Birthing Beautiful Ideas

After attending the NIH Consensus Development Conference on VBAC back in March, I returned home inspired, excited, and motivated to empower other women about their birth options.

At the height of my inspiration, I came up with the idea to create an “NIH VBAC Primer“–something to simplify the NIH recommendations and the latest research on VBAC so that women could use that information to advocate for themselves.

With massive amounts of help from the inimitable Amy Romano, the great Lamaze folks at the Giving Birth with Confidence site, and (last but not least) an amazing group of doula, midwife, childbirth educator, and VBAC-mom contributors, “A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations” will be launched next week at Giving Birth with Confidence!

I cannot express enough how proud I am of this project and of everyone who contributed in ways great and small to it.

This has been a grassroots effort, a triumph of social media, and an empowering collaboration all in one.  And I am thrilled with the final result.

So if you’re looking to compare the risks and benefits of VBAC and repeat cesarean delivery, or if you’d like some advice about discussing the NIH statement with your care provider, or if you have any other questions about the NIH recommendations on VBAC, make sure to check out Giving Birth with Confidence for “A Woman’s Guide to VBAC” early next week!

As of this year, our little family of four had exactly (and only) four family pictures of us.

I’m not talking about professional family pictures.  I’m talking about “snapshots-taken-in-the-last-two-years-(since A’s birth)-in-which-all-four-of-us-were-present.”

And there were only four.

So we strove to rectify this problem this summer.  For the grandparents.  And the annual holiday card.  And the scrapbooks.  And the picture frames.

For our family.

But now that I look back on the three family-of-four photos we took this summer, I’m not so sure that any of them are quite what we were looking for when we set out to add to our family photo collection.

In fact, they might reinforce just why we had a dearth of family photos in the first place.

*

oops

Oh yes.  We’ll get an action shot.  One while we push the kids on the swings!  How idyllic!  And sweet!  And…

OH MY GOD, THERE GOES A!

Even better?  Not the looks on M or Tim or poor A’s faces but the look on my face.

Good lord, there goes my two-year-old, flying off the swing, and it looks like I’m laughing at him.

Happy Holidays!  My you swing through the New Year with lots of fun surprises!

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through the looking glass

A mirror.  That’s what we need.  We don’t even need to solicit the help of another photographer.

Nope, we don’t need anyone else to help us capture our children’s faces as they scream and thrash in this supposedly-haunted restaurant.  (Seriously.)  (And thanks for telling my kids about that ghost, well-meaning waitress.)

It’s all under control, people.

Happy Holidays!  Hope you don’t cry too hard when the ghost of Christmas presents visits you!

*

just...weird

Whatever.  It’s a family self-portrait.  Wherein you can only see the back of M’s head and approximately 35% of A.

But at least you can see Tim and my faces.  Because really.  Why would you want to miss those faces?

You know: the faces of the grown woman grinning like a fool and her crazed husband mugging like a leprechaun in the background.

Happy Holidays!  When winter gets you down, just remind yourself that your family isn’t as weird as ours is!

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Out of curiosity, which one would you include on the family holiday card?  I’m not too proud to send out a bizarre/inappropriate/wtf picture to all my friends and family…

M (4) says a lot of super-duper funny things.  So many super-duper funny things, in fact, that I could probably organize them all in book-form and make dozens and dozens of dollars off of them.

It’d be like Sh*t my Dad Says, pint-size.

Case in point: just a couple weeks ago (during the “Kristen’s Dad Puts the (kick)Ass Back in Bypass” ordeal), M and my brother were talking about Diary of a Wimpy Kid.  (It was the most recent movie that my nephews had seen.)  Upon hearing the title of the movie, M turned to my brother and asked:

“What’s a ‘diary’?  Is that like when the slimy poop comes out of your bottom?”

A couple hours later, when Tim was having some difficulties uploading a game onto his computer, M ran to my sister, tugged at her shirt, and said:

“Uh, Aunt Kellie, we’re gonna need some help.  My dad can’t get it up.“

Super.  Duper.  Funny.

But not all of M’s verbal gems make me laugh.  In fact, some of them shake me right to my feminist core.

I don’t remember how it came up in conversation or in what context he uttered the following statement, but one day a few months back, M told me with all the clarity and assurance in the world that “doctors are boys and nurses are girls.”

My eyes went boing and they went yoing and somewhere inside of me a teeny tiny riot grrrl started to cry.

Oddly enough, I feel as if I have to put on my decidedly un-feminist June Cleaver voice when tackling (presumably innocent) statements such as these with a four-year-old child.  And so I cooed, “Oh M, that’s not true!  What about your doctor?  She’s a girl!  And your uncle is in nursing school.  He’s a boy!  Doctors and nurses can be girls or boys!  What makes you think any different?”

And then I thought to myself, Where, oh where, did I go wrong?  Who has been feeding my child a hefty dose of rigid and outdated gender roles?  Will I ever be able to “correct” his perception of the medical profession?

The real issue, as I saw it, was not necessarily the fact that M had a problematically gendered view of doctors and nurses (though I certainly viewed this as a problem) but that the source of this conception was absolutely mysterious to me.  Where did it come from?  A friend?  A family member?  A commercial?  A television program?  A book?  (Gulp) me?

To the person who makes a concerted effort to prevent her children from developing rigid and/or static conceptions of gender (and sexuality, for that matter), this mystery was highly troubling.  And it still is.

In fact, just a few days ago (in the female pediatrician’s office, no less), M and I had the following exchange after playing with an uber-cute baby dressed in red and blue:

M: “Aww, look at that baby boy!”

Me: “How do you know that it is a boy, M?”

M: “I don’t know.  I just do.”

Me: struggling for words “Well, sometimes it’s hard to tell unless a baby’s mommy or daddy tells you.  And remember–girls can have short hair, boys can have long hair, and both girls and boys can dress in all sorts of colors!”

And then I thought to myself, What sorts of associations does he make when it comes to girls and boys?  What assumptions has his innocent little mind been trained to make when it comes to gender?  WHAT WAS HE ASSUMING ABOUT THAT LITTLE BABY?!

Where oh where did he learn to view the world through a gendered lens?

I suppose the answer is that I must remain content with the mysteriousness of this mystery–to allow that, yes, M will absorb some not-so-great ideas about gender and other social norms from mysterious sources.  I must accept that, because I must also accept that I cannot control everything that he sees, hears, and says.

But I can also patrol the media to which he is exposed (at least for the next year or so).   I can patrol my own words and actions and choices.  And I can help M to think critically about his own assumptions (with my June Cleaver voice and all).

And I need to remind myself of those times when M does display his own open-mindedness about gender.

Case in point: One day when we were at our local library, and M spotted  a pink and purple dollhouse in the library’s play-area.  (It looked like it came right out of the “sparkly pink and purple hearts 4ever” aisle in the toy store.)

And he ran right toward it, choosing it over the trains and trucks and puzzles and toy animals in the room.

As he arranged the dolls throughout the house’s rooms, a young girl who was getting ready to leave with her mother ran headlong toward M, took the dollhouse out of his hands, and shouted, “You can’t play with this!  You’re a boy!”

M stared at her blankly and politely replied, “Um.  This toy is for everyone in the library to share.”

“No!  You can’t play with it!”

M looked at me, and I nodded at him with encouragement.

On and on the struggle went, not with any animosity really, but definitely with some concern on the other child’s part.  She remained adamant, and M remained patient.  I stayed silent, mainly because their disagreement wasn’t escalating and because M was apparently handling it well enough on his own.

Once the girl’s mother saw what was transpiring, she came to retrieve her daughter and apologize to M.  “Oh honey,” she said awkwardly, “of course he can play with the dollhouse!”

“NO!  He CAN’T!  He’s a BOY!”

And soon, they left.

Maybe the girl was just tired.  Maybe she only wanted to take that really fun dollhouse home with her.  Or maybe she had an impossibly static conception of gender norms and roles.  I don’t know.

All I do know, however, is that after she was out of sight, M went right on playing with the dollhouse and muttered to himself (with an awesome and unintentionally bitchy tone), “What’s her problem?”

And M’s very mature and philosophical mother had to mutter to herself, “Oh, SNAP!”

And the teeny tiny riot grrrl did a happy dance.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

How do you–or do you–strive to maintain open-mindedness about gender norms and roles with your own child?  Has your child ever surprised you with ideas about gender that differed from your own?

Doulas, nurses, midwives, and birth supporters of all flavors: I have a question for you!

What do you do when your client has reached the “magic” 10 centimeters and then suddenly a nurse or doctor begins FRANTICALLY coaching her on how to PURPLE PUSH NOW NOW NOW?!

In other words, how does one “unplant” the purple pushing seed once it’s been planted?

Yes.  The dreaded purple pushing.

“Take a deep breath!  Then another!  Hold it!  Pushpushpushpush while we count to ten!  Another deep breath!  HOLD IT!  1-2-3-4-5-6-7-8-9-10!  ANOTHER DEEP BREATH!  HOLD IT!  PUSHPUSHPUSHPUSHPUSH!”

As many of us birthy-types know, this sort of pushing (purple pushing, coached pushing, etc.) isn’t necessarily best for mom and baby.  In fact, pushing according to their body’s urges and in the position of their choosing is healthier for the vast majority of women and their babies.

But once the coached pushing train has begun rolling down the tracks, it can be difficult to stop it from gathering momentum and speeding right on until the baby is born–even if a woman has previously specified that she does not want to purple push/push to a count of ten/follow coached-pushing.

And so unless a woman has told me that she does want to use coached pushing–and to be fair, some really, truly do–I find myself a bit perplexed as a doula once the push-coaching begins.

*

Because on the one hand, I want to preserve the sacredness of my clients’ births.

So I don’t immediately jump in with hands waving and shout, “HEY!  Her body already KNOWS what it’s doing, BUDDY!  Haven’t you SEEN how well she has been coping throughout her labor?!  BACK OFF!”

(Though, to be fair, that’s typically what I’m thinking.)

But my duty is to help my clients advocate for themselves–not to create unnecessary tension (i.e. a fight), especially when they are so close to welcoming their babies.

So sometimes after a contraction or two, I’ll try asking my client, “Hey, do you want to try pushing without the counting for a little while?”

Sometimes I’ll ask, “What do you think about pushing on hands and knees/on your side/in a squat/etc. for the next contraction?”

Or if they’ve specified very directly that they would like to push without any counting and in the position of their choosing, then I’ll gently remind them of their preferences in between contractions.  (And if I’m very lucky, I’ll be able to throw in this reminder before the frantic purple-pushing instructions begin.)

*

What’s more, I want to preserve my clients’ confidence in their bodies.

Here’s the tricky thing about re-framing the way that the second stage is unfolding: trying to redirect a woman’s pushing too forcefully can make her feel as if she is doing something wrong.  And undermining a woman’s confidence in herself and in her body is the last thing that I want to do while she is bringing her baby into the world.

(With this in mind, I should also note that the general spazziness that often accompanies purple-pushing instructions can not only make a woman doubt her body’s abilities to push out her baby but also make her feel as if there is some sort of emergency occurring as she pushes.

Because really.  Who DOESN’T freak out every once in a while when TONS OF DIFFERENT PEOPLE are YELLING at you to do something HARDER without even MAKING EYE CONTACT with you?!?!)

So even if the coached pushing continues without interruption, I still try to assist my clients as calmly as possible.  I don’t count along with everyone else in the room unless a woman has told me that the counting is really, truly helping her.  (And to be fair, some women have really, truly reported that the counting helps them to focus their pushing efforts.)  I also interject as many gentle “You’re doing a GREAT JOB!” comments as I can in order to boost her confidence in herself.

And if and when I do bring up the possibility of changing positions (or even waiting to push until she feels a stronger urge to push), I do so in a way that avoids (as much as I can) the insinuation that she is doing something wrong.  Thus, I’ll often preface these suggestions with yet another, “You are so amazing! You are doing a great job!”

Because really.  Who doesn’t like to hear that they are amazing and doing a great job when they are doing some of the most challenging physical work on the planet?!

*

But on the other hand, the real problem is that I don’t want my clients–or any woman–to get “coerced” into purple pushing.

And there’s the rub.

In an ideal world, none of us would have to do any purple-pushing redirection in the first place.

And in the real world–even when a mom wants to push according to her body’s urges and in the position of her choosing–sometimes these attempts at redirection don’t “work.”

So again, doulas, nurses, midwives, and birth supporters of all flavors, I ask you:

What do you do to support your client when pushing turns purple?

A (2) has been lighting up our lives with a rather marvelous fashion parade lately.

It all started with an unexpected obsession with snow boots.

Snow boots that he must–MUST–wear around the house at all times.  ALL TIMES.

Which, you know, is pretty awesome.  Especially when he insists on wearing the boots (which of course light up whenever he walks) on a summer outing to Trader Joe’s.  And then becomes the most popular kid in the whole store.  THE WHOLE STORE.

And I’ve done nothing but support A’s inner fashionista.  In fact, I’m almost in awe of his sense of style.

I mean, I would never have thought to pair the Spider Man boots with the witch’s hat and the solo striped glove. Never!

Way to be fierce, A-man!

(And yes, sisters of mine, I know what you’re thinking: “Kristen, A’s fashion sense shouldn’t surprise you at all.  You were the one who showed up to high school one day wearing a pair of your best friend’s dad’s old jeans upon which you had scrawled your favorite song lyrics in neon highlighter!“  To which I reply, touche’.)

In any case, I think that a few of his looks are simply too bizarro-cute not to share with you all.  They are a tribute to his independence, his humor, and his fierce fashion sense, all of which deserve to be celebrated.

Just make sure to give credit where credit’s due if you decide to try out some of these “trends” for yourself.

*

It’s 90  degrees outside.  Where are my mittens?

ready for school. and an august blizzard.

*

Safety first.  Even if the helmet is on backwards.

always practice safe tracks.

*

All in.

why would anyone stop with just snow boots and a backpack? the knight's helmet (with a green feather taped on top!), the shield, and the blanket sash are essential components of this outfit.

Dear Dad,

Here you are.  Alive.

Alive.

Living.  Breathing.   With a beating heart.  Blood pumping through your veins.

Last week, we were all worried that you wouldn’t be here with us today–alive, living, breathing, with heart beating.

It all started when, after concealing your symptoms from us (Mom included) for months, you finally scheduled an appointment with your cardiologist once you found yourself unable to walk up the steps to your front porch without having to stop and rest halfway there.

You are an otherwise healthy 60-year-old man, so this was more than a big deal.

(As all five of your children heard over and over again this past week, you’re also a “hot”–or rather, HAWT–60-year-old man.  In Mom’s words, that is.  She even went on and on to the PA about how “sexy” your legs were and that he “better be CAREFUL with them” when he harvested your veins for your bypass surgery.  And then one of your daughters–I won’t name names–almost passed out when she heard the words “harvest” and “veins” uttered in the same sentence.  And then we all laughed at her.)

In any case, during the stress test at your appointment, you went into V-tach after only two minutes on the treadmill.

And then you learned that one of your arteries was 100% occluded and that angioplasty was not even an option for you.  You would need triple bypass surgery.

We were all terrified.  Absolutely terrified.

And you–obviously, unquestionably–were also terrified.  You, the physician who knew how grave your situation was.  You, who was viewing bypass surgery through both a patient’s and a doctor’s eyes.  You, who had lost your mother, your sister, and your brother to massive heart attacks all before they turned 60.

Terrified.

And our terrified family–our wild, crazy, ridiculous family–came together like never before to support you and Mom.

And the day before your surgery, we gathered around your hospital bed, and we laughed and we shared stories and we cried and we prayed.

(One of us said a really spectacular prayer–one of the best I’ve ever heard, in fact.  But this came after a rather decrepit looking minister came into the room and prayed with all of us.  His prayer was so sweet and earnest, but you know how it goes: the more Oganowski children in a room during a prayer, the more likely it is that one of us is gonna start laughing.  And, surprise of all surprises, it was me who started laughing.  You know, the same person who started laughing during that one Easter prayer years back and who tried to cough…or sneeze…or cough…or sneeze in order to cover up the laughter but just ended up sounding like a moose farting into a trombone with the fake-sneeze-cough.  Good times.)

The day of your surgery, all of us–Mom, Kas, Kate, Kellie, Kinsey, and me–gathered around your bed one more time to wish you well, to support one another, and to be the family that we are.  And at one point, you asked Mom to leave, and you lay there with your five children surrounding you, and you gave us a pre-op pep talk.

There were no delusions, there was no candy-coating of the situation.  There was honesty, and support, and even a reverence for the seriousness of what was about to happen.

Once you were wheeled down to the pre-op area, each of us, two or three at a time, went back to give you one last kiss before your surgery.

(In pre-op, Kate, Kellie and I found it oh-so-fitting to talk with you about how AWESOME our family would be on a reality show.  Not because we want to be famous.  Not because we think we’re all that glamorous.  But because we think that everyone deserves to see our wildly inappropriate humor in action.  You even came up with a more-than-fitting title for the series: “Train Wreck.”  I came up with the alternate title, “O My God”–’O’ for ‘Oganowski,’ because I’m clever like that.)

While making plans to contact E! regarding our surefire hit series, one of the nurses came to the foot of your bed and asked how you were feeling.

Your monitors were alarming, but she told you that sometimes that happens when a person accidentally hits the monitors with his or her hands.

But then another nurse came to the bed.  And when she asked you whether you were feeling any pain, you said, “I wouldn’t exactly call it pain.”  And then you became quiet.  And then she asked us to leave.

You were crashing.  This thing was starting to kill you.  Right in front of our eyes.

After a few excruciating minutes, Mom rushed back to the waiting room to tell us that you were “throwing PVCs and were bradycardic” and that they might be able to start your bypass surgery if they could get you stabilized.  (Mom was in nurse mode and thus was speaking nurse-speak–I had to call your office to get one of the doctors to translate “throwing PVCs” to me.  And, just so you know, this prompted everyone at work to gather in your office and pray for you.  Everyone.  That’s a pretty astounding testament to just how much you’re loved, and just how much you have to live for.)

Once you were stable, each one of us was able to return to your bedside, one at a time, to give you a quick kiss and “I love you” before surgery.

(I know it’s not entirely appropriate to describe the following events as hilarious because they were some of the most emotionally frightening moments of my life.  In retrospect, however, they were pretty darn funny.  First, one of us–again, I won’t name names–actually passed out on the way back to your bed.  And I couldn’t stop laughing about it, even through my tears and concern for her and cries that “OH MY GOD, this is so inappropriate but I CAN’T STOP LAUGHING!”  Then you were so drugged up by the time we got to you that your “last words” to us became more and more outrageous.  Case in point?  Your words to me–spoken in a southern accent, no less–were, “Now I don’ wanna wake up tomorra’ mornin’ and read about what youuu’ve done in the newspapers!”  Sure, Dad.)

Once you were finally stable (though only somewhat–you continued to have issues throughout the next few days) and finally in surgery, we began the waiting game.  And we all knew–we were all instructed by Mom–that the scariest part of the surgery was not the harvesting of the veins (cue fainting) or the bypassing of the occluded arteries themselves but the moment when they took you off of bypass and tried to get your heart and lungs to work on their own.

In other words, the scariest part of the surgery was the end of the surgery.

When your heart had to start beating on its own again.

And so we did what any normal family would do with such a terrifying prospect at hand.

We prayed, we cried, and we played Scattergories, ate french fries and brownies, and joked about a person we had just met whose name was Dick Wiener (I kid you not).

And then you were done.  You and your medical team were triumphant.  And we were exultant.  And we gathered in your recovery room and held your hand and held each others’ hands and just loved you.

(And damn Dad, you looked GOOD!  Everyone kept preparing us for how shocking it is to see a patient after bypass surgery, but hell, you looked better than most of the people on the “What You Need to Know about Bypass Surgery” video–including some of those folks who were just the FAMILY MEMBERS of the people who needed bypass!)

Now.  I don’t want you to go and get the idea that it’s fine and dandy to ignore your symptoms and blow off your cardiologist and act out the “doctors-as-the-worst-patients” stereotype again.  No one (yourself most of all, I presume) wants you to endure what you’ve endured any time in the near (or even distant) future.

But this awfulness?  This stress?  This agony of watching and waiting and wondering and holding our breaths and loving you more fiercely than we’ve ever loved you?

It’s brought your family closer together than we’ve ever been.  Ever.

It has illuminated the best in all of us–in Mom, in Kas, in Kate, in Kellie, in Kinsey, and (I hope) in me.

It has brought together friends new and old, co-workers and former colleagues, and just about everyone who has ever loved you–and there are many.

So many, in fact, that I have to believe that this love is what has sustained you through the past week-and-a-half.

You had so much love that day–you have so much love surrounding you–that there must have been at least four-hundred hearts beating for you even when yours wasn’t.

And there are six hearts in particular that will continue to beat steadily and strongly and fiercely for you.

We love you, Dad.

-Kristen

Here I sit in a bedroom  at my parents’ house while my two young children fight sleep more than I’ve ever seen them fight it before.  They are wild and wired and feasting off of the stress swirling around them–the stress that I can’t seem to hide.

My dad is currently in the ICU at a local hospital.  He’s having triple bypass surgery on Thursday.  One of his arteries is 100% occluded.  My mom is with him.

My grandmother is here at the house with me–she and my grandfather live with my parents–and is recovering from gallbladder surgery.  I slept on an air mattress at the foot of her bed last night and got up with her every 45 minutes to make sure that she could get to the bathroom without any trouble.  I was up at 7 to take care of the boys.

Tim is at our house, over an hour away.  He’ll be able to take a day off on Thursday so that he can care for the kids during my dad’s surgery.

All four of my siblings are arriving here at my parents’ house tomorrow.  I have yet to wash the sheets, or do the dishes, or run to the grocery.

In the meantime, I need to make sure that both of my grandparents are fed, that all of the right people get the right messages about my father’s health, and that I stay strong enough for my mother whenever I speak to her.

This summer has already been difficult.  But now it has reached crisis status.

And I am hanging on by the thinnest of threads.

So I prayed a lot today.

Most of the time, I’m ambivalent about the receiver of my prayers.  I fall somewhere in between believing in an invisible bearded man-in-the-sky and rejecting the remotest possibility of a great power altogether.

In other words, I’m not sure whom or what I’m praying to when I pray.

And I’m alright with that.  I like prayer more for its abilities to force me to surrender to the unknown, to re-frame my perspective on the world, and to bring the loving thoughts of a bunch of desperately flawed human beings together.

One of the many, many things I prayed for today was a ray of light.  Just something to give me some levity.

Something to let me be selfish and vulnerable and ephemerally free tonight.

And that great answerer-of-prayers followed through in the form of a Google Alert on c-section.

Folks, I give to you what may just be the funniest translation of a news article (original here) that I’ve ever, ever seen.

(And no, I don’t care that I’m copying and pasting the whole thing here.  The highlights are…well, highlighted.  A few select commentary are in parentheses.  But I didn’t want to include too many.  Thought they would take away from the translation’s glory.)

NEW YORK (Reuters Health) – The super a meaningful blackamoor (somebody’s Google translator has a nasty racist streak!) is when she checks in on conveying day, the greater her venture of having a caesarian section, suggests a super infant study.

Nearly digit of every threesome births (kinky!) in the U.S. is today delivered by cesarean, a surgery that has been linked to complications for both mom and female much as infection, injury and hysterectomy. This evaluate is most 50 proportionality higher than it was in the mid-1990s, according to the U.S. Centers for Disease Control and Prevention.

“As clinicians, we are visaged with so some issues when attractive tending of patients with higher BMI, and digit of them is a greater venture for cesarean,” advance scientist Dr. Michelle Kominiarek of Indiana University told Reuters Health.

She additional that patch preceding studies had already linked caesarian conveying and embody accumulation finger (BMI) — a manoeuvre of coefficient that takes into statement peak — hour had been super or careful sufficiency to watch how another factors strength edit that risk, much as preceding births or caesarian sections.

To intend a fireman countenance at the issue, Kominiarek and her colleagues composed accumulation on nearly 125,000 women from the National Institutes of Health’s Consortium on Safe Labor who gave relationship between 2002 and 2008. Then they analyzed the circumstances close apiece birth, as substantially as the conveying route.

A amount of 14 proportionality of the women unnatural underwent cesareans, inform the researchers in the dweller Journal of Obstetrics and Gynecology.

They institute that for every organisation process in BMI, as rhythmic on achievement for delivery, a woman’s venture of caesarian conveying chromatic by 4 percent.

The aggroup also unconcealed that this venture multifarious depending on whether or not a blackamoor had presented relationship before or had previously undergone a caesarian section. A one-unit process in BMI upraised the venture of caesarian 5 proportionality for a blackamoor delivering her prototypal child, 2 proportionality for women with children and preceding cesarean, and 5 proportionality for women with children but without a preceding cesarean

These personalty remained after business for factors much as motherlike age, vie and cervical enlargement at infirmary admission.

Overall, those who had a preceding caesarian had most threefold the venture of having another: more than 50 proportionality of busy women with a BMI over 40, which is thoughtful morbidly obese.

Part of the need for move cesareans is anxiety over a vaginal relationship violent scars mitt over from the preceding surgery. However, a removed think fresh institute that these uterine ruptures are not as ordinary as previously thought, occurring in inferior than digit proportionality of vaginal births after cesarean. (See Reuters Health report, July 21, 2010.)

Other factors related with the venture of caesarian in the underway think included an geezerhood of 35 or older, black or dweller race (is this another racist thing, or are they talking about people from middle earth?) , and diabetes.

“The process in the caesarian evaluate in this land is a varied issue,” Dr. Hugh author of The river State University, who was not participating in the study, told Reuters Health. “Obesity is sure a momentous tooth in that wheel.”

Ehrenberg also spinous to a some weaknesses of the study, including the demand of accumulation on infant filler and the contradictoriness of caesarian rates crossways the think centers — ranging from digit in quaternary to digit in 10 women.

The latter could equal differences in bourgeois attitudes as a termination of varied levels of experience. “If you’re not sight a aggregation of fat women at delivery, you haw more pronto revilement somebody because you’re uneasy and not because they’ve unsuccessful in labor,” said Ehrenberg. “Being rattling bounteous doesn’t needs stingy you shouldn’t be allowed to labor.”

Exactly how blubber contributes to caesarian venture ease has not been substantially addressed, (wise words, my friend) additional Kominiarek. “What is finally the safest conveying line for someone with a broad BMI? Is it prizewinning to hit an nonappointive c-section, or is it meet as innocuous to fag and then hit a c-section? (and they’re homophobes too!)  It module order more investigate to respond much questions.” (my question exactly!)

SOURCE: http://link.reuters.com/fyc74n dweller Journal of Obstetrics and Gynecology, online August 5, 2010.

If this is how the good lord/lordess answers prayers, then count me in as a bona fide believer.

YOU HAW MORE PRONTO REVILEMENT!

(And if you’re in the praying mode, please send a few my dad’s way.  His heart–and my heart–could use ‘em.)

Advocating for birthing rights and options can seem like a daunting (and time-consuming) task–especially for those of us who have birthed children and are mired in the daunting and time-consuming task of raising them!

Sometimes, however, we can do this sort of advocacy work with small yet meaningful tasks.  We can make phone calls, write emails, or even simply fill out surveys and thereby potentially help countless other birthing women.

(For what it’s worth, this is one of my very favorite things about technology and social media!)

If you’re looking for some “small-yet-enormous” birth advocacy work, here are a few things you can do on behalf of yourself and other women:

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1. Ohio Home Birth Survey

Martha Nieset, an Ohio State University graduate student, is conducting a research study on home birth in the state of Ohio.  According to Nieset:

This study will investigate the reasons women choose home birth, how they go about finding health care support, and the factors involved with their decision. The results of this study can help to improve access to midwives and home birth care providers in Ohio.

Nieset is currently looking for women who have had a planned home birth in Ohio in the past five years to fill out a short (15 minute) survey. If you fall into this category, or if you know of any women who fall into this category, I strongly encourage you to complete the survey and/or send it on (url: http://bit.ly/homebirthohio) to others.

Your efforts will be helpful not only to Nieset and her research study but possibly also to other birthing women in the state of Ohio!

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2. VBAC Ban Reversals

ICAN is currently encouraging women to contact their local maternity care providers and hospitals to encourage them to change their VBAC policies in light of the new ACOG Practice Bulletin on VBAC.  (The many VBAC bans across the United States have been attributed partly to language in the previous bulletin on VBAC.  ACOG made significant changes to this language in the most current bulletin.)

If you’re interested in helping to improve VBAC access in this way, the ICAN site has a helpful list including links to letter templates and instructions for filing formal complaints with hospitals.

The ICAN Blog has even posted an example of an email exchange in which an Iowa woman pressed her OB/GYN office to change their VBAC policies in light of the new ACOG recommendations.

So please, especially if you are currently facing VBAC bans in your area, make a phone call, write an email or letter, or even file a complaint on your and other women’s behalf.  You never know what sort of changes you’ll be able to make in your community!

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3. Galactagogue Survey

Have you used or are you currently using Reglan (metoclopramide) or Domperidone to stimulate and/or increase your breast milk supply?  Dr. Thomas W. Hale and Dr. Kathleen Kendall-Tackett are currently conducting a survey to help them examine women’s experiences with these galactagogues (i.e. substances used to promote lactation).

Please share your experiences and help Drs. Hale and Kendall-Tackett help other breastfeeding mothers!

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4. The Birth Survey

The Coalition for Improving Maternity Services (CIMS) has been (and is still) compiling information from about maternity care providers and facilities from women all over the United States in a project known as The Birth Survey.  While the results they have compiled are available to the public, they still need many more women to complete the survey.

So whether you’ve had an amazing or an awful experience with your care provider or birth site, the information that can be gleaned from the survey is crucial to helping other moms choose their own care providers and birth sites!  And taking the survey is easy to do!

(Thanks to Sheridan from Enjoy Birth for reminding me to include the survey on here!)

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5. There must be others!

Do you have any other examples of “mother-sized birth activism” that you’d like to share with others?  Please let me know, and I’ll make sure to add them here to the post!

Many women who want to have a vaginal birth after cesarean (or VBAC, pronounced “vee-back”) in the U.S. and elsewhere have faced some sort of opposition from their care providers when they have expressed their desire to VBAC.  Oftentimes, this opposition comes in the form of ” VBAC scare tactics.”

The (outrageous) statements are often misleading, exaggerated efforts by OBs (and yes, even midwives) to discourage women from VBAC and to encourage them to “choose” a repeat cesarean.  (Of course, it’s not really a choice if your provider won’t even “let” you VBAC, is it?)

If you find yourself up against a barrage of scare tactics–as I once did–it can be exceedingly difficult to stake your claim and argue against the doctor (again, or midwife) who may or may not have your and your baby’s health prioritized higher than medico-legal concerns and who may or may not be insinuating that VBACs are synonymous with driving your child in a car without a car seat.

If you do find yourself facing such scare tactics, and if you do want to have a VBAC, there are some questions that your care provider should be able to answer when s/he hurls those scary and/or outrageous comments and standards your way.  And if s/he refuses to or even cannot answer these questions, then you might want to consider finding an alternative care provider–one who is making medical decisions based on research, evidence, and even respect for your patient autonomy and not on fear, willful ignorance, or even convenience.

I encourage all mothers who read this post (and others in my “VBAC Scare Tactics Series”) to  take the information contained herein as a springboard from which they can 1) continue their research on VBAC, 2) maintain a communicative relationship with their care providers, and 3) find a care provider who best supports the mother’s interests and plans for the birth of her child.

(To read my disclaimers about “why I am not anti-OB” and “why I take the gravity of uterine rupture seriously,” please see my posts on VBAC scare tactics (1) and (2) .)

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Scare tactic #10: Based on this recent sonogram, your baby is getting way too big for a vaginal birth, especially a VBAC.  You can’t safely have a VBAC with a macrosomic baby.  We’re going to need to schedule a repeat cesarean as soon as possible.

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Questions to ask your care provider:

• How accurate are sonograms at predicting fetal size, particularly at the end of a pregnancy?
• What special concerns do you have when it comes to a woman birthing a “big baby”?
• Does fetal macrosomia increase the risk of uterine rupture?
• What does ACOG recommend when it comes to fetal macrosomia and VBAC?

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A more nuanced analysis:

When a physician or midwife uses terms like “suspected fetal macrosomia” or “LGA” or “large for gestational age” in reference to your baby, what s/he means is that your baby’s estimated weight has exceeded a particular cut-off point: typically, either 4000 g (or 8 lbs. 13 oz) or 4500 g (or 9 lbs. 15 oz).

The reasons for denying women the opportunity to plan a VBAC with a suspected macrosomic baby may vary.  Some care providers might think that this increases the risk of uterine rupture.  Others might want to forego the slightly increased risks associated with fetal macrosomia.  And many might regularly schedule cesarean sections for all suspected macrosomic babies, whether or not their mothers have scarred uteri.

And, to be fair, there are some increased risks associated with fetal macrosomia, particularly if women have diabetes or uncontrolled gestational diabetes/gestational diabetes mellitus/GDM.

For one, fetal macrosomia is associated with a greater risk of shoulder dystocia, a labor complication that is serious but nearly impossible to predict, especially before labor even begins.  (Notably, the overall risk of shoulder dystocia during labor is approximately .6-1.4%.  What’s more, approximately one-half of all cases of shoulder dystocia occur with infants who weigh less than 4000 g–that is, who are not macrosomic.  )

Fetal macrosomia is also associated with a greater risk of cesarean section, although this is likely related (among other things) to the relative immobility with which most women labor in hospitals, to the rising rates of labor induction, and to the fact that many care providers recommend prophylactic cesarean section for suspected fetal macrosomia.  (Worth noting is that labor induction–which does slightly increase the risk of uterine rupture–has not been found improve labor outcomes for women and babies where the fetus is suspected to be large.)

Nonetheless, barring any pregnancy complications that would greatly increase these and other risks associated with fetal macrosomia, the absolute risks themselves are quite low, and certainly not high enough to bar all women carrying fetuses who are suspected to be macrosomic from delivering those babies vaginally.

In this respect, it is exceedingly important to remember that any suspicions about fetal macrosomia are just that–suspicions, estimates, educated guesses.  In fact, weight estimates gleaned via ultrasound can be “off” by as much as one to two pounds!  So even if ultrasound measurements determine that your baby is measuring 10 pounds, you might actually have an average-sized 8 lb. baby (or, to be fair, a larger-than-average 12 lb. baby).  Thus, it is worth asking your care provider why this estimate by itself would disqualify you from planning a VBAC.

To this effect, your care provider might state that fetal macrosomia lowers the likelihood of a successful VBAC and that it increases the risk of uterine rupture.  S/he might even mention the most current ACOG Practice Bulletin on VBAC, which does refer to some “limited evidence” showing a higher risk of uterine rupture associated with “women undergoing TOLAC [a trial of labor after cesarean] without a prior vaginal delivery and neonatal birth weights greater than 4,000 g.”

But this very excerpt from the ACOG Bulletin demonstrates that the issue is more complicated than simply claiming that “fetal macrosomia increases the risks of uterine rupture.”  For instance, while there is evidence suggesting that higher birth weights are associated with higher rates of uterine rupture, ACOG itself acknowledges that this evidence is limited.  (The study I’ve linked to here examined 2586 women, but only 269 had babies with birth weights greater than 4000 g.  This is a fairly small population, especially when one is considering using the study to disqualify women with suspected large babies from planning a VBAC.)

What’s more, although a large baby may lower one’s chance of having a successful VBAC, this does not mean that one has an absolutely low chance of having a VBAC with a large baby.  In fact, in the aforementioned study, the VBAC success rate among women who birthed babies weighing over 4000 g was 62%–not exactly a low success rate!  (And to be clear, the other 38% were simply those women who had cesarean sections following their VBAC attempts–not necessarily those who had uterine ruptures following their VBAC attempts.)

Finally, the current ACOG Practice Bulletin on VBAC also mentions the fact that most (if not all) of the studies examining VBAC success rates, uterine rupture rates, and fetal macrosomia used “actual birth weight as opposed to estimated fetal weight thus limiting the applicability of these data when making decisions regarding mode of delivery antenatally.”  In other words, the data used in these studies pertained to babies who were actually macrosomic–not babies who were suspected to be macrosomic.  It pertained to actual birth weights–not to weight estimates.  Thus, particularly since fetal weight estimates are notoriously inaccurate, it is questionable whether or not one can or even should apply these studies to any sort of prenatal counseling–especially counseling that dictates whether a woman should deliver her baby vaginally or via cesarean section.

In this respect, it is important to take note of ACOG’s most recent recommendation on VBAC with suspected fetal macrosomia:

… it remains appropriate for health care providers and patients to consider past and predicted birth weights when making decisions regarding TOLAC, but suspected macrosomia alone should not preclude the possibility of TOLAC.

So if your care provider is denying you the opportunity to have a VBAC based only on suspected fetal macrosomia, you should definitely consider asking why s/he is departing from ACOG recommendations in this matter and/or what other reasons s/he has for barring you from a VBAC.  (You might also consider finding a more supportive care provider!  Or just refuse an unnecessary cesarean, as it is your right to do!)

What’s more, you can always maximize your chances of a successful VBAC with a suspected large baby by walking, moving, and changing positions during labor and by avoiding giving birth on your back.  The more you move and remain upright, the more you take advantage of gravity and of your pelvic flexibility and mobility to help bring your baby into the world.

And suspicions about a large baby should not preclude you from doing just that.

Update: Congratulations to Maureen, the winner of the Signing Safari DVD giveaway!

Review of: Signing Safari DVDs: 1) “Beginner Signs & Alphabet” and 2) “All About Me!  Daily Life & Family Signs”

Retail price: $30.00

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A little background: Founded by Child Sign Language Specialist Sharon Said, Signing Safari is a company devoted to teaching hearing infants, toddlers, preschoolers, and their parents how to communicate with one another using American Sign Language (ASL).  Signing Safari currently currently offers two instructional DVDs and video downloads and will soon offer an additional DVD and book series.

As explained on the DVDs and on the Signing Safari website, signing with hearing babies and older children has numerous benefits, including (but not limited to) helping babies to communicate before they can speak, reducing frustration by empowering babies to communicate with their caregivers,  promoting larger vocabularies and accelerated literacy skills, and lessening parental anxiety.

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My review: I can say without hesitation that I loved both “Beginning Signs & Alphabet” (intended for ages 6 months and up) and “All About Me!” (intended for ages 6 months to 5 years).

Here are some of the “little things” that I loved:

• I loved that the children and adults featured on the DVDs represented various races and varying levels of ability.
• I loved that both DVDs used a mixture of songs, images, rhyming, and explanation in order to teach each sign.
• I loved that the DVDs included not only simple words (such as ‘more,’ ‘all done,’ ‘help,’ ‘baby,’ and ‘potty’) but also the letters of the alphabet and the numbers 1-10.
• The feminist in me loved that the segment on the signs for ‘girl’ and ‘boy’ depicted both girls and boys as active, “strong,” “smart,” and compassionate.
• The breastfeeding advocate in me loved that the rhyme used to teach the sign for ‘drink’ included the phrase, “Babies drink from mommies, bottles, or a cup.”
• And the educator in me loved that the DVDs included tutorials showing parents how to teach signing to small children and how to integrate it into daily activities.

Here’s one “little thing” that I didn’t like (at first):

• The short segments (45-60 seconds each) devoted to each sign seemed to pass by far too quickly for a small child to really absorb what they were teaching.

But this brings me to the “big thing” that I loved about the Signing Safari DVDs:

• The Signing Safari DVDs are active (rather than passive) videos, and they encourage active (rather than passive) viewing.  They are intended to help parents engage with their children in their everyday lives, and they are intended to promote active learning among small children.
• Thus, the short segments devoted to each sign seem to be intended to give infants, older children, and their parents a springboard from which they can use ASL away from the television.
• And thankfully (as the boys and I discovered while watching the DVDs), the format and style of both DVDs makes it easy for both the parent and the child to learn some basic sign language.

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My recommendation: I would absolutely recommend these DVDs!  In fact, although I taught some very basic sign language to the boys when they were infants, I wish that we would have had these DVDs so that they could have expanded their signing vocabulary at an earlier age–and so that I would have had the resources to help them do so!

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How to win the Signing Safari DVDs: Do you have a small child (or a friend or family member with a small child) who you think would benefit from learning sign language?  Then you should enter the contest to win both of these Signing Safari DVDs!

There are three ways you can enter:

1. Leave a comment here or on my Facebook fan page explaining why you think your child (or your friend’s or family member’s child) would benefit from learning ASL.
2. Visit the Signing Safari website and check out the list of benefits of early signing.  Report back here (or to my Facebook page) with one of those benefits.
3. Send a tweet mentioning this contest and linking back to this post with the hashtag #signingsafari.

Each person is allowed up to three entries (one from each entry option).  The contest ends at 11:59 p.m. on Monday, August 23, 2010, and I will announce the winner (who will be selected randomly using random.org) the next day.

Good luck!

Void where prohibited.  Entries must be limited to those living in the United States and Canada.

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Disclaimer: I received no compensation, monetary or otherwise, for this review.  The DVDs to be awarded in the giveaway are the DVDs that I have reviewed here.  The opinions expressed in this review are my own and were not influenced by any other individual or entity.