Thursday, November 18, 2010

new resources

I have updates some of the resources on my pages, including finally adding the Breastfeeding Resources page and the Baby Care Resources page. I will be adding more to them as I bring the links and books in, but if you have anything to contribute, please let me know!

Monday, November 15, 2010

busy bodies

Life has taken over these last few months, what with school kicking into high gear and a new job for me. Oy! But we are all here, still kicking, and I am hoping for more up-to-date posts soon as the season gets cooler. One thing is for sure--Esme has been a ham for the camera lately. Here are some pics of her with my coonhound, Minnie.

Sunday, October 10, 2010


I knit this scarf for my Oma for Christmas. The pattern is Drop Stitch Scarf by Christine Vogel, and can be purchased from Frazzled Knits. I used an wool-acrylic blend and cast on almost twice as many stitches in order to make the scarf wider.

This round cloth was knit for a swap using cotton and is from 1870 Pearl's Pinwheel pattern.

For the same swap, I also knit another cloth, also with cotton, using one of my favorite patterns, Chinese Waves from Maggie's Rags.

This little scrubbie, also knit for the swap, is another of 1870's pattern's--Tribbles. It was easy and fun, really only took an hour or so to finish.

I made this pair of shoes for my cousin's newborn little girl. They are lined with extra soft fleece to keep her toes warm this fall.

This bag has taken me forever to finish. It has been knit up for ages, I just never quite got around to the felting. Over four years later, it is finally done--and may be my longest knitting project! I’m really pleased with how the colors turned out. The pattern is Fulled Lopi Tote from Adrian Bizila.

I knit this pair of Sartjee's Bootees for a friend’s gender neutral layette. I used scrap wool-blend yarn for this excellent, fast-knit project! Finished one bootie in June in just one brief sitting, but didn’t get around to the second bootie until September.

I sewed up this little drawstring project bag for a swap this past spring. I loved the alternating patterns of the fabric. It is the perfect size for a small project, like socks or a hat.

Monday, September 27, 2010

beetle juice?

After reading about the voluntary recall by Abbott Laboratories for the 5 million units of Similac baby formula contaminated with beetle parts and larvae, I was not surprised in the least. Formula recalls are a constant and regular occurrence, with 17 major baby formula recalls since 2000, and countless more in the two decades before that, according to NABA. However, the recall is voluntary, as the FDA determined that the presence of the beetles poses "no immediate health risks," aside from"symptoms of gastrointestinal discomfort and refusal to eat."

Nor I am not surprised in the FDA's stand on this issue. Actually, many of the processed foods that are regularly consumed in the United States contain more than only traces of bacteria and microscopic insects and are considered by the FDA to be safe for human consumption. Bacteria and small insects are regularly present in all forms of baby formula sold in the US, especially as there is no way to produce a perfectly sterilized product, which, according to the FDA, there is an expected allowance, and the number of beetles in the Similac formula recall falls into that allowance.

Then I read this article, Similac Recall Outrages Parents: Are Beetles Bad? from Time Magazine. I have some knee-jerk reactions, not to the formula recall, but to the article itself.

One particular aspect of the article, the statement, "It may be extremely difficult to determine whether beetles are responsible for a baby's symptoms. Inconsolable crying might simply be, well, inconsolable crying, which is sometimes just what babies do," was a jaw-dropper for me. Inconsolable crying is not normal. It is a sign that something is wrong. I know my babies. If they ever cried inconsolably (which was very, very seldom, as their needs were met directly, and in most cases, before it came to crying), then I knew that there was something seriously wrong. Inconsolable crying is a very direct cue for the mother or father to find out what is wrong and fix it promptly.

Another statement that then floored me was the closing of the article:

Not surprisingly, news of the recall rekindled bottle vs. breast animosities, if only online. One woman predicted breastfeeding advocates would wax triumphant. "Very upsetting, and here comes the ‘breast is best!' brigade to add to the anxiety by telling us all we asked for it." Sure enough, another poster wrote, "Yea, breastfeeding is the best. My breastmilk has never ha(d) beetle parts in it." [...] As millions of parents are reeling from the thought that their babies have chowed on bugs, it's a time for support, not gloating.
First of all the Breast is Best 'brigade' (or campaign) exists primarily to promote awareness of the true dangers of formula feeding. Breast IS the best provider of nutrition and immunity for baby, and formula is inferior in that babies who are fed formula as their sole source of nutrition tend to, on average, have lower IQs, suffer from more ailments and infections, and cry more than their breastfed counterparts. When a mother chooses formula, as with anything processed, she takes a risk with the health and nutrition of her baby.

However, for the Breast is Best campaign to be considered successful, facts and information must be available and presented to ALL mothers up front in order for a mother to make an informed decision on how she chooses to feed her infant. Furthermore, informed consent is only valid if the mother who tried (and failed) to breastfeed received TRUE assistance and diagnoses in regards to the problems she faced. How many women do I know who state they "could not" breastfeed for reasons that I, as a birth and postpartum professional, realize are fairly easy fixes had the mother actually had true, trained and knowledgeable assistance? The number is countless. And growing at a steady rate. Many times, it is hard for a mother to know which advice is sound and informed, and which advice is unintentionally misinformed or just plain ignorant.

As a mother who once was faced with the option of breastmilk or formula, I would rather have the facts--the other course is to sugar-coat everything and leave out what is legitimately important information to a major decision of parenting. That this article yet again plays the "guilt" card, comparing any pro-breastfeeding statements to "gloating," irks me. After hearing about this recall, I am thankful that I breastfeed. I am glad I had the foresight, resources and ability to seek out true, factual information regarding the risks of formula when I was pregnant with my first child. And I consider it a true disservice not to pass on my knowledge and the facts to other mothers. Every mother deserves truth and knowledge to lead her to an informed decision. I am glad I did not have to face any of the severe gastrointestional problems many babies are currently recovering from. My heart goes out, yet I continue to remain thankful.

Sunday, August 8, 2010

another batch for baby

Like I have said before, apparently everyone in my life is having a baby. And I have been busy knitting little baby things for these teeny arrivals. One of my projects has been sitting in my knitting basket since April, and with all the crazy things happening around here in the last week, I have had the opportunity to do some mindless knitting and get it done. Take a look:

The pattern is Organic Heirloom Blanket, which can be found in Hadley Fierlinger's book Vintage Knits for Modern Babies. I used some miscellaneous nylon blend yarn from Plymouth Yarn. It is very soft and nice and fine. Please note that there is an errata in the pattern as published. Cast on 124 sts (instead of 125, as published).

Saturday, August 7, 2010

wrapping up World Breastfeeding Week by nursing with confidence

Painting by Katie M. Berggren.

Today brings an end to World Breastfeeding Week 2010. Yesterday, I had the opportunity to talk with one new nursing mother, congratulate her on the arrival of a beautiful baby girl and give her some information and suggestions for breastfeeding in public, something she was very nervous about.

Many new mothers fear nursing in public more than anything else about motherhood. I know I did. I was afraid of flashing someone, of showing too much skin or breast or tummy, of making others uncomfortable, of someone confronting me. I could never get the hang of using a nursing cover. I could not see what I was doing, could not check position and latch. Plus, the cover constantly slipped down or bunched up. It was more distracting to those around me when I used the cover than when I nursed without one. Instead, I opted to dress in layers or wear nursing tops that strategically covered my breasts and stomach. By a few months, I was a pro at nursing in public.

I have been breastfeeding for seven years now. I have nursed everywhere, from airplanes to buses, from the beach to amusement parks, from restaurants to museums. Not once has anyone told me to cover up while I was nursing in public. In my seven years of breastfeeding, I have never been hassled for nursing in public. I got an eye roll then narrow from an older woman once in a mall food court, but that has been the extent of negative experience, though I was always prepared with some witty comeback if someone asked me to put a blanket over my baby's head or feed my baby in the bathroom.

There are articles everywhere of women being harassed for nursing in public, of those mothers who are told they cannot nurse here or there, who are forced out of restaurants and out of parks. You read all of the time about women asked to leave restaurants and public buildings because they were nursing. But why didn't anyone say anything about nursing in public to me?

What is my key to success? Confidence. I learned how to latch and position my baby quickly and smoothly without revealing much skin to nearby onlookers. I did not appear nervous or intentionally attempt to hide what I was doing. I instead, I looked like I was doing exactly what I was supposed to be doing. I was feeding my child the way Mother Nature intended. I made eye contact with those around me. I smiled and looked at my nursing child. I continued in conversation with my family and friends.

One thing that helped my confidence, almost above all else, was that the law in the United States is on the side of breastfeeding mothers. According to the National Conference of State Legislatures website, 44 states have laws with language specifically allowing women to breastfeed in any public or private location. On their Breastfeeding Laws page, they have a running list of state and federal laws in regards to breastfeeding. Another wonderful resource, from Mothering Magazine, is the map, Breastfeeding In Public: Are You Protected? I urge all breastfeeding mothers to know the law and educate themselves on their right to breastfeed. In a confrontation, many problems may be avoided if the mother is knowledgeable on legislation for the protection of breastfeeding in her state. With the government behind her, those who criticize will be more likely to lay off.

And I leave you with this wonderful story of a nursing in public escapade as told by The Poor Husband, I Used to Hate Camping on his blog Life with Rachael.

Friday, August 6, 2010

this moment

{this moment} - from SouleMama - A Friday ritual. A single photo - no words - capturing a moment from the week. A simple, special, extraordinary moment. A moment I want to pause, savor and remember. 

If you're inspired to do the same, leave a link to your 'moment' in the comments for all to find and see.

Wednesday, August 4, 2010

the normal newborn and why breastmilk is not just food

What is a normal, term human infant supposed to do?

First of all, a human baby is supposed to be born vaginally. Yes, I know that doesn't always happen, but we're just going to talk ideal, normal for now. We are supposed to be born vaginally because we need good bacteria. Human babies are sterile, without bacteria, at birth. It's no accident that we are born near the anus, an area that has lots of bacteria, most of which are good and necessary for normal gut health and development of the immune system. And the bacteria that are there are mom's bacteria, bacteria that she can provide antibodies against if the bacteria there aren't nice.

Then the baby is born and is supposed to go to mom. Right to her chest. The chest, right in between the breasts is the natural habitat of the newborn baby. (Fun factoid: our cardiac output, how much blood we circulate in a given minute, is distributed to places that are important. Lots goes to the kidney every minute, like 10% or so, and 20% goes to your brain. In a new mom, 23% goes to her chest- more than her brain. The body thinks that place is important!)

That chest area gives heat. The baby has been using mom's body for temperature regulation for ages. Why would they stop? With all that blood flow, it's going to be warm. The baby can use mom to get warm. When I was in my residency, we would put a cold baby "under the warmer" which meant a heater thingy next to mom. Now, as I have matured, if a baby is "under the warmer," the kid is under mom. I wouldn't like that. I like the kids on top of mom, snuggled.

Now we have a brand new baby on the warmer. That child is not hungry. Bringing a hungry baby into the world is a bad plan. And really, if they were hungry, can you please explain to me why my kids sucked the life force out of me in those last few weeks of pregnancy? They better have been getting food, or well, that would have been annoying and painful for nothing.

Every species has instinctual behaviors that allow the little ones to grow up to be big ones and keep the species going. Our kids are born into the world needing protection. Protection from disease and from predators. Yes, predators. Our kids don't know they've been born into a loving family in the 21st century- for all they know it's the 2nd century and they are in a cave surrounded by tigers. Our instinctive behaviors as baby humans need to help us stay protected. Babies get both disease protection and tiger protection from being on mom's chest. Presumably, we gave the baby some good bacteria when they arrived through the birth canal. That's the first step in disease protection. The next step is getting colostrum.

A newborn baby on mom's chest will pick their head up, lick their hands, maybe nuzzle mom, lick their hands and start to slide towards the breast. The kids have a preference for contrasts between light and dark, and for circles over other shapes. Think about that...there's a dark circle not too far away.

Mom's sweat smells like amniotic fluid, and that smell is on the child's hands (because there's been no bath yet!) and the baby uses that taste on their hand to follow mom's smell. The secretions coming from the glands on the areola (that dark circle) smell familiar too and help the baby get to the breast to get the colostrum which is going to feed the good bacteria and keep them protected from infection. The kids can attach by themselves. Watch for yourself! And if you just need colostrum to feed bacteria and not yourself, well, there doesn't have to be much. And there isn't because the kids aren't hungry and because Breastmilk is not food!

We're talking normal babies. Breastfeeding is normal. It's what babies are hardwired to do. 2009 or 209, the kids would all do the same thing: try to find the breast. Breastfeeding isn't special sauce, a leg up or a magic potion. It's not "best. " It's normal. Just normal. Designed for the needs of a vulnerable human infant. And nothing else designed to replace it is normal.

Colostrum also activates things in the baby's gut that then goes on to make the thymus grow. The thymus is part of the immune system. Growing your thymus is important. Breastmilk= big thymus, good immune system. Colostrum also has a bunch of something called Secretory Immunoglobulin A (SIgA). SIgA is made in the first few days of life and is infection protection specifically from mom. Cells in mom's gut watch what's coming through and if there's an infectious cell, a special cell in mom's gut called a plasma cell heads to the breast and helps the breast make SIgA in the milk to protect the baby. If mom and baby are together, like on mom's chest, then the baby is protected from what the two of them may be exposed to. Babies should be with mom.

And the tigers. What about them? Define "tiger" however you want. But if you are baby with no skills in self-protection, staying with mom, having a grasp reflex, and a startle reflex that helps you grab onto your mom, especially if she's hairy, makes sense. Babies know the difference between a bassinette and a human chest. When infants are separated from their mothers, they have a "despair- withdrawal" response. The despair part comes when they alone, separated. The kids are vocally expressing their desire not to be tiger food. When they are picked up, they stop crying. They are protected, warm and safe. If that despair cry is not answered, they withdraw. They get cold, have massive amounts of stress hormones released, drop their heart rate and get quiet. That's not a good baby. That's one who, well, is beyond despair. Normal babies want to be held, all the time.

And when do tigers hunt? At night. It makes no sense at all for our kids to sleep at night. They may be eaten. There's nothing really all that great about kids sleeping through the night. They should wake up and find their body guard. Daytime, well, not so many threats. They sleep better during the day. (Think about our response to our tigers-- sleep problems are a huge part of stress, depression, anxiety).

And sleep... My guess is everybody sleeps with their kids- whether they choose to or not and whether they admit to it or not. It's silly of us as healthcare providers to say "don't sleep with your baby" because we all do it. Sometimes accidentally. Sometimes intentionally. The kids are snuggly, it feels right and you are tired. So, normal babies breastfeed, stay at the breast, want to be held and sleep better when they are with their parents. Seems normal to me. But there is a difference between a normal baby and one that isn't. Safe sleep means that we are sober, in bed and not a couch or a recliner, breastfeeding, not smoking...being normal. If the circumstances are not normal, then sleeping with the baby is not safe.

That chest -to -chest contact is also brain development. Our kids had as many brain cells as they were ever going to have at 28 weeks of gestation. It's a jungle of waiting -to-be- connected cells. What we do as humans is create too much and then get rid of what we aren't using. We have like 8 nipples, a tail and webbed hands in the womb. If all goes well, we don't have those at birth. Create too much- get rid of what you aren't using. So, as you are snuggling, your child is hooking up happy brain cells and hopefully getting rid of the "eeeek" brain cells. Breastfeeding, skin-to-skin, is brain wiring. Not food.

Why go on and on about this? Because more and more mothers are choosing to breastfeed. But most women don't believe that the body that created that beautiful baby is capable of feeding that same child and we are supplementing more and more with infant formulas designed to be food. Why don't we trust our bodies post-partum? I don't know. But I hear over and over that the formula is because "I am just not satisfying him." Of course you are. Babies don't need to "eat" all the time- they need to be with you all the time- that's the ultimate satisfaction.

A baby at the breast is getting their immune system developed, activating their thymus, staying warm, feeling safe from predators, having normal sleep patterns and wiring their brain, and (oh by the way) getting some food in the process. They are not "hungry" --they are obeying instinct. The instinct that allows us to survive and make more of us.

Dr. Jennifer Thomas

Monday, July 26, 2010

heartfelt handmade bag swap

I got home from a very busy day at work yesterday to the most fabulous package from Angel waiting for me on the front step!

The bag is crochet and the colors are perfect! And I love the pink button! Also included in the package was a hank of re purposed yellow wool and a tin filled with notions! Awesome! Many thanks go out to Angel, who is so very thoughtful and generous! I already used the bag for my knitting today when I went to the park and I love it!

Tuesday, July 20, 2010

felt journal

This little felt journal is a simple, quick and practical project, great for little hands learning to sew. Evelyn made this pink bird notebook for her kids swap last month. The theme of the swap was anything Spring related, and her partner really likes the colors pink and blue. I drew the shape of the bird and she cut it out and stitched it on herself with a teeny bit of troubleshooting here and there.

Here is what we did: We used wool felt for the cover and the applique, but eco-felt works just fine, too. You can cut it to any size you desire. Sew on the applique or shapes of your choice, embellishing with beads, buttons, embroidery, or anything else. Cut a second piece of felt to line the inside of the cover to hide the stitches from the back of the applique. Then cut the paper you wish to use for the inside; we used plain white recycled scrap paper, cut to slightly smaller than the felt cover. Colored paper looks very nice, too.

Next, fold the pre-cut paper in half and punch a hole on the fold-seam. Then, with yarn or embroidery floss, sew through the layers and assemble the book by sewing along the seam. Tie the thread on the inside or the outside of the book. We left some string on the top end to create a little book marker and tied two colorful buttons to the bottom as weights (beads work perfectly, too!).

Then, take the embroidery floss and sew all around the edges, using either a running stitch or blanket stitch, to create a border and to attach the cover and liner.

The best part of this project is that you can experiment with different sizes and embellishments and come up with something completely different every time! 

summer lovin'

Monday, July 19, 2010

breastfeeding ad

I just wanted to share this new breastfeeding advertisement. From what I understand, it comes from the Brazilian breastfeeding campaign, though I do not know the original source.

The image is not what it seems. Take a look for a moment and see if you can figure it out. It didn't take me too long, but some people cannot see it!

my yarn stash

I have quite a stash of yarn. Right now, my stash consists of three large plastic tubs of acrylic blends in one tub, natural fiber blends in a second tub, and pure wool in the third tub, as well as one large tote bag full of cotton yarn. A lot of the yarn I have is either hand-dyed or hand-spun or one-of-a-kind in some way. And beautiful. Take a look at a few of the unique yarns I have collected:

Merino Sock Yarn from damselflyyarns
75% Superwash Merino wool, 25% nylon
200 yds, fingering weight, violets & purples

Geneva Cashmere Blend Sock Yarn from TraciKnits
80% Merino Wool/10% Cashmere/10% Nylon
435 yds, fingering weight, green & turquoise

Mulberry Merino from Plymouth Yarn
52% Mulberry Silk, 48% Merino
5 skeins, 495 yds, worsted weight, black

Silky from Malabrigo Yarn
50% Silk, 50% Baby Merino wool
3 skeins, 450 yards, DK weight, Archangel

Hand Dyed Chunky Alpaca from SoupToKnits
100% Alpaca
2 skeins, 212 yards, chunky

Tuesday, June 22, 2010

on the needles

I just finished the cutest knitting project ever! As a gift for David for Father's Day, I knit up this little elephant. The pattern, Flower Power Elephant, is from Ala Ela on Ravelry. I fell in love with it as soon as I saw it. This little guy was a very fast knit. He is nearly a foot long and occasionally tips forward since his trunk is so top-heavy. If you decide to knit one of these guys, I recommend placing a couple of rocks or weights in the rump to weigh it down a little.

I used the lovely Malabrigo Merino Worsted that I got last month in the Mal swap. I still have quite a bit of yarn left, and I thought I would knit up Maddox the Mischievous Monster from DangerCrafts with some of the leftovers.

And with the arrival of yet more babies, I knit a few more bibs to hand out as gifts. I really like the first one, which I adapted from the versatile Baby Bib'O Love pattern from Mason-Dixon Knitting. I did not get a good photo of the second bib, though, as I gifted it and forgot to snap a picture. But I used the pattern for the Petal Bib from One Skein in a rich brown cotton.

I also knit this hair bow for my eight-year-old daughter from Stefanie Fail's Moss Stitch Bow Headband. I shrunk down the size by CO 9 sts and worked until about 5 inches long. For the center piece, I CO 3 sts and did a few rows.

And, currently in progress, I am knitting another bib as well as a little shrug from the Malabrigo that David gave me for my birthday.

Friday, June 18, 2010

born in the caul

I just came across a very impowering homebirth story in pictures. The pictures are of the birth of a baby born in the caul, meaning he is born with the amniotic sac or membrane still intact around his body. The sac then balloons out around the baby at birth, covering his face and body as he emerges from the mother. When still inside the sac, a baby continues to be nourished through the umbilical cord and is not in danger of drowning and has nearly zero chance of neonatal infection. A baby born in the caul is very rare, especially in today's obstetrics, and children who are born in this way are considered, based on legend, lucky for life.

View Born in the Caul on homebirth midwife Beth Miller's website, Birthing Way to see this amazing birth.

Thursday, June 17, 2010

crowns for the forest spirits

We were out in the garden, trimming the trees, and we had so many nice leaves laying around the yard. After collecting a big pile of them, I decided to make the neighborhood girls some crowns made of the leaves!

The crowns will not last long, but they only took a few minutes to slap together. Here is what I did: I took a piece of construction paper (newspaper or scrap paper works fine) and cut it into one to two inch strips. I stapled two pieces together longways to make a ring, fitting it to each child's head. Then I took the leaves and stapled them one by one onto the paper ring, mostly pointing down, but in slightly different directions. These crowns could easily be made with flowers, fall leaves in bright colors, or even feathers!

Friday, June 11, 2010

may swap

I sent a swap package out to the Lady of the Month of May a few weeks ago, and she finally got it, so it is now safe for me to post pictures!

I used the Chinese Waves pattern for one of the cloths. This pattern has turned out to be a very simple and reliable knit over and over again. I highly recommend it if you are in search of a good scrubbing cloth--even though the pattern takes a little bit of practice and some patience to get the knack of.

For the green cloth, I used the double-bump cloth pattern. I also made another lovely little notions pouch. These pouches are very fun to make, and the options for creativity are endless. This particular pouch may just be my favorite yet. I love the colors and the flair. Hopefully the recipient likes it as much as I do!

Esme helped model the inside of the pouch so you could see how it is lined in the same green used on the leaves. Notice the paint on her hands? We had just finished painting her face.

Tuesday, June 8, 2010

considering the cesarean section

The rates of cesarean births are increasing alarmingly each year, with over one in every three births ending in major abdominal surgery. When a cesarean is necessary, it can be a life saving technique for both mother and baby. With countless documented medical risks to the mother's health, including infections, hemorrhage, transfusion, injury to other organs, anesthesia complications, psychological complications, and a maternal mortality two to four times greater than that for a vaginal birth, it is hard to understand why cesarean births are becoming the new norm. Even the World Health Organization states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. If we hope to do anything meaningful to decrease the rate of cesarean births, we need real culture change. However, change can only begin with understanding the barriers. This post highlights the common reasons cesarean sections are performed.

Placenta Previa This occurs when the placenta lies low in the uterus and partially or completely covers the cervix. One in every 200 pregnant women will experience placenta previa during their third trimester. The treatment involves bed rest and frequent monitoring. If a complete or partial placenta previa has been diagnosed, a cesarean is usually necessary. If a marginal placenta previa has been diagnosed, a vaginal delivery may be an option.

Since placenta previa involves pre-term bleeding, it can be a very traumatic experience for pregnant women, especially as some women believe they are miscarrying. The diagnosis can help medical practitioners rectify the problem, but the baby is usually delivered by cesarean. In this case, is definitely safer to have it by cesarean than to try to push a baby over a placenta, especially when it can detach during the birthing process. There is truly a difference between placenta previa and a low lying placenta, though in the case of true placenta previa, cesarean births are definitely worth the risk.

Placental Abruption This complication occurs when the placenta separates from the uterine lining before the baby is born. Approximately 1% of all pregnant women will experience placental abruption during the third trimester. The mother will experience bleeding from the site of the separation and pain in the uterus. This separation can interfere with oxygen getting to the baby and, depending on the severity, an emergency cesarean may be performed. There are two types of placental abruption, partial placental abruption and complete placental abruption. In the case of a partial separation, a cesarean is not necessary if the bleeding stops and the baby is not in distress. A complete separation, however, is a true medical emergency requiring immediate cesarean.

Uterine rupture In approximately 1 in every 1,500 births, the uterus tears, or ruptures, during pregnancy or labor, leading to hemorrhaging in the mother and interfering with the baby's oxygen supply. Uterine rupture is a reason for immediate cesarean as it can lead to a hysterectomy and death if it is not repaired right away. While uterine rupture can occur during any form of birth, the risk is higher for women who have had a previous cesarean birth, which in itself increases the rate of repeat cesarean birth.

Breech Position When dealing with a breech baby, a cesarean delivery is often considered by obstetricians to be the only option, especially due to the increased chances of cord prolapse and fetal distress. Even if the baby is in a breech position before the pregnancy is full-term, a cesarean may be preformed pre-term, resulting in premature delivery. Since medical schools no longer teach obstetricians how to deliver breech babies, cesareans are considered the 'safer' option for the baby. However, breech babies are commonly and safely born vaginally every year. In Canada, for instance, cesarean birth is no longer routinely performed for breech babies. Birthing position (such as squatting or hands and knees) is the key factor in order for a woman to successfully birth a breech baby vaginally. Breech birth is only a variation of normal childbirth, not necessarily something that is completely abnormal and to be feared.

Cord prolapse This situation does not occur often, but when it does, an emergency cesarean is performed. A cord prolapse is when the umbilical cord slips through the cervix and protrudes from the vagina before the baby is born (occurring, for instance, when the water breaks and there is too much space between the baby’s head and the cervix). As the uterus contracts, pressure is placed on the umbilical cord which diminishes the blood flow to the baby. Increased risk for cord prolapse occurs when the water is artificially broken. In the case of a cord prolapse, the baby must be delivered immediately, often by cesarean, so his oxygen levels do not decrease; if oxygen is cut off for too long, death or mental retardation may result.

Fetal distress The most common cause of fetal distress is lack of oxygen to the baby. If fetal monitoring detects a problem with the amount of oxygen that the baby is receiving, then an emergency cesarean may be performed. When this is correctly diagnosed, a cesarean is the best option. Unfortunately, fetal distress is often misdiagnosed in order to move labor along and get a woman to deliver faster. However, numerous tests are available to make sure the baby is not actually in fetal distress. It is common for a baby's heart rat to slow during contractions; a change of position may show that the baby is not in distress at all. If there is true fetal distress, however, changing positions will not help, and if a woman is not far enough along in her labor to speed a vaginal delivery, a cesarean may be imperative. 

Failure to progress Once a woman is in labor, a failure to progress can occur when the cervix has not dilated completely, labor has slowed down or stopped, or the baby is not in an optimal delivery position. Since the first phase of labor (0-4 centimeters dilation) is almost always slow, failure to progress is diagnosed correctly only when the women is in the second phase (beyond 5 centimeters dilation). Once a woman reaches active labor (more than 4 centimeters dilation), it is commonly thought that dilation should proceed by once centimeter every hour. However, as labor is drastically different for many women, some women will open faster, some much slower.

Unless there is an actual medical emergency that requires the baby to be delivered immediately, failure to progress is not a good reason for a default cesarean, even though many medical professionals believe that some women's bodies just cannot handle labor and cannot give birth. In its natural course, labor naturally speeds up and slows down and plateaus and then speeds up again. Sometimes a laboring body needs time to rest and gain strength for the next leg of the race. If labor 'stalls,' a woman can change positions, walk around, and be active in order to get things moving again.

Repeat cesarean A cesarean section is major abdominal surgery. While the first cesarean is not necessarily considered a big deal, subsequent cesareans are particularly dangerous. Any number of complications can arise, including placenta previa, placenta accreta (abnormally deep attachment of the placenta into the middle layer of the uterine wall), uterine rupture, injury to internal organs during surgery, excessive blood loss, need for hysterectomy, and maternal death. These risks rise with each subsequent repeat cesarean delivery. However, nearly 90% of woman who have already had a cesarean birth are candidates for a vaginal birth after cesarean (VBAC) for their next birth. The biggest risk factor involved in a VBAC is uterine rupture, which is common in 0.2-1.5% VBACs. There is certain criteria a mother must meet in order to be eligible for a VBAC; women should consult their care providers in order to understand their options. The U.S. has such a low VBAC and high cesarean rate because obstetricians deliver most of our babies, and obstetricians are not primary care clinicians. In his article VBAC rates are low, but are obstetricians to blame?, Kenneth Lin, MD, explains that labor managed by family physicians and professional midwives is considerably more likely to result in a vaginal birth than labor managed by an obstetrician, especially when considering VBACs. As with labor in general, there are risks in VBAC, but the risks are far greater with a repeat cesarean.

Cephalopelvic Disproportion (CPD) A true diagnosis of CPD occurs when a baby’s head is too large or a mother pelvis is too small to allow the baby to pass through. Like failure to progress, most cases of CPD are misdiagnosed (based upon the belief that the baby is too big for the mother to sufficiently dilate in a timely, scheduled manner), especially as pelvic measurements are based upon estimations. If a woman has rickets or something else has altered her pelvic bones, CPD can be legitimately diagnosed. But for the most part, a woman's body naturally will not make a baby bigger than she can push out, especially not the 30% of women in the US who give birth via cesarean. Remaining active and maintaining mobility helps a baby to position itself for vaginal delivery and helps a mothers cervix to dilate.

Active genital herpes: If the mother has an active outbreak of genital herpes at the end of her pregnancy (diagnosed by a positive culture or actual lesions), a cesarean may be scheduled. A cesarean is necessary in this case in order to prevent the baby from being exposed to the virus while passing through the birth canal. However, if the mother does not have an active outbreak, she is perfectly able to have a vaginal delivery safely without exposing the baby to the disease. 

Diabetes If a mother develops gestational diabetes during her pregnancy or is otherwise diabetic, her likelihood for having a baby larger than normal increases, as does the likelihood for other complications to arise. If the case of diabetes is uncontrolled or undiagnosed, the baby may grow too large for the mother to push out. However, diet goes a long way in controlling diabetes and baby growth; by discussing options with her care provider, a mother can control the diabetes to prevent excessive growth in the baby and successfully have a vaginal birth. 

Preeclampsia Preeclampsia is a condition of high blood pressure during pregnancy, which prevents the placenta from getting the proper amount of blood and decreases oxygen flow to the baby. This condition is very severe, and, once diagnosed, a mother is closely monitored. Delivery is sometimes recommended as treatment for this condition, and most women are able to deliver vaginally, but there are rare, extremely severe cases of preeclampsia where an emergency cesarean is necessary in order to save the mother and baby. 

Birth defects If a baby has been diagnosed with a birth defect, a cesarean may be performed in order to reduce the risk of any further complications during delivery. In some instances, a vaginal delivery will only complicate a particular birth defect, especially when the baby rotates and shifts during the birth process. Since this shift does not occur during cesarean birth, a cesarean is the lesser of two evils. 

Multiple births As multiple births are labeled as 'high risk,' these babies are usually delivered via cesarean. However, vaginal delivery is a safe option for many multiple births given that the babies are in a favorable position (any position other than transverse). If she is pregnant with multiple babies and hopes to deliver vaginally, she should find a supportive care provider who is confident in the female body's ability to naturally birth multiples, who believes twins do not require additional interventions, and who is knowledgeable about positions that are favorable for delivering multiples.

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Monday, June 7, 2010

how to be comfortable around breastfeeding

Before I had a child, I was very supportive of breastfeeding, even though my experience with it had been minimal. Many of the women in my family had breastfed their children and have, for the most part, fond awareness of it. Breastfeeding was never a big deal. I do, however, remember wondering a few things when I was near a breastfeeding mother: where do I look? Do I try to act casual and pretend I don't notice at all? Do I make a comment about her nursing (a positive one? but it would draw attention to the fact)?

When I was pregnant, I discovered lactivism by reading stories of women breastfed and received rude comments or who were asked to leave certain establishments. Like many new mothers, I was terrified to nurse in public for fear of being ridiculed. I expected that I would be told to cover up, leave, or be stuck at home until my baby weaned. When my baby was born, and for a long time after, I was the first and only one in my group of friends who breastfed. And even though I had a nursling of my own, I was still uneasy around other breastfeeding moms. It was easier for me to breastfeed around others than to be around another woman who breastfed. Over time, though, things got much easier.

The most important step for me was being around more moms who breastfed. I started going to LLL meetings and baby play- and music-groups where there were plenty of other nurslings present. As I saw the confidence of these breastfeeding women, my own confidence grew. I began to question why I felt uneasy. I knew that breastfeeding was normal and not obscene or indecent. I knew it was the right way to feed a baby and that, as a breastfeeding woman, I was legally protected against discrimination. In my mind, though, I tried to approach my feelings of confusion. Was I struggling with my understanding of modesty? Was I sexualizing breasts? Was I uncomfortable with my own body and my breasts and their function? Was I imposing my own discomfort on the breastfeeding mother next to me?

After some subconscious contemplation, I realized that I was afraid that the breastfeeding mother would feel uneasy if I was looking at her during conversation. What happened when the baby popped off and I saw a teeny bit of nipple for a tenth of a millisecond? Would she be uncomfortable? Then it dawned on me. If this woman is comfortable breastfeeding in front of me, then she is comfortable with whatever I might happen to see. After all, if the mother was handing a piece of fruit to her child, I surely would not look away or feel uncomfortable. And, if I was the one breastfeeding, it would not bother me if someone saw my nipple when my baby was latching on. I figured, then, that it was safe to just keep talking and enjoy myself.

Being a breastfeeding mother was what contributed most to me beginning to feel at ease around other breastfeeding mothers. Experience is often the best teacher. I learned what it was like to be on the other end; it is what helped me to be comfortable with my body and my breasts, as well as being comfortable around other breastfeeding mothers. After nearly seven years of nursing two children, breastfeeding is nothing I haven't seen before. And, now, I am the experienced one, the one who can reassure the new breastfeeding mothers out there that, not only is it ok to nurse in front of others, it is also ok to look at other breastfeeding women and not feel ashamed or uncomfortable.

And now I leave you with this lovely comic, Distract-a-ta-tas, from my favorite lactivist, Heather Cushman-Dowdee, for further contemplation.

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Sunday, June 6, 2010

growing in our garden

May brings huge peony blossoms.
Radishes make our first harvest this year.
And our backyard is literally a carpet of violets. In the early spring, it is a breathtaking sight.
We harvested our first blueberries today. Esme ate them all.
And meet one of our little albino thieves.

Another growing season is well on its way. Mother Nature has given us a beautiful spring, alternating both wet and sunny. We already have had our first harvests of blueberries and heirloom radishes. And just like last year and every year before, we started quite a few vegetables and herbs from seed, including a variety of heirloom tomatoes and peppers, sunflowers, pole beans and lima beans, dill, cabbage, pumpkins, squash, and gourds. We also have innumerable perennials and biennials--mint, catnip, chives, parsley, strawberries, onions, chamomile and rhubarb.  I cannot help but get a bit nostalgic about how our garden grows and changes year after year.