics b/c i don't think you're allowed cameras... what a memory for dd1, and i am sooooooooooo happy to finally get to see my candidate speak in person. my dh RAWKS! he drove 45 minutes on a sunday morning and is going to watch the baby tomorrow, just so i can go...

Canvassing Pittsburgh (ORIGINALLY POSTED 3/1/08)

Today I canvassed for the next President of the United States... what an AMAZING experience! People filled the tiny office set up for the campaign, flowing out into the streets of East Liberty. Others, happening by, stopped to see what was going on and were drawn in by the enthusiasm and friendliness of Obama supporters. Two older gentlemen helped me find a free parking spot (I was out of change!) and held my arm as we navigated the ice-covered sidewalks to the headquarters together, talking, hopefully, about politics. They were black men and got tears telling me what it meant to them to see a black man with a real chance at becoming president. I cannot even begin to imagine how they truly feel.

Then, inside, it was beautiful. People of all ages, all colors, tall and short were standing together, listening to a staffer tell us what to do. She was young and embodied the spirit we were all feeling in that room. Then, everyone broke off to get neighborhood assignments and pair up. I met an woman in her 50s and we headed out to canvass...

It was truly amazing. I made a new friend and together we went house to house, talking about feminism, politics, architecture and of course how we are hard-pressed to exactly articulate why we believe so deeply in Barack Obama. House by house we rang doorbells and knocked. Mostly no one answered, either they were not home or did not want to talk to two strangers with clipboards. But at a few homes we spoke with voters, at two homes we left behind registration forms and at one home we actually got a registration change form!

The feeling from knowing that I may have helped secure one more vote for Barack here in Pennsylvania is elating. Today, not only have I helped him get one vote closer to being the democratic nominee, but I also took back the process from "the powers that be" and helped another individual voice be heard.

It is a great feeling. Volunteer to canvass. Truly. It is an amazing way to meet people, get some exercise and help your country.

barack (ORIGINALLY POSTED 1/4/08)

happy is not even close to how i feel about what happened in iowa. i trust him for some reason... his energy is so real and genuine. what an amazing person. i recently put up a sign for him in our front window. i live in an upwardly mobile upper-middle class community with rules. we shall see if i get a letter from the homeowner's association. i know my rights, so it is not coming down until inauguration day :) and maybe not even then!

i do get scared that something bad will happen to him. when i was in school, a teach told us that the reason there had not been a black president yet was because it was commonly understood that the first black president would be assassinated. what an ignorant statement. still, it has stuck with me. i was not alive when kennedy was president, but barack really reminds me of the movies i have seen of kennedy. so youthful, (finally) representing the future, positive about change instead of spewing what is wrong about the country. that makes me feel so scared because there are so many in this country that have a vested interest in making sure things do not change.

all i know is that for the first time in 8 years or more, i feel truly hopeful that we can change the direction in this country.