National Rally for Change - September 3, 2012

I am blown away by the excitement with which Americans have embraced the National Rally for Change. The Rally will be held in over 100 cities across the United States this Labor Day, Monday, September 3, 2012, from 10:00 a.m. to 12:00 p.m. local time. The Rally is sponsored by Improving Birth, an organization started by San Diego doula Dawn Thompson, whom I have met at several ICAN meetings. Dawn is so passionate about normal birth, drawing on her own four very different birth experiences and her work as a doula to inspire others to learn about and support normal birth.

The high profile the Rally has achieved is thanks to Dawn's vision of a national shift in birth culture. Though the United States outspends every country in the world for maternity care, we rank just 49th of all countries for maternal mortality rates. By demanding evidenced-based care in pregnancy and birth, the Rally seeks to educate the public, including hospitals and care providers about better birth practices that lead to better birth outcomes for mothers and babies.

The most encouraging response to the Rally has come from hospitals themselves, many of which are supporting their local Rallies by providing parking, toilets, and a space to gather so that Rally signs will be visible. Hospitals want to work with the organization to improve their labor and maternity care, and the Rally is a great way to open a dialog.

To find a Rally location near you, visit http://www.improvingbirth.org/national-rally-for-change/participating-cities/.

To support the Rally financially, you can shop here for ImprovingBirth.org branded items such as t-shirts, wrist bands, and bags, or you can donate money directly to the cause.

Please, spread the word, invite your friends, neighbors, family members, and acquaintances to your local Rally. Share the information on your social networks. Blog about it!

We hope to see you there this Monday!

Stealth-Adjusting a Car Seat: Right or Wrong?

I have a rule for myself, when it comes to the things I feel I know something about. That rule is: I don't give advice unless I'm asked. If someone asks me for help with breastfeeding, I'll jump in with both feet and tell them everything I know. If they don't ask for help or advice, I keep my mouth shut. If someone asks for help with their car seats, I'll throw at them everything I know. If they don't ask, I won't say anything, even if I can see how poorly their kids are buckled. I tend to assume my friends are intelligent, know when to ask for help, and want what's best for their kids. I also tend to assume that most people don't want me butting in and telling them they're doing something wrong unless they ask my opinion. Sometimes I can't hold myself back even with this internal rule, but most of the time I refrain from saying anything in the interests of maintaining cordial relations.

A few weeks ago, I started to watch a friend buckle his young baby into her car seat. I turned away quickly, having a hunch that he would not buckle her well. I said to my husband, "I think I'd better not watch, because it will just make me angry." I couldn't help sneaking a peak after he finished, and, well, I was right. There were just so many things done improperly that I couldn't bear to look. There was something like a Snuzzler behind her. While I hear good things about Snuzzlers from parents who have used them, I was fairly certain that a car seat tech would tell you not to use one. A quick Google search later on confirmed for me that Child Safety Passenger Technicians say that no aftermarket products should be used with your car seat, including Snuzzlers, Bundle-mes, etc., that go between the baby and the seat, because they may interfere with the harness or the padding of the seat itself. Reserving my judgment about that, the baby was also wrapped in a receiving blanket, which he did not remove before buckling her. This meant that the crotch strap was not snugly between her legs because the blanket interfered with the straps. Finally, and most troubling, the straps were quite loose and the chest clip was in the middle of her belly. For a moment when no one was tending her - she was asleep in the seat - I stealthily approached the seat, fixed the chest clip, and tightened the straps as much as I dared. I didn't want to wake her or draw attention to myself.

I mentioned to my husband and a friend that I had done this. There were a few arguments made for and against what I'd done. (No one argued that she shouldn't be buckled properly or that she had been buckled just fine before I changed it.) One point made was that if I didn't say something to the parents about it, then they wouldn't know for the future. On the other hand, they may not, in their sleep deprived, agitated state, want someone to criticize them (as they would see it), so saying something to them might mean straining our friendship, which I value. I said that at least for this one trip, she would be buckled correctly. And maybe since I'd tightened the straps, they wouldn't loosen them again, and they'd be properly tight the next time they put her in the seat (unlikely, but you never know). Finally, my friend suggested that we could bring up the issue of how to buckle a car seat in a general way around them in the future so that they could hear the instructions without feeling like they were targeted, which would be the best way. I muttered, have jokingly, "Doesn't she [the mother] read my blog?", which I don't think she does. (If she did, would I be wrong to post this story here? Would she know it was about her? Probably. That's a whole other topic!) I do feel that many people think they are doing it right until they are shown how it should look. It's not that they are intentionally buckling their seats wrong. It's just that they don't realize that they're not doing it right.

Now, there are plenty of people who say, "If someone would just show me, I'd be happy knowing that my child was safe." There are also plenty of people who don't want anyone to interfere with their parenting choices, which include whether they want to learn to correctly buckle a car seat. Hey, to each his own. I'm sure I put my kids into plenty of situations that would make other parents want to inform me about how unsafe it is.

Still, car accidents are a leading cause of injury and death for children. Children correctly restrained in cars are at significantly reduced risk of injury and death in a car accident. Sure, my kid might get hurt falling out of a tree at the park, but he's more likely to be injured or killed in a car accident driving to or from the park. Should he not learn to climb safely because of the risk of falling? He can't "learn" to ride in a car safely. He doesn't have control over that. He's either safe in the car, or he isn't. Drowning is the leading cause of death for children one to four years of age. Should I not let my kid in the pool because of this? No. I should teach him to swim and make sure that when he is around water, he is supervised, and that the pool has a fence so he can't accidentally wander in. Again, this is a risk that can be reduced through teaching him to swim. I can't teach him to not get in a car accident, especially since he's not even the one driving. The only way to reduce his risk of injury in the car is to make sure he is in a proper restraint and buckled correctly. The only way. And, of course, for me to drive safely. And, yes, there's an element of luck and trust in G-d, too. I don't deny that.

So, was I wrong to adjust my friend's baby's car seat? I wouldn't say I was morally wrong. They probably didn't even notice, and, if they did, they probably wouldn't know who had done it. And, it doesn't mean they'll do it correctly next time. But when you see something wrong that you can fix, the urge to fix it is sometimes so strong that you can't let it go.

On the other hand, another friend who was there that day asked me to look at her sons' car seats and make sure all was well. And since I was asked, I gave her my opinion, made an adjustment, and pointed out a problem. I also answered questions she had about weight and height for her older son in his Graco Nautilus (Google Affiliate Ad*), and about her rear-facing 16-month-old's feet being against the back of the seat. I told her, "Legs bend; necks break." Kids like crossing their legs in the car or propping them up on the seat rather than having them dangle. Rear-facing is more comfortable. Plus, that recline! It's like an easy chair.

And, for your further edification:

SB in his car seat carrier, about 5 months old, buckled correctly. No aftermarket products behind or around him, (except the toys on the handle, which should be removed when the car seat is in a moving vehicle, which it's not in this picture). The head support and shoulder strap covers came with the car seat, so they are perfectly fine to use.

SB front-facing in his Graco Nautilus, about two years old. Straps tightened properly, chest clip at armpit level. Again, the shoulder strap padding came with the car seat and so are fine to use.

Things that are permissible:

• Putting a blanket over the child after he is buckled. A blanket will fall away in an accident and not interfere with the functioning of the car seat.
• Putting rolled up receiving blankets around the child's head or body for support after the child is buckled securely. Again, blankets will fall away from the child in an accident, allowing the car seat to do its job.
• Using any accessories that come in the box with the car seat, such as additional padding, head support, and shoulder strap padding. Check the car seat's manual for age or weight limits on using the additional padding. For example, my Chicco KeyFit30 has newborn support padding that can only be used until the baby is 11 pounds, after which it should be removed.
• Using any accessories sold separately by the car seat manufacturer that they specifically state are acceptable for use with your exact car seat. This means it has been tested using that accessory. For example, Diono sells an angle adjuster that can go under the car seat to change the recline angle of the car seat. When used properly, according to Diono's instructions, with a Diono seat, this would be a permissible accessory.
• Using an aftermarket accessory that your car seat's manufacturer specifically states is acceptable to use with your car seat. For example, some manufacturers state that putting a thin towel between the car seat and the vehicle's seat is permissible to protect your upholstery. Please check with your car seat's manufacturer to find out if this is acceptable to do with your car seat. 

If you have other questions, please consult with a CPST (Child Passenger Safety Technician). CPST's are trained in proper car seat installation and use and must keep up to date on new research and new seats, as well as being aware of vehicle compatibility issues. You can often have a consultation for free through your fire or police department, a local hospital, or a baby supply store. Check SafeKids.org to find a inspection station near you.

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*I have not been ask to mention nor have I been previously compensated for mentioning any of the brands in this post. However, if you click through a Google Affiliate Ad link and purchase that product, I may receive minor compensation. You can help support this blog and keep the posts coming supporting the advertisers on this page.

Today, My Firstborn Started First Grade

It was by no means his first ever first day of school. NJ has been in some form of daycare or preschool since he was a baby. But, somehow, his first day of first grade feels incredibly significant.

He was in public school for kindergarten last year, but they still treated kindergartners with a great deal more tenderness than the rest of the elementary schoolers. Kindergarten was only half a day, for one thing (although he and I would have both preferred a full-day program, had that been an option). The kinders had their own entrance, their own building, and their own playground. They had their own schedule. They didn't mix with the older kids at all, they weren't expected to know much of anything when they started, and there was a lot of love and hand-holding.

Today, I took NJ to school for his first day of first grade, and I realized, he's not a baby anymore. Not in the least. He's expected to be in school all day, in uniform (which I love, by the way). The bathrooms are not connected to the classroom, and if he needs to use the bathroom, he goes by himself. He is expected to control his own food - we send him along with a lunch and a snack, and it's his job to eat the snack at snack time so he'll have lunch later to eat. His day is more structured, more classroom-oriented. This is "for real" school, now!

I was relieved when I dropped him off that some of his friends from his kindergarten class were in his first grade class with him, even sharing a table with him. I was relieved that his teacher seems incredibly sweet and caring and organized. I was relieved to see that many parents are very involved in the classroom, helping out and volunteering, since I can't be (when I introduced myself and apologized that I couldn't be much help in the classroom because of the two younger boys, the teacher laughed and said, "I should be helping you!" See? Sweet.).

I think I am more nervous about his first day than he is. My mom pointed out that he hasn't had a lifetime of summer vacation and first day of school experiences like I have, so he hasn't learned to anticipate the first day in the same way that I have. And he tends to take new experiences in stride. He neither seemed particularly excited nor particularly anxious.

My husband and I are still concerned that this is public school, and, let's be honest, the public schools in our district are not stellar. They're barely mediocre, in fact. We are also concerned that NJ, with his October birthday, will be one of, if not the youngest in his grade, and we hope that his social skills are mature enough to handle being with kids who may be up to a year older than him. He's not even six yet, and won't be for two more months. We considered having him repeat kindergarten, but he's four feet tall and 63 pounds, he can read and add and subtract, he's incredibly articulate, and he's so smart. If he were in kindergarten again this year, he would tower over the barely-fives, and he would be bored out of his skull.

We had this dilemma last year, when we were debating whether he should do another year of preschool and then start kindergarten this fall instead of last fall. Certainly, there are kids in his class with fall birthdays who will be turning seven soon, when NJ will have just turned six. That's the trouble with a December cutoff date. California has since decided to shift the cutoff slowly back to September 1, but NJ was still in the group that could start as long as he had turned five by December 2, 2011, which he certainly did. Most of the other still-fours who started last year were in a pilot program called "transitional kindergarten," which is a two-year kindergarten program to ease the little ones into school, especially those who had never been in a school setting before. They were going to put NJ in that class last year, but thankfully our neighbor was a kindergarten volunteer and said, "No way you are putting him in the TK class. He's way too smart!" And he would have been soooo bored learning to count to 10 and pick out letters. He had already started reading by the time he started kindergarten!

I'm not bragging about NJ, by the way (well, maybe a little). I'm expressing the dilemma we had. Because though NJ may know as much as an average first grader, he is not as socially developed. As a toddler, he was always a little behind in his social skills, preferring the company of kids six months to a year younger than himself. However, he always did more intellectual and developmental growing when he was put in a class where he was one of the younger ones. He likes to be in charge, but he needs to learn to be led. He likes to run the games, but he needs to learn to cooperate. He wants to have friends, but he needs to learn to let his friends make their own choices. And sharing is still hard for him. My husband was especially worried about his social skills for first grade, because if he starts having disciplinary or behavioral issues in first grade, that could haunt him for the rest of his school career. His academics will never be a problem, but he has to get along with his peers, too. But if he's bored in class, that could cause a different sort of behavioral issue, so we made what was the obvious choice: push him forward rather than hold him back. It's not an easy choice. He has a friend who is five days older than him who goes to a different school, and his parents held him back, so he's just starting kindergarten this year. On the other hand, that boy has an older sister who is also an October birthday, and she's quite large for her age (and a girl, so possibly more emotionally mature anyway), so they decided to push her forward! It so much depends on the child.

So far, though, so good. He came home happy. It will be interesting to see how the year progresses and he is challenged more. I was imagining that in two years, I'll be walking two kids to their first day of school, a new kindergartner and a new third grader. I found that very hard to get my head around. At least we have no choice regarding SB's start date. He'll be 5-1/2 when he starts kindergarten, because he has a mid-December birthday. GI, on the other hand, born September 5, will be four days past the cutoff by the time his turn comes around to register for school. Then we'll have to decide whether to try to test him into kindergarten and have him be a barely-five when he starts, or whether we'd rather hold him back and have him start as a just-six. Well, for that, we have four years to worry about it!

On the bright side, NJ's only complaint today was that we didn't pack him enough food for lunch!

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Kids Can (and Should!) Help around the House

We had some people over for dinner the other night who are expecting their first child next month. NJ was mugging for attention, so I finally gave him a job to do. I sent him upstairs to get a clean tablecloth, and he took it upon himself to put the tablecloth on the table. He then wanted to help set the table. It's so nice when he willingly helps and even takes some initiative! Our guest mentioned that one of the things she's looking forward to with having a kid is when he can do stuff for her around the house, like wash dishes. Our response was a tongue-in-cheek, "Do you like having dishes?" We know how many dishes we've lost because NJ or SB have wanted to "help" wash them.

That's not really fair, though, because they're still young. I do try to give them jobs to do, commensurate with their age and level of understanding. For example, I've started making them help with their laundry. NJ likes putting laundry in the washer and then transferring it to the dryer. Fine by me, because I find this to be a task that, though it takes me just a minute or two, is kind of annoying. So if he wants to do that, great! He doesn't, however, enjoy helping to fold and put away his clothes, which is where I really want help. It occurred to me this summer, though, that both NJ and SB are old enough to help with their laundry in some way, and if I make them do it every time, it will simply become the norm. I hope. I taught NJ to fold shirts and pants (took quite a few weeks for him to get the hang of it without a demonstration each time). He and I fold, and SB's job is to put his own clothes away and match socks. Knowing how to wash, dry, fold, and put away clothes is very important. I know there are kids who go off to college having never done their own laundry, which I think is sad. It's something that can be taught in stages over many years, and it's not difficult. By the time NJ and SB are teenagers, my expectation is that I won't have to have anything to do with their dirty clothes beyond supplying the detergent to wash them. I hope.

Then there's the dishes. NJ likes to help, and I guess SB does, too, but the last time I had NJ help me with dishes, he broke a mug. I think they're just too young and too short to be actively helpful with dishes. (We don't have a dishwasher.) My husband and I keep meaning to make them clear the table after meals, which I think they could handle, but we've been kind of lazy about it. They can wash the plastic stuff, but I find it easier to just do the dishes myself in the evening. It's hard for me to allow something to take longer because they're "helping" when I would really just rather do it myself.

My housekeeper has gone AWOL and I haven't found another one yet. I usually had her come about once a month to do a really good cleaning of the kitchen, bathrooms, floors. She picks up after us and does whatever needs doing. Such an angel to have around when she comes, and I know just how spoiled I am to have paid help at all. But she disappeared, and my house is in dire need of a good cleaning, so I bit the bullet. "Guys, today we're cleaning up your room!" I told them. And we did. We cleared out too-small clothes from NJ's drawers (some of which went straight into SB's drawers!), picked up books and clothes from the floor and put them away, got stuff out from under the beds. Their room looks 100% better. I cleaned the downstairs bathroom over the weekend, and my husband and I worked together on the living and dining rooms and the kitchen. It doesn't look nearly as good as if my housekeeper had done it, but it made us remember that we are capable of cleaning if we have to.

Then the kids and I tackled the upstairs bathrooms. I sent them into their bathroom in the morning to pick up trash and consolidate the bath toys. Then I went in with them and sprayed cleaner in the bathtub, on the counter, and on the toilet and did the toilet-bowl cleaner. NJ got in the bathtub with a sponge and scrubbed. I cleaned the toilet (lucky me!) and the sink and counter. Then I helped NJ rinse the tub and sprayed the floor and showed him how to wipe the floor, especially around the toilet. Then we migrated to Mommy and Daddy's bathroom, where it was SB's turn to de-pants and get in the tub to scrub (they actually fought over who got to do this in which tub. Go figure.). I helped NJ with my toilet, and I cleaned the counter and sink. Then NJ and I did the floor together. I'd say the whole project took less than half an hour, and we were all happy when we finished. Except for trying to keep GI out of the bleach and out of the way, it was a relatively painless experience for all of us. (I do recommend cleaning bathrooms when either someone else can occupy the baby or when the baby is asleep, for future reference. GI loves baths, and whenever anyone is in the bathroom, he assumes he's going to be taking a bath and gets...kind of in the way.)

Having the boys help me with the chores related to their areas gives them ownership over it, too. If they've worked alongside me to pick up, I hope they would be more reluctant to make it messy again. Maybe. In any case, at least I don't have to do all the work to clean up after them. Just some of it.

I have learned that I have to be actively involved, though. If I say, "Go clean up your room," they'll whine and protest and eventually go up to their room and just sit there. If I go with them and give them very specific instructions - "NJ, pick up all of those shirts from the floor and put them in this bag;" "SB, put those books on the bookshelf" - then stuff gets done, and they understand what "clean up your room" actually means. At their age, they do well with concrete, specific instructions, while a vague demand gets me nowhere. I still have to supervise, though, which tends to be my own downfall.

I would really rather have my housekeeper back, as she would do a much better job, but at least the bathrooms are relatively clean and usable in the meantime. We'll tackle one or two rooms of the house at a time and rotate through so that it doesn't get too out of control around here, and when I can find a new housekeeper (or my old one finally returns), her work will be that much more appreciated! This hiatus has given me the opportunity to teach the kids a little something about good, honest housework. Having the kids help us clean is also teaching them to clean, which is a valuable and necessary skill for them to have when they finally go out into the big, bad world one day.

Lynne's Birth Story - Jessica's Birth!

This is a very, very special blog post, written by my mom, about my birth and her breastfeeding experience with me. I'm struck both by how many similarities there are to giving birth 30+ years later, and also by what was different. Much of this should seem familiar to those of us who have had hospital births. There was far less breastfeeding support back then, but many of the challenges my mom faced are the same challenges faced by working women today. There wasn't much on the books at the time for breastfeeding mothers in the Navy, but my mother made her own rules! I hope you can see where I get some of my passion from in reading my mother's story.
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I really don’t remember why I decided that my baby would be born naturally and I would breastfeed. I’m the type of person who, when confronted with a new situation, will spend hours researching and reading, so it is possible that when I found out I was pregnant nearly thirty-two years ago, I rushed out and purchased as many books (no Internet) as I could find on childbirth and breastfeeding. I was greatly influenced by a book called The Immaculate Deception, by Suzanne Arms, published in 1975, which described the horrors of modern childbirth. I still have a copy of the book.  [Ed. note: This book is now out of print, but apparently the author wrote a second one: Immaculate Deception II: Myth, Magic and Birth, in 1994.]

Natural birth was becoming the “rage” in the early '80s, with hospitals opening up “Alternate Birth Centers” called “ABC rooms,” so I’m sure I was influenced by this trend, but there could have been other women in my life at the time who influenced me. As I said, I don’t remember. I do know that I wanted the very best for my baby, that she (I didn’t know it was a girl until she was born – no regularly-scheduled ultrasounds then) would have every benefit I could give her as she came into this mean, cruel world. I wanted her to be perfect.

I was (and I guess still am, but with less energy) a perfectionist and was not afraid of challenge or hardship, as I tended to push myself over the limit in everything I did. I was also extremely stubborn and tended to believe that if I wanted something, I would get it, so being an officer in the U.S. Navy at the time did not seem an obstacle to fulfilling my goals for my baby.

My pregnancy wasn’t anything interesting except for my high blood pressure, which the doctors passed off as nothing since it didn’t get any higher from my first prenatal visit. I gained more weight than I should have and I tended to eat a lot of chocolate but I exercised and did yoga. I expressed my desire for a natural birth and wrote up a “birth plan” to present to the attending doctor when the time came.

I worked passed my due date without a problem. That weekend, we went to a Triple A baseball game and fireworks at the stadium (the major leagues were on strike that summer). My water broke in the middle of the night and we called the hospital. They said to come right in. I knew that was a mistake; that I needed to stay home as long as I could and walk, walk, walk but I was also scared that something could happen with my water breaking so we trudged to the hospital in the middle of the night. I was only one centimeter dilated. They said that they preferred that I stay, because my blood pressure was high (no kidding), and I had signs of preeclampsia and a chance of infection, and we were too many miles away from home to turn around. I was admitted to a ward but I didn't want to just lie there, so my husband and I walked around the hospital campus for a while. I was hurting and scared and knew that I was starting out on the wrong foot, but I presented my birth plan to the resident. The poor guy; it was early in his rotation to OB, and he wanted to do well but was inexperienced, which is probably why he agreed to my birth plan. It included no drugs and no IVs or monitors so I could move around. I was hooked up to the monitors once an hour but was free to walk around the rest of the time. Ideally, when the contractions started and I was well on my way, I would gather my strength and all that I had learned from the myriads of reading materials and move around. Alas, I didn’t. I lay there for hours on my back, enduring the pain, which I could not believe was so bad, ignoring the breathing techniques we learned in our Bradley classes, but still determined to avoid drugs. I did not have an IV and did not drink anything, so I became dehydrated and the baby also. The doctor would come in periodically and check on me. He felt sorry for me and would induce a semi-trance to help me, which wasn’t helping since it reinforced me lying still for so long. My husband came and went, bored and scared.

The doctor did talk to me about a cesarean as my labor wasn’t progressing as quickly as it should have, but I declined. After twenty-six hours, on Monday morning, I was finally ready to push. I was transferred from the labor room to the delivery room. My husband was prepared with his camera but he had forgotten to put film in (no digitals then) so we don’t have a record of the birth. I pushed and pushed but the baby wasn’t coming out so the doctor took up his scissors (or whatever they were) and did the longest and deepest episiotomy on record (at least it seemed that way to my husband who nearly fainted, equating the sound to tearing a chicken wing in half) without asking. I had also been doing exercises to avoid an episiotomy but I guess they didn’t help. The baby slid right out amid a lot of blood and it was announced that it was a girl. I asked to have her on my chest and see if she would latch on but since her Apgar scores were too low, they let me have her for less than a minute and rushed her off to the neo-natal ICU. Not part of the plan but I was exhausted at that point.

I went to recovery and had to pee 1,000 cc’s before I could go to the ward. I requested that I be discharged as soon as possible, that I didn’t want to stay in the hospital. I had it in my mind to take the baby home right away, as I wasn’t sick and therefore did not need to be in the hospital. When the pediatricians visited, I told them I was going home and taking the baby with me. They said I could go home but the baby was in the NICU and wasn’t going anywhere. They had come to consult with me about her condition. She was extremely dehydrated and had “thick blood”. Her white cell count was elevated, suggesting an infection. They needed to take out half her blood and replace it with plasma because it was too thick to travel her veins and she was headed towards major brain damage if nothing was done, all because I wanted a natural birth, but I was stunned from the pain and the contractions into a trance and my doctor was too ignorant to compensate for the lack of modern intrusions like the IV for hydration.

I went home eleven hours after giving birth; the baby didn’t. I visited daily, tried to pump and tried to breastfeed her when they would let me, but they convinced me to start her on formula so she didn’t lose any weight so I agreed. She developed jaundice and spent five days in the NICU altogether before she was released. Luckily, she recovered completely.

I was still determined to breastfeed and started immediately. No one told me that babies can’t switch from formula to breast milk smoothly. She was up the entire night crying and pooping, crying and pooping. I knew nothing about the proper latch so every time she latched, I’d literally cry out for the pain. We finally settled into a routine and I tried to pump in between feedings (huh, she wanted to nurse all the time) in preparation for going back to work. I had six weeks off and decided to stay home full time for four of those weeks and return part time for four weeks, which was approved by my command.

I needed to pump and store the milk at work. I marched into my commander’s office and announced that I needed a private office so I could pump. It never occurred to me that he’d disagree; I was that sure of myself. He never said a word and I pumped until the baby was four months old and then had to start “supplementing” with formula as I couldn’t keep up with her demand. She nursed at night until nine and a half months and then stopped altogether, probably because I didn’t have enough milk.

In a way, that inexperienced doctor with a heart of gold did me a favor by not performing a cesarean, as there were no such things as VBACs then and I would have probably not breastfed (although I don’t really know), but there was also the real possibility of damage to my little girl because of my shock when labor actually came.

I learned a lot with her and knew a lot more when my son came along three years later. But, of course, my daughter is perfect!

It's Time to Take Back Birth

The first time I was pregnant, I wish I had done more of my own research regarding childbirth.
The first time I was pregnant, I wish we had known more about labor coaching and support.
The first time I was pregnant, I wish I had known that there's more to baby's position besides "head down" or "head up."
The first time I was pregnant, I wish I had known it was okay to labor at home.
The first time I was pregnant, I wish I had known that being mobile during labor can mean the difference between vaginal birth and c-section.
The first time I was pregnant, I wish I had know more about the risks of c-section.
The first time I was pregnant, I wish I had known what I know now.

The second time I was pregnant, I decided to listen to people other than my care provider. I decided to hear what natural birth advocates were saying. I decided to find out for myself everything I could so that I would have a shot at a vaginal birth instead of a repeat c-section.

And what I've learned since then is shocking to me. Many obstetricians and Labor & Delivery nurses have never seen a birth without interventions. Many women have no idea the risks of an epidural. Many women have no idea the risks related to c-section, especially as they pertain to future pregnancies and births. And many women, and even some doctors, have no idea that inducing labor even a week or two before the due date can have lifelong consequences for baby and/or mother.

I want women to be informed. I want them to know the facts. I want doctors and midwives and other care providers to understand the difference evidence-based care can make. Women should be told all of their options at their prenatal appointments. They should be able to make a decision based on facts, statistics, and information. Their care providers should help them make these decisions based on best outcomes, risks and benefits, and the desires and goals of the parents-to-be.

That's why I'm so excited about the National Rally for Change taking place on Labor Day, September 3, 2012. Organized by ImprovingBirth.org, the Rally will bring together women, men, and children in dozens of cities all over the United States to demand evidenced-based maternity care.

Research shows that labor does not need to be rushed along with drugs, that epidurals can interfere with the natural progress of labor, that c-sections are not necessary 32% of the time (the current national c-section rate), that induction of labor is not medically indicated nearly as often as it happens, and that induction of labor leads to c-sections in well over half of cases. Research also shows that c-sections carry much higher risks than vaginal births, to both mother and baby.

C-sections, inductions, and fetal monitoring certainly have their place. Without them, we would see far more mothers and babies suffering injuries or death in childbirth. When we know the baby is in distress and we can quickly retrieve him from danger, we can give thanks for these life-saving interventions. When we know the mother may be in danger of life-threatening blood loss, stroke from toxemia, or damaging complication, the fact that we can identify risks and bring mother and baby through the birth safely is nothing short of miraculous, especially compared to the much higher mortality rates of the past. However, these types of cases are not the norm, and normal childbirth does not need to be treated like an emergency.

When we demand evidenced-based care from our maternity care providers, we are improving birth outcomes across the board. When we inform women of their choices in childbirth, we are creating a new culture of birth that moves away from fear into a place of empowerment.

When I was pregnant for the first time, I wish there had been a National Rally for Change. Thank you, ImprovingBirth.org!

To find a rally site near you, or to organize one for your city, visit ImprovingBirth.org.

More on Sleep, 11-Month Report

It's not that the only way I can get GI to sleep is by nursing him. He'll fall asleep in the car, or when being held by someone else, or occasionally even when being held by me and not hungry. But to transfer him to the bed, or to get him to sleep when I don't have any other option, I lay down with him in bed and let him nurse until he drifts off to sleep. Sometimes this is less peaceful than it sounds, with me having to wrestle him back to me and convince him that, more than anything else in the world, more than chasing the cats, more than looking out the window, more than pulling on the curtains, more than playing with his brothers, he wants to nurse and fall asleep. Other times, he makes it clear in no uncertain terms that he wants to nurse right now and suckles until his eyes slowly close and stay closed, his hands relax, his legs bend and settle into what I guess is a comfortable position for him, and his breathing slows and evens out. When this second scenario happens, which is the case fairly often, it is truly the most blissful, peaceful way to fall asleep.

When I think he's asleep, I'll gently unlatch him from my nipple by sliding my finger into the corner of his mouth until he lets go. Now that he has two top and two bottom teeth, it's dangerous to try to pull away. I wouldn't want my yelp of pain to undo all the hard work of getting him to sleep in the first place! If he's totally out, he'll relax further, close his mouth, and not even twitch as I slide away from him and leave the room. If he's not quite all the way asleep, he'll immediately start looking for the nipple again. First, he opens his mouth and nods his head as if he's got some kind of nipple-detecting sonar. If he senses nothing, he starts rocking forward and backward, getting a bit more frantic. If still the coveted boob does not reappear, he'll start whimpering and calling. Only after a few minutes of this sonar-ing and yelling does he escalate to crying. Typically, I haven't even rolled away yet, so as soon as he starts his search, I'll let him latch back on and continue to suckle. Usually it takes only another two or three minutes before he falls completely asleep and I can leave. If I let him escalate, it takes more time for him to re-settle.

I love that first bit of maneuvering, the gentle opening of the mouth, the quiet nodding of the head. I love it, because he just assumes that I'm still there, that he doesn't have to cry or look for me. He knows that nipple is around there somewhere, and all he has to do is open his mouth and it will reappear. To me, this shows the ultimate trust, that Mommy is there. When he needs me, I'll be there. When he asks for me, I'll respond. He doesn't have to worry. He doesn't have to wake all the way up. He doesn't have to despair. Mommy's here. When I need her, she'll come. If I'm not done, she'll let me finish.

There's a whole spectrum of opinions about how babies "should" sleep, whether we should let them nurse to sleep or become reliant upon our "help" to fall asleep. There are those who would tell you that picking up your three-week-old every time she makes a noise is going to mean that she'll never be able to sleep without you. There are others who would tell you that if your five-year-old still needs to sleep in your bed next to you and have you rub her back for her to fall asleep, you should do that. There are schools of thought that say by about five or six months of age, a baby shouldn't be eating at night and should be able to fall asleep on his own and stay asleep all night. There are others who would say that your child will sleep how he sleeps and you shouldn't try to "sleep train" or night wean, because eventually he'll sleep on his own, when he's ready.

In trying to show the extremes of the spectrum, I'm not saying either side is right or wrong. I believe, as I have stated before, that every child is different, and what works for some parents and babies/children won't work for others, either emotionally or physically. Some babies are sound sleepers who, without any "work" on the parents' part, simply start sleeping eight or nine hours in a row at three months and never look back (or so their parents say). There are other children who still, at three or four years old, have trouble staying asleep the whole night and need their parents to help them go back to sleep.

I do believe, wholly, that cultivating trust between parent and child is absolutely vital. I do believe that your child needs to know you're there, and that that attachment needs to happen as babies and toddlers. We know that children who are neglected early in life have trouble ever learning to trust, bond, and love. I'm not saying that letting your child cry it out or leaving him to sleep on his own at night is neglectful. A child who is loved and attended to while awake is hardly neglected. I also am not convinced one way or the other that letting a child cry himself to sleep for a few nights will cause long-term damage or mistrust or any other emotional or behavioral problems. I just don't know. Nobody does. You can't take the same child and raise him two different ways.

But when I put myself in the baby's place, it hurts me to the core. Imagine: One night, I wake up and nobody's there. Nobody comes when I call. I'm alone in a dark room, I'm hungry, I need comfort, and nobody comes. I cry, and nobody comes. I wail, and nobody comes. Where's Mommy, with her warmth and her special scent and her milk? Why am I trapped in this place all by myself? Eventually, I'll lay down and go back to sleep, having exhausted myself with crying. I'll wake up in the morning, and someone will come get me. Where were they a few hours ago? And then, tonight, will it happen again? Will I be ignored? After a few nights, I won't even bother to cry, because I'll know nobody will come, and my parents will congratulate themselves on successfully "sleep training" me. "Oh, he sleeps through the night now. A few nights of letting him cry, and now he doesn't wake up! It was worth it!" The thing is, it's not that I didn't wake up. It's that when I woke up, I knew no one would come, and I went back to sleep because I had no other choice.

Maybe it is worth it. I don't pass judgment. I know that some people really can't function without good, solid sleep, and they will be better mothers during the day if they get to sleep through the night. I understand that. I just can't bear the thought of my baby going through that feeling of abandonment, even if it means we'll all sleep at night. And let me tell you, right now, exhausted as I am, sleeping through the night would feel like winning the lottery. But there are gentler ways to help everyone get more sleep. Sure, it's a longer process, and more work in some ways, and a longer time with less sleep, but you're a parent at night just as much as during the day. I like to wait until my kids have enough language ability to understand, "It's time to sleep. Go to sleep now. No more nursies," or whatever. If I can explain that I'm still around but that nighttime is for sleeping, then I don't feel like they're on par with that six-month-old baby left alone in his crib. When they can understand that Mommy's still nearby but that everyone needs to sleep, then they can still maintain that trust in you.

My older two generally sleep through the night. SB has backslid a bit in the past couple of months, partly because he's three and a half, and that is a very tough age. The half-years are typically bad times for behavior and sleep, as they enter a period of brain development and a bit of internal confusion. When they come out of it, they are stabler, happier kids, but we need to be there to support them through the tough times, even though we, as parents, want to tear our hair out. But they do generally sleep through the night, and if it weren't for GI's poor nighttime sleep, I'd say that we would all be pretty well rested. I think that helps me get through these bad nights with GI, because I know, from experience, that it does get easier and it will get better. Eventually. I do have fantasies of putting all three boys to bed in their own room, in their own beds, saying goodnight, and being left alone the rest of the night. And I also have fantasies of going in their room when they're teenagers and having to wake them up. It will happen. One day.

I was looking back through my LiveJournal from when NJ was about 11 months, as GI is now. NJ was sleeping terribly at the time, waking often, being up for an hour or two in the middle of the night, having trouble getting to sleep in the evening, just as GI is doing now. Actually, GI isn't even as bad, since it's not too hard to get him to sleep once he's ready, and he has only had a couple nights of being up for no reason and playing. The reason I bring this up is twofold. One, it's really just the age. They're learning so much at this age, coming up on one year old, that their brains just don't want to settle down. They want to walk, they want to talk, they want to play, they want to interact, and they do not want to relax and go to sleep and maybe miss out on something fun or important. And, two, it seems to me to put to rest any argument that GI still wakes so often because I nurse him through the night and cosleep. You see, NJ didn't nurse - indeed, by 11 months he didn't even eat at night. He had a pacifier and a blankie. He slept in his own room in a crib. And he was having all the exact same sleep "problems" that GI is having, despite completely opposite sleeping arrangements. Interesting, no?

So, I love that GI will be secure in the knowledge that Mommy is there for him when he needs me. I love that GI knows he need only open his mouth to receive that which he needs more than anything - Mommy's best source of comfort. I love that he can communicate that need, and that I can understand his message, without even waking up. And I love that I can get him to sleep with so little battle (most of the time) just by laying down with him and sticking my nipple in his mouth. I'm not saying I love every minute of it. That would be dishonest. My ribs hurt, my neck hurts, I sleep horribly, and sometimes his latch is so bad at night that I cringe when he wants to nurse again. But, frankly, I can't imagine any other way to get him to go to sleep, or go back to sleep, that would be more restful than not even having to get out of bed to tend to him.

I think, in a few months, when GI is old enough to understand, I'll be able to move him out of my bed, possibly out of my room, and he'll sleep on his own. I may still have to nurse him at night - I continued to nurse SB two to three times a night until I weaned him completely - but in between I'll get to sleep more comfortably. Until then, I'll muddle through and enjoy the peaceful moments, the tiny hand resting on my side, the little foot against my thigh, the warm head nestled in the crook of my arm, and the absolute trust and unconditional love of a baby. There's nothing like it. Nothing.

Breastfeed Just Once, and Then Decide

I stumbled across a rather polarizing article on why a particular author decided even before giving birth that she wasn't going to breastfeed. I'm not going to link to it, because I found it offensive and simply argumentative, but it can be found on the Mommyish site, if you care to go hunt it down. The problem I had with her article was that all of her reasons for not wanting to breastfeed were uninformed nonsense. She clearly wrote the article just to antagonize and not to convince or even to simply state her position.

Look, I said this in my very first paragraph of my very first post here: "I don't so much care what you choose to do. I just care that you make an informed choice." And I hope that you feel my posts since then have held to that basic philosophy. So if you give birth having already decided that you just don't want to breastfeed, then you don't have to defend yourself. Simply saying, "I just don't want to" is perfectly fine.

But it got me thinking. How can you decide even before giving birth that you just don't want to? I understand if there are underlying issues, such as previous sexual abuse, body image issues, or emotional or health issues that make breastfeeding difficult or insurmountable. Those are reasons far beyond, "I just don't want to." I'm talking about perfectly healthy women who have had healthy pregnancies and healthy birth scenarios who immediately request formula to feed their babies. How do you know you just don't want to? What turns you off so much about it?

For those women, I have a proposal. Breastfeed once. Just once. As soon as the baby's born, the best place for her to be is on your chest, skin-to-skin. Why not give the baby that one dose of colostrum? Nurse for 20 minutes, an hour, just once, while they clean you and the baby up and get you ready to go to the maternity ward. After that, do what you want, but why not give it a try at least? It certainly wouldn't do any harm, and you might be surprised by how it feels. Maybe try it once more when the baby wakes up. And then switch to bottles. After all, those first few breastfeeds help you out almost as much as the baby, by helping your uterus contract, which will help prevent hemorrhage and help you regain your shape.

I'm not going to try to convince you to continue nursing. I'm not even trying to convince you to nurse that one time. I'm just asking, why not? The thing about breastfeeding is, it's almost impossible to change your mind later if you choose not to breastfeed. But you can always change your mind and stop breastfeeding once you've started. Every drop of colostrum and every drop of breastmilk your baby gets makes a difference in her health and in yours. More is better than some, but some is better than none, after all.

Feel free to ignore me. I'm not pushing anything on anyone. I'm just making a suggestion. You might ask my opinion on a car seat or where the baby should sleep or how he should be dressed for this weather. You might ask me whether I swaddled or if I used a pacifier or which pediatrician I like. You might ask me which hospital I delivered at and why. You might ask what stroller I use, whether I let my cats near the baby, and if I took any medications during pregnancy. And, you might ask my opinion on whether you should breastfeed or not. If you're dead-set against breastfeeding, then don't breastfeed. There are plenty of other decisions you have to make about your child, stretching into the long years ahead. If the idea of breastfeeding is just too overwhelming, or you don't want your breasts to belong to someone else for the next year or two, or you just generally find breastfeeding "icky," or you're afraid you'll get sexually aroused by nursing, or you're uncomfortable bearing your breasts, or you have sensitive nipples and you're afraid it'll hurt, or you think breastfeeding will make your boobs saggy, or you want to be able to hand off baby to someone else to feed, or you just don't want to, then don't breastfeed. I'm no one special, that you should listen to me more than anyone else, more than yourself. In the end, you're the mommy, and it's your baby, and you get to choose.

But, just a friendly suggestion, breastfeed once. All of your worries or fears or just not wanting to aside, one feed, one time, the first time will not change anything. If it hurts, then stop. If you get aroused (highly unlikely right after giving birth, I'd think!) and you don't like it, then stop. If you want someone else to feed the baby, then stop (or, you can pump and let someone else give the expressed milk - just a suggestion!). One breastfeed isn't going to make your boobs any saggier than pregnancy already has (although it's a myth that nursing makes your breasts saggy - it's pregnancy, gravity, and age that do that). And having just given birth, your breasts and all the rest of you are going to be bared anyway, so what difference does it make?

Breastfeed just that one time, and then decide. You can always choose not to breastfeed, any time from day one until day 730, but once you've passed the first few days without breastfeeding, it's going to be mighty difficult to choose to breastfeed.

The most important thing, though, is that you love your child, that you make the decisions that you think are best, and that those decisions are informed decisions.

Happy Breastfeeding Awareness Month!

How to Be a Work From Home Mom (As If I Know!)

For the past five and a half years, I have been a "WAHM," a work-at-home mom. Working from home presents unique challenges as well as some great benefits.

One of my strong desires for when I had kids was to be that mom who was able to chaperon field trips, come to the school for daytime events, attend parent-teacher conferences, be home with the kids when they were sick, and volunteer at school. I grew up in a single-parent household, and my mom had to work to support us, so from sixth grade and up, I was a latchkey kid with my younger brother. Our mom set a great example of work ethic and reliability, sticking to commitments, and doing everything for your kids. But since she had to work, she wasn't able to be home with us when we were sick, come to school stuff during the day, or help out at school events. Once she left for work, we were on our own until she got home. I don't want to paint this as a dismal picture. My childhood was happy, and I don't resent or regret anything my mom had to do to keep us in a comfortable home and give us almost everything we wanted.

But, all the same, it gave me a vision of motherhood different from the one I grew up with. I began to feel that it was vitally important for me to be home with my kids, at least until they were preschool age. And when the opportunity came up for me to work from home when we moved from Philadelphia to California not long after our first son was born, we seized it. So, when I started my job as a transcriptionist, I thought, how great that I'll be working from home. I can be here with NJ all the time. We don't have to worry about paying for daycare or a nanny, and I'll be able to spend lots of time with him. I very quickly (within a week) found something out: It's really hard to get work done when you have a baby.

(Before you get excited and ask me how I can help you get a job working from home, I have to reveal that I work for my aunt, in a two-person (her and me) operation, and I can't do anything to help you get a job in my field. Sorry.)

I didn't know what to do with a baby all day long. I didn't know what to do with myself. I was new to the area and had no friends. My few feeble attempts at finding other moms around fell flat (I went to one Meetup where only one other mom showed, and we didn't really click.) My husband and I decided that, for my sanity and ability to get work done, we would put NJ in daycare three days a week (that was all we felt we could afford).

I was definitely happier being able to take him to daycare, drop him off, go home to a silent house, get my work done, and then pick him up at the end of the day. This worked out reasonably well on the three days he was at daycare. On the two days he was home, I felt like I spent half the day trying to get him to nap so I could work, and the other half of the day hoping he would stay asleep long enough for me to get some work done. And in between, I didn't know what to do with a baby.

Eventually, I found my stride with him, and we were able to put him in daycare full time so I could work during regular business hours. Also, he finally started going to bed around 7:30 or 8:00 a little before he turned one, and then I could also relax in the evenings, and my stress lifted quite a bit. I started making friends, finding other moms, joined a Mommy & Me, and life started to make sense for me.

And then along came SB. Though NJ continued on in daycare, we could not afford to put SB in daycare along with him. When he was a tiny baby, I found I could work in short spurts during his little naps, and sometimes he'd be happy in his swing for a bit while I typed. But he would get cranky and need me. I couldn't leave him sitting and staring all day, after all. And when he gained mobility, things definitely got more difficult again.

When SB was about six months old, my mom moved to California and into our house. She got a part-time job, and she took care of NJ and SB in the afternoons for me so I could work. This was, by far, the best arrangement I have yet found as far as work and having kids home, but it couldn't last forever. And it didn't. Mom got a full time job as a preschool teacher, NJ went to her school, and I was home with SB again. I did get some part-time baby-sitters and such to help me out, but what I learned to do was work work work while the baby sleeps. I also got more in the habit of working in the evenings after both kids were asleep. Since my husband works late, usually past 9:00 if not later, I was alone in a quiet house after the kids went to sleep, and I was able to relax, work, goof off on the computer, or do whatever else struck my fancy. Usually, I worked.

Now, I don't have to work eight hours a day or anything. Really, my job is sort of part time, and I need to put in between two and five hours of solid work in a given day (from the time I get up in the morning to the time I go to bed at night) in order to make my goal billing. This can sometimes be done by working during nap times, but not always. Plus, I like to find time for, say, blogging, internet surfing, random freelance work if I can get it, and simple relaxation. Oh yeah, and stuff like laundry and dishes. And at some point during the day, I also need to take care of my kids, right?

Now that GI's come along (actually, he's almost one already!), I feel like I've finally figured out, to an extent, how to be an at-home mom. Especially now that NJ is in public school, the value of my being home is really making itself clear. We don't have to scramble to find baby-sitters, camp settings, or alternative daycare options during school breaks (of which there are many). We don't have to figure out which one of us uses a sick day or PTO when one of the kids is sick. Even though kindergarten was only half a day, we didn't have to have wonky work schedules or hire a nanny or find before and after care. In other words, my being home has saved us a lot of money on the childcare front.

But the challenges still exist. I have to balance getting my work done with giving the kids what they need, taking care of the household, feeding my own soul with my hobbies (mostly blogging), and sleeping. It's Not Easy. (Whoever said parenthood was easy, anyway?) This summer has been a real test. GI, like his brothers before him, does not like when I am sitting at my computer. He might be in a perfectly good mood, playing with toys and whatnot, right up until I sit down at my computer. Then, BAM, he's right there, holding onto my chair and wailing. Why? What is it about me sitting at my computer that upsets him so? NJ and SB were the same way at this age. I never did figure it out. What it means, though, is that I realistically can only work while GI naps, which can be hit or miss. He usually naps for a total of at least three to four hours during the daytime, which should be enough to get a fair amount of work done. The trouble is, with NJ and SB home, they bicker constantly, and I find I'm always having to stop what I'm doing to tend to them. They're pretty self-sufficient, and I thought I had come up with an ingenious idea to help them want the baby to stay asleep: Screen time! They can watch TV, play with the iPod, play on the Wii, and use the other computer only when the baby is asleep. This turned out not to work as well as I'd hoped, as they simply fight over what show to watch or whose turn it is with the iPod or the Wii, but I tried. Oh well.

The most unfortunate consequence of my relying on GI's nap in order to get work done is that I'm obsessive about his naps. I become very resentful and angry if he is kept from his nap, or if he is awakened early, or if he naps anywhere but at home, because it means I've missed out on valuable work time. It also means that I'll have to stay up late after he's gone to sleep for the night in order to finish my work. I got very angry with the two older boys on Friday, for example, when they were arguing and woke up the baby.

Things will change as GI grows into a toddler. I'm hoping he'll become more able to entertain himself and not be so upset when I'm at my computer. I can't remember when SB reached that point. Also, NJ will be in first grade, at school all day, starting next week, so the dynamic (and routine) will change once again!

The main challenge for me is that my work isn't "mobile." The only place, the only place I can work is at my specific work computer, at my desk, in my office nook. I can't work on a laptop in the living room, or in the back yard, or at the park or Starbucks. I have transcription equipment that can't travel around the house and special software that can't be transferred to other computers. For people with work-from-home jobs where they are more portable, as it were, I would imagine working from home is slightly easier. Of course, you also have to contend with little hands banging on keyboards and such.

I have learned a few things that might be helpful to others considering taking up the work-from-home challenge.

• When you have a chance to work, sit down and work. Anything that can be done while the baby is awake, leave for when the baby is awake. Dishes, laundry, cooking, errands all can be done while baby is awake and being entertained by brothers or toys. Work can't. And try not to squander your time. (I am a pro at procrastination. I should really take my own advice.) If you have 10 minutes, get 10 minutes of work done.
• Spend a few hours each day doing stuff with the kids. Take them to the park, wander around the mall, go to a local amusement park or the zoo (get memberships to places you like to go!), even just spend time playing with them, reading to them, and talking to them in the house. They crave attention, the little ones do, and if they know they're going to get some Mommy time, they'll be more willing to leave you alone when you need them to.
• Make sure they have a safe place to play, so that if your eyes aren't on them all the time while you're working, you know they can't get up to too much mischief. With babies and toddlers, this means a baby-proof area within view and ear-shot that they can't get out of. With older kids, it means making sure they know the rules about where they're allowed to be and what they're allowed to be doing. And, it goes without saying, check on them periodically!
• Get some help. Any kind of help. Whether it's a neighborhood girl who comes over twice a week after school or a part-time nanny, whatever fits in your budget and your style, get some help. Or do a childcare trade with other stay-at-home/work-at-home moms, if you could handle other people's kids along with your own. It buys you more time to work and get other stuff done around the house, and it makes sure there's someone paying attention to your kids while you do those things. 
• Lay down the rules with your kids about your work time. They have to understand that Mommy sometimes can't play with them because she has to work. I like to use a carrot method, too, though. "If I get all my work done in the morning, we can spend the whole afternoon at ____." My oldest is very interested now in how much I've gotten done each day. "Did you get all your work done, Mommy? Do you have a lot of work?" It's cute.
• Be flexible with your hours and be realistic about how much work you can take on. Get an idea of how much you can really get done in an average day so that you don't overbook yourself. If you get overloaded, you'll either be taking too much time away from your kids or from yourself, and neither is healthy.

What's the secret to working from home? Finding a balance, being forgiving of yourself, and setting realistic work goals. If only it were as simple as it sounds.

The National Rally for Change - Improving Birth

Labor Day seems a fitting time for us to think critically about birth in this country. This Labor Day, September 3, 2012, women, men, and children will come together all around the country for ImprovingBirth.org's National Rally for Change. "The National Rally for Change is to encourage and insist that all maternal healthcare providers practice evidence-based care," to bring about a shift in the public perception of birth and the way care providers handle pregnancy and birth.

The statistics about birth in the United States show a disturbing number of unnecessary inductions and cesarean sections, unneeded interventions during the labor and delivery process, and a general fear of allowing nature to take its course. While modern medicine certainly has created an environment where it is theoretically safer than ever to give birth, the high rates of inductions and c-sections are disrupting the natural progress of pregnancy and labor and creating a culture of fear surrounding birth.

It's time to "take back birth!" When we demand evidenced-based care during pregnancy, labor, and delivery, we find that c-section and induction rates plummet and maternal and neonatal mortality and morbidity rates improve. Research is showing that our rates of cesarean section, induction, Pitocin augmentation, and other interventions during the birth process are far higher than necessary. Unnecessary or too-early inductions lead to c-section in a staggering percentage (67%) of cases, and c-sections carry a whole host of risks, such as premature birth to lifelong health problems such as asthma for the baby, and infection, infertility, and complications in future pregnancies for the mother.

It's not that c-section, induction, and other interventions don't have their place. Indeed, they are life-saving procedures when used properly. That's where the idea of "evidence-based care" comes in. Use interventions when necessary, based on solid medical research, not just because that's how it's done. 

The National Rally for Change and ImprovingBirth.org want women to be informed about their choices surrounding childbirth. Just as you are entitled to informed consent when it comes to any medical procedure, women have the right to make an informed choice about how they want to handle their births. We have a right not to be bullied by doctors and nurses into unnecessary inductions and c-sections. We have a right to labor in our own time and not on a hospital timetable. We have a right to know when procedures are necessary and when they are for the convenience or protection of the care provider. We have a right to know what a normal birth looks like, and we have a right to choose a normal birth. We have a right to give birth in a birth center or at home or in a hospital, with a midwife or a doctor, in the water or in a bed. We have a right to be mobile during labor, to eat and drink when we are hungry or thirsty, and to give birth in whatever position is most comfortable. We also have a right to choose a scheduled c-section or induction, to have an epidural administered, or to receive other pain relief via IV, as long as we make those choices knowing the risks and benefits. 

What is Evidenced-Based Materinty Care? "'Evidence-based maternity care' means that the care that is provided has been proven by reliable research to be beneficial to mothers and babies, reducing the incidences of complications, injury and death."

We need to raise awareness of the state of maternity care in this country and call for change. Please check out ImprovingBirth.org for information about rally sites in your area, how to become a rally coordinator in your city, and to find out other ways you can help. 

We hope to see you at The National Rally for Change, September 3, 2012!

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Birth Is Just One Day - or Is It?

I originally wrote this post over at BlogHer.com, where it was recently featured on BlogHerMoms and generated some discussion on the BlogHer Facebook page and on Twitter. I've reproduced it here for my Jessica on Babies readers.

I had an interesting discussion at a recent ICAN meeting. Most of us there had had successful VBAC's and were attending the meeting to support the couple of women who were hoping to have one. As a result, the conversation centered on how we can offer information and support without coming across as overzealous.

We talked about how some people wonder why we're so focused on birth, when birth is just one day out of years and years of parenting. It's true that, for some women, birth is "only one day," and it's the many years of child-rearing that come after that "one day" that matter. They feel that as long as your child is born healthy, it doesn't matter how he came into the world, or when, or what the mother's experience was. You have a healthy child, now move on! But for others, that "one day," that birth-day, is a pivotal moment for a woman. It's not just that now she has a child and has 18+ years of parenting to look forward to. It's not just whether she has a healthy baby that matters. Birth is a huge event. It changes you for life. It changes your brain. It changes your body. It changes your life.

For those women, those in the latter category, birth does matter. It matters a great deal. If she has a traumatic birth, it can leave her with deep psychological scars. If she has a picture-perfect birth, she can carry that bliss for years.

Birth, while it may be only one day (or two, or three), does leave a lasting impression on mother and baby. Studies show that there is a difference between being born vaginally and being born via cesarean section. There are documented risks to both mother and baby of a c-section that do not exist for vaginal birth. In a complicated birth, the consequences can continue for more than just "one day," or even just a few weeks. For some, the consequences of a birth that does not go as anticipated can continue for years.

Before my oldest son was born, I was in the camp that as long as you have a healthy baby, it doesn't matter how he was born. I believed that c-section has its place (which it does), that modern medicine has made giving birth safer than ever, and that the goal of pregnancy and labor is to end up with a healthy baby. When he finally emerged from an incision in my stomach, 29 hours after labor began, I felt like I barely knew who my child was. I didn't hold him for hours. I couldn't breastfeed for a day. I lost a lot of blood, was in a great deal of pain, and had no connection at all to this gorgeous boy they'd taken out of me.

After my oldest son was born, even that very day, I knew that birth is more than just the "one day," more than just "having a healthy baby." There is a whole cascade of biological processes that occur in childbirth that make you emotionally and physically ready to become a mother, and when birth doesn't go the way you expect, you miss out on those processes. Because of the craziness of his birth, I feel that I didn't properly bond with my son in those first few hours, like nature intends. I didn't know I was a mother. My brain didn't know. My body didn't know. And because the c-section also interfered with breastfeeding, I didn't get that second chance to bond right away, with the oxytocin rush of nursing.

It's not to say that I don't love my son. He's a healthy, happy almost-six-year-old now, bright, tall, and handsome. But that "one day" of his birth still haunts me, and I still wander down memory lane, thinking of those first few weeks, when this baby was a complete stranger, and I wasn't even sure he was mine.

I've since had two VBAC's, one drug-free, and I can tell you that the "one day" of those births left a completely different, no less important impression on me. When those babies were born, put right on my chest, nursed immediately, well, my brain clicked on. I had had a baby. This was my son. I gave birth. The birth of my second son taught me what it meant to be a mother. The birth of my thirdshowed me that my body is made for motherhood.

The trouble with birth being "just one day" is that you only get one shot at it. You don't get do-overs for births. No birth is the same, just as no woman, no pregnancy, no child is the same as any other. It's important to be educated and informed before that "one day," so that you can make the most of that once-in-a-lifetime experience. It's also important to know that sometimes things don't go as planned and to be active and proactive in making the best out of a situation that might not be ideal. And it's important to admit to yourself, and to allow others to admit, that when things don't go as planned, you can be affected for days, weeks, even years afterward, and that acknowledging the pain or trauma of a birth gone awry doesn't mean you don't love your child less and aren't grateful to have her. Birth is not "just one day."

Guest Post: A Tiny Toddler

The following is a guest post from a reader, who asked not to be identified. Hearing other mothers' stories will open up discussion on topics I may not have any personal experience with and provide a different perspective on parenting. I'm excited to present this first in a series of guest posts, in which this mother talks about her difficulty in getting her daughter to gain weight and grow according to the doctors' expectations. At what point do we go with our gut instinct over what the doctors think? How many tests, specialists, and evaluations do we put our children through before we decide on our own that maybe there's really nothing specifically wrong? And how do you convince a two-year-old to eat when she doesn't feel like it? We'd love to hear your comments!

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I should begin this post with some vital stats- I am barely 5 feet tall and was 20 years old before I hit 100 lbs. My daughter was born 5 lbs 3 oz full term but two weeks early.  At 6 months she was a healthy 11 lbs having doubled her weight as expected.  At 12 months she was just under 14 lbs and at 24 months just under 20 lbs. Twenty pounds is the average weight for a 1 year old . Between ages 1 and 2 my daughter has had 3 visits with a nutritionist, 3 visits with a gastroenterologist, numerous visits to the pediatrician, blood testing for every known allergy and carries a “failure to thrive” diagnosis on her medical record. Between ages 1 and 2 my daughter has also developed an impressive vocabulary, shockingly accurate memory, all of the age-appropriate gross and fine motor skills, “friendships” with her toddler classmates, and a thriving personality.  In that same year, our lives have turned into an endless feeding chore- finding food with the highest possible fat content, finding the best toys/stories/tricks to get food into her and most often finding the energy and patience within ourselves to get through one mealtime after the next.

A few months ago, after yet another period of no weight gain, I decided to do an experiment. I was pretty convinced that her lack of weight gain was due to insufficient intake of calories- there didn’t appear to be anything medically wrong- she just ate very small amounts of food and was much more interested in doing everything else under the sun other than eating.  On any given day she probably burns all of the calories she takes in, if not more. Or whatever is left over for growth translates into height increases and brain development- both parameters for which she is on the charts and growing on the curve. So we found a solution that held her attention and physically kept her seated long enough to shovel large quantities of high fat food into her that required as little chewing as possible: we let her have an iPad.  She watched and played and, blissfully unaware that she was “eating”, swallowed anything on a spoon we put in her mouth. The results were striking- she put on just over 1 lb in 1 month.  QED. But not wanting to make a habit out of it and having proven satisfactorily to myself that this was unlikely to be a medically-based problem, I went back to more “normal” meals. Weight gain over the next 6 weeks- 5 oz.

And so it is that I find myself in my current predicament- do I give in to her current medical providers' requests and put her through specialist visits and further testing? Do I trust my instinct that she is fine, try to cultivate a liking for food in her in a relaxed non-forceful environment (someone please describe what that is because I certainly don’t know!)? Do I find an alternate medical provider who might think more along those lines? Or do I simply go back to the iPad-fuelled feeding frenzy and get her “on the charts”? Do I, as many of my colleagues have suggested, not give a second thought to “Westernized” weight standards? In a society so plagued by obesity the concept of focusing on weight gain is hard to explain. Case in point- the insurance company’s repeated denial of our nutritionist visit claims because they would only be approved if the patients’s BMI is greater that 35. i.e. if you are obese we support your treatment, but if you are underweight we don’t recognize that as a medical problem. Is it time then that I stopped considering this a problem too? 

Reader Birth Story: A Precipitous Birth

Good Monday to you all. Today we have a special guest post from Snehal Naik, a college classmate of mine. Snehal tells us about the rather unusual circumstances of her daughter's birth. 

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At my first childbirth education class the instructor went around the room asking all the women what they were most worried about. Her goal was to make sure she allayed each of our fears during the course. My answer was completely different from everyone else’s: I was afraid I would be in labour and not know it. She assured me that my fear was unfounded. At my 36-week checkup when I repeated the concern to the midwife, she too told me that it was very highly unlikely. Perhaps it was my particular situation that made this fear so acute for me- at the time my husband worked in another state and I would commute a 100 miles daily by car.  My head was full of ideas of having to deliver my baby by myself in my car on the highway or on the bathroom floor, even as my screams went unheard.  But every single person I expressed this concern to told me it was unfounded; since this was my first child, I would surely have plenty of time to get to the hospital and get my husband to rush back too.

On the last day of week 37, I woke up at 4 am to use the bathroom. The instant I climbed back into bed I felt a rush of something and, thinking my water had broken, rapidly waddled back into the bathroom. To my horror, it wasn’t amniotic fluid but blood. I yelled for my husband to call the doctor and get dressed- we were going to the hospital. We were there in 15 mins with nothing but the clothes on our backs, we left two days later with our daughter.  As soon as the midwife finished examining me she exclaimed, “You’re fully dilated, you’re ready to push!” I think my response was something along the lines of, “No, no my baby isn’t due for another 2 weeks, I’m just here to stop this bleeding and then I’m going home.”  They showed me the full-strength contractions on the monitor and kept asking me again and again if I felt anything? No! I had felt nothing at all- the hours of agonizing pain that I had braced for before I would be hearing those exact words the midwife had greeted me with- they never happened. A mere 12 hours before being wheeled into the OR (a precaution due to the bleeding) I was at my baby shower.  I had literally slept through 10 cms of dilation and to everyone’s utter surprise I was, in fact, in labour and did not know it! I watched the monitor with surreal interest as the nurse’s aide told me, “Look here comes another contraction!”  Without the monitor, I would have no idea. I can only imagine how absurd that sounds to anyone who has ever experienced a contraction, and that too one in active labour!

The medical term for what I experienced is precipitous birth- defined as labour lasting less than 3 hours. 5:12 AM I was wheeled into the OR, 7:12 AM I heard that first screeching wail. There was of course no time for medication but I was just glad that I was able to deliver non-surgically.  They had to break my water for me and once that happened I experienced pain that I have no words to describe. Perhaps because I didn’t have the time everyone else spends in labour to prepare my body and mind, perhaps because she turned while coming out and I experienced back labour which is more painful- whatever the reason, I think I delivered in a state of shock. I skipped labour- lucky, unusual, blessed, whatever you want to call it.  I certainly feel blessed that everything turned out fine- it was before office hours and a Sunday so I was not alone, my daughter was healthy despite the bleeding being from a placental infarct, and my doctor and midwife made sure I got every chance to deliver non-surgically even in that unusual circumstance.  I also feel amazed when I think back to my number one concern during the pregnancy- was it instinct or pure coincidence?  My husband wanted a refund on our childbirth education classes. I simply hope that anyone else out there who has an unusual concern about their pregnancy finds a way to prepare for that circumstance no matter how far-fetched it seems. Surely anything’s possible if you can be in labour and not know it!
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Snehal is the mother of a two-year old, a molecular geneticist by training, and a research scientist by profession. Thankfully she only commutes 15 miles now, but her husband continues to work in a different state. Discussions on part-time single parenting or the effects of a traveling parent on a growing toddler are always of interest to her.

There She Goes Talking about Her Car Seats Again

Last Saturday night, on the way home after a rather long day, we stopped for gas while GI screamed in his car seat because he was tired and wanted Mommy to hold him. (Normally, under these circumstances, he falls asleep after five or 10 minutes, but this time he seemed insistent on screaming. This is not relevant to the rest of the story.) I twisted around in the passenger seat to look at him and stroke his head to try to calm him while my husband pumped the gas. I glanced at the other two boys, who were mellow, and then my gaze caught on a seat belt that wasn't buckled. It took me a while to decide that that was indeed the seat belt that was supposed to be securing GI's car seat to the car. Except, it wasn't buckled. I studied it a while longer, then finally said to my husband, "I think GI's car seat is unbuckled." We realized quickly how it had happened. NJ, when unbuckling his own seat belt, must have accidentally hit the button on the center seat belt anchor instead of his own, causing GI's belt to become unbuckled. This meant we had been driving around with, essentially, a useless car seat. For how long? We didn't know. I put GI in his car seat all the time and hadn't noticed the seat belt dangling there, but that doesn't mean it was a recent development.

We asked NJ if he remembered accidentally unbuckling GI's seat belt. He said he did. I said, "You have to tell me if that happens so I can reinstall it! It's very dangerous if the seat belt isn't buckled!" He didn't remember when it had happened. Really, I wasn't interested in punishing him or seeing him get in trouble. I just wanted to know how long I'd been nonchalantly driving all over town, assuming GI was safely buckled in a well-installed car seat! How terrifying!

In reality, I couldn't budge the car seat anyway, with the way it was wedged between SB's and NJ's seats. Naturally, a crash force is much stronger than my tired right arm, but at least it wasn't just sliding around all over the place. I also had connected the rear-facing top tether, so the car seat wasn't completely loose. But the most important bit of installation was completely undone. I reinstalled the car seat as best I could with the baby in it, sitting in a gas station at 10:30 at night, with GI's seat wedged up against SB's and NJ waiting with Daddy while the gas finished pumping. I did a terrible job, and I knew I needed to redo it ASAP. (The lesson here is, check your car seats' installations on a regular basis and re-tighten/reinstall as necessary.)

So, Monday morning, I said to NJ that since I had to reinstall GI's car seat anyway, we may as well try to rearrange the seats the way I'd kept meaning to all summer. I really, really wanted NJ in the center position, rather than the outboard passenger side, and I really, really wanted GI behind the passenger rather than in the middle. I have three major reasons for this: 1) When my husband is driving, he has to move the driver's seat back far enough that it butts up against GI's (admittedly massive) car seat back, and that's not ideal. Behind the passenger seat, his car seat wouldn't be interfered with that way; 2) It's better for the least-protected child to be in the safest, center position, and since NJ is just in a booster, GI is rear-facing, and SB is front facing in a 5-point harness, NJ claims the title of "least protected child;" and 3) The middle position doesn't have LATCH connectors in my car, so GI's seat was installed with the seat belt (which caused the above problem). I was never happy with the installation - it never felt quite firm, and I would much rather be using LATCH if I could. The seat belt anchor in the center position in my car is on a three-inch long stalk, and it was difficult to tighten the seat belt to prevent the car seat from twisting to the left if you pushed on it. Even after consulting with a car seat technician, I couldn't get it installed to my satisfaction. If I put GI outboard, I could use the LATCH to install the seat, and this problem would no longer exist, since NJ would use the seat belt in the middle position, and the tightness issue wouldn't apply.* 


Plus, NJ is the only one who can get in totally on his own, so him being in the middle is more convenient. Plus, GI is getting heavy, and I was less and less enamored of lifting him over into the middle seat, and that was only going to get harder as he gets taller and heavier. So having him in an outside position would be easier on me, too.

The reason the seats weren't already like this is that with his booster seat wedged between two car seats, NJ couldn't access the buckle for his seat belt! However, fortunately, I had stumbled upon this extremely handy tip, which NJ was more than willing to try: Leave the seat belt buckled and have the child climb in and out of the buckled seat belt. So, I reinstalled SB's seat (behind the driver's seat), which I had un-LATCHed thinking I might move it then changed my mind, put NJ's booster in the middle and buckled the seat belt, then installed GI's seat rear-facing behind the passenger. I was extremely happy to be able to use LATCH to get a nice, tight install for GI's car seat, finally. We spent a few minutes in the driveway having NJ practice climbing in and out of his seat without unbuckling the seat belt. He got very quick at it. We then went for a short outing, and he was into his booster before I finished buckling GI. Yay!

For those interested in this trick: Pull out the shoulder belt so you can loosen the lap belt. Have the child sit in the booster and pull the lap belt over his legs and settle it on his hips. Then have him put the shoulder belt in the proper position and pull the belt tight across his lap. To get out, reverse the process: Loosen the shoulder belt, put the shoulder belt behind him, loosen the lap belt, have him pull his legs out from under it, and get out of the seat. This gives you the added bonus of knowing that the booster seat is always buckled in, even when there isn't a child in it, which is the safest thing to do so that the booster doesn't become a projectile in the event of a crash when there isn't a child in it.

Here's NJ climbing into and out of his booster:

To get in, slide feet and legs under loosened lap belt

Settle shoulder belt in place, make sure it's not twisted, and tighten

Good job, NJ!

To get out, loosen shoulder belt and put behind you

Loosen lap belt and pull legs out

And you're done!

And, just for fun, here's GI, buckled (correctly) in his rear-facing Diono car seat:

I have two new problems, which I hope are offset by the benefits. One is that NJ now does not have access to a cupholder. He had been using the one on the door. Minor, but may come up on a long trip. The other is that SB and NJ are now practically touching while in the car, which might mean a lot of bickering and "he pinched me," and "he pulled my arm" and all the other nonsense. We shall see...

* Installing a car seat with LATCH or seat belt is equally safe if done correctly. Do not use both simultaneously. Make sure, if using the seat belt, that the seat belt is LOCKED so it can't loosen in a crash. (In most cars, you pull the seat belt out all the way, then let it retract. This will trigger the automatic-locking retractor.) If using LATCH, check if your vehicle and/or car seat has an upper weight limit for use of the LATCH system. Use the seat belt if your child exceeds this limit.