A letter to my High-need Daughter: reposted from Journey into Midwifery

I had only ever met one high-need baby in my ten years of working with kids - a three month old who I nannied for in Seattle.  This little baby, who was huge for his age, was a very precious only child to a couple who practiced ecological breastfeeding, baby-wearing and, if my experience serves me correct, co-sleeping.  I did not understand at the time why the mother was so particular about knowing the baby's schedule. Nor did I understand her constant concerned voice over the phone when she would call 3-5 times throughout the day finding out how the child was doing.  I now fully understand.  I had thought that parents who complained about their 'difficult' babies were exaggerating when they said that they did not know if they could ever be emotionally ready for a second child.  Again, I now understand.

A letter to my wonderfully needy high-need daughter

My Dear Cora Beth, in so little time we have been through so much.  You have taught me more about myself and my relationships with others in your first year of life then anyone previous. The first time I held you against my skin I felt a rush of love ill compared. I was going to do everything in my power to help you along in this world.  I only hope that I serve you well in your eyes.

From hour one you nursed like a champ (we should have know then that you would have a love for food), slept wonderfully and let anyone hold you.  This wonderful temperament that typical newborns have was short-lived.  You soon began to use me as a pacifier, screamed when you were not held, slept only in arms, and refused bottles.  Then at three months you began screaming if anyone but me even looked at you, or God forbid tried to hold you!  It was the first time that papa had to hold a screaming you outside the shower with the door cracked so you could see me while I washed that we finally gave in and labeled you as a high-need baby. Thank you Dr. Sears for the kind term! I could go on for pages about the sleepless nights or missed outings over the past year but instead I would like to focus on the positive aspects of having a high-need daughter. Because like I said before you, my precious daughter, you have taught me more then I could imagine.

Patience - Before you I will admit that I had lived a bit of a spoiled life. The extent of my patience was waiting 30 minutes for the delivery man to bring my food.  Now I have the ability to see the long-term benefits of my efforts.  Whether it is waking up every hour to calmly nurse you back to sleep or holding you for your two hour naps because I know that you have a better chance of sleeping well at night if you are rested in the day.  I know that if I attend to your need it makes the need disappear and helps to aid you in creating a secure self-image.  Everything I do is to help you become a happy, healthy and secure person even if it means quitting my job because you refuse to let anyone else care for you.

Self confidence- You would not imagine the grief someone gets for being an attachment parent!  When people learn that you do not bottle feed they ask why I don't think that others should have the bonding experience of feeding my baby.  Like you gave me a choice!  When people learn that we co-sleep comments are sometimes made about how parents 'need their own space' or that we are 'coddling the child'. People comment on how much you are held or how I breastfeed you on cue. But my favorite is when people learn that I have not left you for more then three hours at a time in your entire life.  It makes me laugh when people offer to 'break you'.  Funny, I did not know you were a horse.  Through all of the questioning looks I hold true to my commitment to you.  I look at how far you have come over the past year and you give me all the proof and confidence I need when my parenting practices are questioned.  We have an amazingly close relationship that I would never trade for a night out.

Empathy- The mother-child relationship is the most influential on this trait.  If a mother responds promptly and with empathy to a babies needs the child will grow up with empathy instilled.  If a parent responds with aggression and impatiens the child will learn the traits respectively.

There are times when the last thing I want to do is put aside my needs / wants and attend to you.  I will admit that I have a selfish side (surprising, I know). But when I looked at the situation from your point of view I realized that crying is your only way of verbalizing a need or fear.  This realization completely changed my approach to not only our relationship but all relationships.  I now always try to not only see but to understand every angle of a situation before I decide how to respond.  Being the main caregiver of an infant is a life changing experience.  To be solely in charge of another persons life makes you realize that haircuts, new clothing and a clean house are nowhere near as important as a content baby sleeping on your lap.

Yes, this first year has been sleep-less, challenging and draining but it has also been full of empathy, patience, lessons and love.  You, and your big brother, have taught me what is to be a mother and I will forever be thankful for that.  For you are my life and I will gladly live it parallel to yours.

Lots of loves-

Mama

-What is a high-need baby?  Check out Dr. Sears article 12 Features of a High-Need Baby:

http://www.askdrsears.com/html/5/t050400.asp

5 Things You Could Avoid Saying To A Woman Who Has Had An Unwanted Cesarean*: reposted from Journey into Midwifery

Preface:

I have been holding off on this post for weeks for fear that it may offend those that visited us after the birth of our daughter, not wanting them to believe that they said, or did not say, something offensive. Then, after talking with a new friend, I came to the conclusion that it is okay for people to disagree. Everyone views birth differently, but the only way to help each other heal is share our stories. So here goes some open communication.

Last week I attended my first Birth Circle through the midwifery center that received care from.  A birth circle is a get together of women who share their birth stories with each other in an effort to heal and understand what happened during their labors or postpartum period.  Some of the issues we talked about were difficult labors, hospital transfers, breastfeeding issues and NICU experiences.  Every story was different and the entire experience was very inspiring.  After five hours of listen to everyone’s stories we started talking about how good it was to talk with other like-minded women.  I found out that, like me, every other mother found it difficult to talk about their birth experience with women who choose to birth at hospitals.  Of course not all women who choose hospital births feel this way, but I have felt a sort of ‘I told you so’ attitude when people find out that my labor ended with an emergency cesarean.

Since the birth circle I have thought a lot about this issue and I came up with a list of five things that people could avoid saying to a woman who has had an unwanted cesarean.  Again, some women may be content with their surgical birth experience, but others are not.  We need to support every mother no matter her opinion, not judge her.

5 Things You Could Avoid Saying To A Woman Who Has Had An Unwanted Cesarean:

1-    What is said: “It’s a good thing you were in a hospital.”

What is heard:   “Told you so.”

If a woman chooses not to birth in a hospital there is a reason.  Maybe she has a fear of hospitals, maybe she is attempting to avoid unnecessary intervention, maybe she believes that birth is a life event and not a medical event. No matter the reason, if a woman is transferred to a hospital it is most likely the absolutely last place she wants to be.  Be sensitive! Hospitals are great when there is a need but that does not mean that the mother wants to be there.

2-    What is said: “ At least you are both healthy and okay.”

What is heard:  “Your process does not matter.”

Yes the baby arrived, hopefully unharmed, and the mother survived but that does not mean they are okay. 

During a vaginal birth the baby experiences the thoracic squeeze and clears all the fluid out of her lungs.  She is also exposed to vital bacteria in the birth canal that protect her from the outside world.  A baby born via cesarean does not experience these benefits and is more likely to have lower apgar scores, experience difficulties breastfeeding and is, in most cases, denied skin to skin contact with her mother directly following the birth.

If you have had a cesarean you know that surviving does not equal okay.  Not only are you denied the emotional bond of immediate skin to skin contact with your child, but you may soon find out that you hurt to much to pick your child up when she cries (what a crushing feeling!!).  You feel absolutely helpless while still medicated to the point that you shake uncontrollably and struggle to stay awake to meet your child.  When you expect a natural unmediated birth weather it be in your home, a birth center, or a hospital, surgery is the last thing you expect and the shock can be quite traumatic.

3-    What is said: “The only thing that matters is that the baby is healthy.”

What is heard: “ You are being selfish and putting your desires above your child’s needs.”

No one will argue that a healthy baby and mother are the most important when talking about birth outcomes, but that does not mean they are theonly important factors.  People often focus only on the child and forget that a mother is also made during birth. The way that the mother perceives and experiences her child’s birth affects not only her relationship with her child, significant other and care provider, but it can also affect subsequent births. 

A mother who already feels cheated out of her birth does not need to also feel guilty.  Even though you may not mean to evoke feelings of guilt by dismissing her feelings you inevitably do.

4-    What is said: “You can always try for a natural birth with your next child.”

What is heard: “ Try, try again”

First of all, who is to say that post-operative mom will have another child.  Maybe the surgery will leave her unable to conceive or carry another baby to term (two possible complications from cesarean), maybe birth ptsd will leave her mentally unsure she could handle another birth experience (yes, this is a real condition), or maybe she just flat out does not want another child. Weather she does or does not plan to have another child the possibility of a fulfilling birth experience does not heal the brokenness of a bad birth experience.  She must first heal before she can move on.

5-    What is said: nothing.

What is heard: “I don’t really care what happened. I am just here to see the baby.”

This can be the most hurtful of the ‘5 Don’ts’. What the mother needs more than anything is support not denial or ignorance. When someone says something, anything, uninformed support  is far above a complete lack of any. Now, you may just not know what to say or you may not know that she wants to talk about it, but open the door to her, support her and just listen. Talking through her story will help her heal.

The conclusion of this talks me back to something I constantly repeat. Women must come together and support each other. Our culture lacks this sisterhood bond that prevailed us and it is detrimental to, not only the birth process, but to friendships as well.

*Should has been replaced with could

**This is not meant to offend but rather to inform people of how their comments might be interpreted by someone who went through an unexpected surgery or for any difficult unexpected life event.

MOMS for the 21st Century:reposted from Journey into Midwifery

MOMS for the 21^st Century Act

Please think about taking action and help to demand that care providers use evidence based practices.

 Groups that support this legislation include Amnesty International, Childbirth Connection, The Big Push for Midwives Campaign, the American College of Nurse-Midwives, the National Association of Certified Professional Midwives, the American Association of Birth Centers, and the Midwives Alliance of North America.

This important legislation, whose full title is Maximizing Optimal Maternity Services  21st Century Act,  Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS), acting through the Office on Women's Health, to:

(1)- establish the Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes; and

(2)-develop and implement a consumer education campaign to promote understanding and acceptance of evidence-based maternity practices and models of care for optimal maternity outcomes among women of childbearing ages and families of such women. Requires the Secretary, acting through the Agency for Healthcare Research and Quality, to make publicly available and update an online bibliographic database identifying systematic reviews for care of childbearing women and newborns. Requires the Secretary, acting through the Administrator of the Health Resources and Services Administration, to:

a- designate maternity care health professional shortage areas under the National Health Service Corps program;

b-establish a loan repayment program to alleviate critical shortages of maternal care professionals; and

(3)- award planning and implementation grants to address workforce disparities for such professionals. Directs the Secretary to support the establishment of two additional Centers for Excellence on Optimal Maternity Outcomes to conduct research to improve maternity outcomes. Requires the Secretary to convene a Maternity Curriculum Commission to discuss and make recommendations for:

a- a shared core maternity care curriculum;

b- strategies to integrate and coordinate education across maternity care disciplines; and

c- pilot demonstrations of interdisciplinary educational models. Amends title XVIII (Medicare) of the Social Security Act to cover services provided by a supervised student midwife or an intern or resident-in-training under a teaching program under certain circumstances.

(http://www.opencongress.org/bill/111-h5807/show)

What can you do? Contact your representative and tell them to support this important groundbreaking act.  Find your representative at:http://www.house.gov/

Follow the bill as it goes through congress!http://www.opencongress.org/bill/111-h5807/show 

10 Things to do before I die

This is my compilation of the most important milestones I want to accomplish in my life. The list was written maybe five years ago and, every so often, I still look at it  as a way to remind myself what all my hard work and determination (what others might call obsession) are accomplishing.

Numbers one and three are checked off and I am currently en route to accomplish numbers two and eight. For being only twenty-six I feel pretty good about my list.

1) Become a mother
2) Complete my Masters
3) Witness a baby being born (not my own)
4) Write a book
5) Learn to sail
6) Spend an entire summer sailing
7) Visit every continent
8) Volunteer in a third world country
9) Live abroad with my family so my children can experience another culture
10) Design and build a house

Writers block and family update

This past week I have had some serious writers block.  Maybe due to the massive amount of delicious food that I have very willingly eaten or to the amount of stress, I mean shopping, cooking, play dates, making and labeling of Christmas cards and menu planning for the upcoming Christmas party. I have not had time to sleep let alone write. So here is a quick update of life in our house and hopefully, later this week, I will get to the five other posts that I have ambitiously begun.

Cora started walking two weeks ago and is now running around everywhere!  Her orneriness reminds me so much of my younger brother.  I think we need to have another kid just to humble her a bit.

But don't hold me to that.

Miles is really blossoming! He loves playing Rocket bird and has us convinced that he needs his own Ipad.

Don't worry he is not getting one.

He is also really interested in words and I am sure will be reading in no time. He is such an amazing kid!  The other day he told us that he records movies in his head and plays them whenever he wants just like the DVR.  Now that is one smart kid.

Mark is working away as usual and I am very thankful that this month he only travels once.  There were a few weeks in a row recently where he was out of town two to four days out of the week every week.  I miss him (and showers) when he is gone. He is such a dedicated husband and father and I love him very much.

As for me I am working through my writers block and living off of rescue remedy.

What our food says about us

Cora eating a midnight snack

Monday I read  What Food says about Class in America, an article on Newsweek.com that I found very interesting.  I have always liked loved food but ever since having a family it has been a constant struggle to eat good quality food and keep our bill under budget.  I will be honest that over the past twelve months this is the first month that I have actually kept our bills within our monthly budget (a victory that I credit to me taking over finances this month). So I thought it would be a fun experiment to track what the kids and I eat for a month, explain how I budget and see just where we fit into the "Class in America" article.  I will do weekly updates on Sundays with a list of our daily menus and my favorite recipe of the week. If I get really creative I might even take pictures of the food!

This is going to be fun!

See you on Sunday!

Why Midwifery Part 1: Why are people choose OB /GYNs over Midwifes

I can name thirteen friends, myself included, who have been pregnant over the past two years. Out of them I can count on a single hand those who have gone to a midwife for care.  Actually I can count then with two fingers.  One, myself, went to an out-of-hospital birth center and number two went to an in-hospital midwife.

Seven of the thirteen friends were induced.

Six were first time moms whose labors ended with cesareans. 

Two labored without drugs. (This includes myself but I will disclose that my daughter was born surgically requiring me to get an epidural for the procedure)

A single mother completed the entire birth process without drugs.

What these numbers are telling me are that more then half of these women can not labor and birth without medical intervention.

Does that seem correct?

The World Health Organization  (WHO) tells us that once the cesarean limit exceeds 10-15% the risks of the procedure outweighing its benefits .  Our national average is at 31.8%.  Colorado’s cesarean rate is 25.9% (click here for a list of ceserean rates by state) 

So why is our rate so high?  According to Childbirth Connection there are 7 reasons:

-Low priority of enhancing women's own abilities to give birth

-Side effects of common labor interventions

-Refusal to offer the informed choice of vaginal birth

-Casual attitudes about surgery and cesarean sections in particular

-Limited awareness of harms that are more likely with cesarean section

-Providers' fears of malpractice claims and lawsuits

-Incentives to practice in a manner that is efficient for providers. (emphasis mine)

All of these reasons coincide with OB /GYN care and are contrary to the midwife model of care.  But I will get to this later..

Now I am digressing…

The point is not that the cesarean rate is rising to epidemic proportion; rather I am posing a question:

Why are women in our country choosing to use OBs over midwives?

I understand that it is engrained in our culture that you go to a hospital for birth and to OB /GYN for pre-natal care but I want to change that.  My hope is that as midwifery becomes more mainstream people will conduct their own research and make an informed decision.  I know too many people who go to a provider just because it is easy to go to someone who is in-network or close.  Are these good reasons to choose the person overseeing one of the most emotional and important events in your life?  Is the fact that something is easy a good reason to choose anything in life?  Now, I am not saying that people who go to OB /GYNs are uneducated or making the wrong choice, but I do believe that sometimes people go to an OB /GYN because they are under-informed or misinformed. I often think that people forget that care providers are providing a service and that you can shop around until you find the one that best suites you. Sometime this will be a midwife other times it will be an OB. You wouldn’t just buy the first pair of jeans you tried on in a store would you?  So why choose the first care provider you run into?

Fear also dictates choice.  Couples choose OB /GYNs for the ‘just in case’ or ‘what if’ factor believing that a hospital is the safest place to birth. My response to this is look at the research. Women who planned homebirths overseen by midwifes experienced “significantly lower risk of obstetric interventions and adverse outcomes, including augmentation of labour, electronic fetal monitoring, epidural analgesia, assisted vaginal delivery, cesarean section, hemorrhage, and infection” when compared to a group of women who had in-hospital physician attended births according to a study in the Canadian Medical Association Journal.

Additionally women who birthed in out-of-hospital birth centers were half as likely to have a cesarean section and had a similar rate of death among babies after 20 weeks of pregnancy or in the first four weeks after birth. This information is from the website Childbirth Connection.  Here is a link to a great article that compare physician attended births, in-hospital birth center births, out-of-hospital birth center births , and homebirths against each other.

In reality though the majority of the people I spoke with did not even consider a midwife because they didn’t know they had an option. 

We do have options and our choices do influence. This is the great aspect of such a varied maternity care system- there truly is a care provider for every type of woman.  For those who have a fear of hospitals and prefer a home like setting you can hire a certified home-birth midwife. For the person who wants the safety of a hospital relationship but wants to avoid the interventions that are common placed in hospitals there are free standing birth centers run by nurse midwives.  For in hospital birth women have the options of hospital based nurse midwives who work under the OB /GYNs, Family Practitioners as well as an OB /GYN.

Feminism and Motherhood

Me and my two adorable children!

Earlier in the week I ran into a very sad and interesting article written by Rebecca Walker, daughter of Alice Walker, famed author and feminist, that discussed Rebecca's decision to mother and the affect it had on her relationship with her own mother. According to the article Alice felt that motherhood was a "calamity" that held her back. She left her daughter in the care of others or alone for long periods of time, approved of her being sexually active at 13, and disowned Rebecca by taking her out of her will when she made the decision to become a mother herself.

This got me thinking.

Lately I have come across a few different situations that have made me wonder when the feminist movement became as oppressive as the 1950's culture that said women belonged at home. Being a feminist should not be about rejecting all things feminine, family oriented or relationships.  Isn't the point of feminism choice?  Personally I would consider myself a feminist, not a radical one, but a feminist none the less; I believe that all people should be able to choose their path in life without judgement and with accurate information.  I do not believe that men and women are equally built for the same purpose in life but do believe that they should be given equal opportunity to pursue whatever life they choose. Feminism is not about being stress free or burden free.  Every life has burdens.  What it is about is the ability to choose them.

In our culture the word burden has earned a bad reputation (as well as the word feminist!), but by definition a burden is something that carries a heavy weight, or by my account, responsibility.  This would include a demanding job, relationships and children.  Yes children. Don't get me wrong, I LOVE my children and spouse and find more joy in them then in anything else life has to offer, but they are a heavy weight and require daily upkeep and therefore responsibility. I pride myself, as a woman, on my ability to work with my husband, raise our children and, in due time, pursue my calling as a midwife.  I believe that the work of feminists before us gave us a great gift: the gift of choice. Weather or not they intended for us to get married or have families is irrelevant. The gift is still the same.  Their struggle enables all of us modern day women to *choose* our path, and that is a great gift.

A Change of Plans

Again, as things often do in our house, plans have changed in regards to my schooling.  The previous plan was for me to begin classes for direct-entry midwifery at Aviva in January.  I love the school and the plan but after months of going back and forth over what I want my end goal to be I have, yet again, and for the last time changed my mind.

I have debated for and against the benefits of becoming a direct-entry midwife and over the possibility of becoming a nurse midwife.  Lists have been made, research has been conducted and I have discussed endlessly with family and friends the reasons that I prefer the direct-entry approach:

-community based learning
-hands-on approach
-more financially feasible
-all education being midwifery specific
-working in a home-birth setting
-online program
-not to mention that  my views of birth are more aligned with the direct-entry approach

as well as the reasons that I have reservations over this approach:

-the possibility of relocating to Portland in order to obtain my births in the allotted time (making it no so community based)
-I would be unable to work or apprentice at the wonderful Mountain Midwifery, our local birth center
-I would only be certified to attend births at home

I have also been considering the nurse-midwife approach. Of course, in my mind I always think of the cons first because this really is the option I least prefer of the two.  Realistically though, the reality of our situation keeps leading me back to this path. So this is what appeals to me about this option:

-financial security for our self-employed family
-ability to work in a home setting, birth center setting or hospital setting
-insurance
-job stability (as much as one can expect this)
-mainly online / no need to relocate

Then there are always the reservations:

-three years of non-specific education
-large time commitment (5 years instead of 3)
-lack of agreement in the routine interventions and the medicalization of normal birth that is taught to L and D nurses

After considering all the possibilities I am confident to say that even though it may not have been my original plan I am very happy and excited with the decision to first attend nursing school then continue on to earn my masters in nurse-midwifery.

The best way to affect change is from the inside right? And boy is our maternity system due for some
change.

Get it? Due.

So here is my new plan of action.  Attend Arapahoe Community for my pre-requisites and Associates in Nursing then transfer to Frontier School of Midwifery and Nursing for the bridge to masters program and finally the masters in nurse-midwifery.  After 5 (8 if you count the out-of-school studying) long years I will finally be a midwife.

I am very excited to take the next step of my life in January!

All Growed Up

My little boy is getting so big!  Just last month we decided that Miles was getting big enough to start taking on more responsibilities around the house.  So, after talking this over, we assigned a list of five weekly chores that when finished he would earn himself a paycheck. It was a difficult decision to decide how much he should earn.  The discussion went somewhat like this:

Mark: "I only got a quarter for my allowance."
me: "Mark, stop exaggerating.  Besides what could he possibly get for a quarter?"
Mark:"He could buy some candy."
me:" When was the last time you went shopping? You can't even buy a candy bar with a quarter."

You would think that he grew up destitute with the way Mark talks (destitute meaning private Christian education and a house on Harvard Park).  Anyway, after much deliberation we settled on an allowance of four dollars a week and a chore list consisting of:

-Feeding Nar in the morning and evening
-Caring for Cora (or as he says: making sure nothing bad ever happens to my baby sister)
-Putting his laundry away
-Dusting the living room
-Cleaning bedroom and picking up toys before dinner

Over the past two weeks he has done a wonderful job of completing his chores

and earning all four dollars each week.

This week we even got him a wallet to carry around his money and his rec center id.  Too cute!

One very proud boy and two very proud parents!

Why I miss the gym

Dear Gym,

I miss you.  There was a time, about two years ago, when we often met and, although I was most likely tired from the day and wanted nothing more than to return to my pajamas and sit comatose on my couch watching Mad Men, we would still meet. I would overcome my overwhelming laziness, dress into my running pants and sports bra then enter your doors.

Why? 

Was it because I wanted to spend 90 minutes running and climbing stairs till I felt like Gumby?

Was it because I missed watching the ladies in full hair and makeup walk through the weight room in an attempt to attract attention?

Was it because I missed the awkwardness of dressing in a public locker room?

Was it because I miss the way I felt after a good workout?  Come on…really?

No.

What do I miss?

I miss the bad pop culture magazines!! The gossipy ones that I will not bring myself to purchase. You know the ones - US Weekly, Cosmo, Glamour. The ones that while waiting in the check out isle at the grocery store you glace over at and really start to wonder: Is Brad really leaving Jennifer? Or is it Angelina?  I never know. Is the Teen Mom star going to get her child taken by social services? (I sure think they should at least investigate!) I look at these magazines and I want so badly to pick them up and guiltily read all the most recent gossip.  But spend money on them? Never.  I try to avoid embarrassment and judgment when in the checkout lane as is. My kids have that area covered fairly well. The gym is the one place where I have the ability to read this ‘newsworthy gossip’ without the monetary investment.  Beside, if I notice the person on the elliptical next to me judging my reading material all I have to do it turn to them and say disgustedly “Can you believe that someone was reading this?” Then drop the magazine on the ground and pick up my strategically placed Newsweek. Problem solved.

Yes.  Gym, I miss you.

Your long lost friend,

Jenn

Suburbia?!

Honestly we moved here to be part of a certain school district (yes, we are those people).  Our plan was straightforward: we were to rent a house in the school district where we wanted Miles to attend school in then, once he was accepted into the kindergarten our lease would conclude and we would move back to our beloved city. Simple right? Well it turns out that where we live we are unincorporated and part of different district. The same district that I went to school in! (Now, I feel like a townie and am looking for a way to avoid mentioning that my daughter was born on the same maternity floor I was.) Huh…our move to the southwest suburbs turned out to be in vein. Miles is still eligible to attend this school, he just goes to the very end of the waiting list, the same place he would have been if we would have only moved to that beautiful 100 year old Victorian just north of Wash Park. Anyway, we are here, for now it is suburbia.