Just a couple of things

Over at the Motherlode there is a post about how Consumer Reports put out a list of five things not to buy for your baby. On the list were co-sleepers and baby slings. Both items are associated with attachment parenting and nursing. Consumer Reports was concerned that there were no safety standards for these products and that baby slings have accounted for a whopping four deaths in five years due to dropped infants. The comments on Motherlode have turned into "Women who do AP/nurse/co-sleep are warped" vs. "Consumer Reports is in bed with the crib industry, big pharma, and Hanna Rosin." Go check it out.

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Also, tonite's episode of Law and Order: SVU starts out with Hillary Duff as a Casey Anthony wannabe but it turns into a mother being arrested for murder for . . . not vaccinating her child! The offending mother hadn't gotten her child vaccinated against measles and the little boy infected the little girl who ended up dying. The basic premise was that not vaccinating your child is criminal. I don't know how the episode ended. The stupid was making my brain hurt. It looks like next week, SVU takes on sexting! Can't wait.

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And finally, still no baby. I'm not experiencing anything that might suggest that labor is anywhere near happening. Every once in awhile I will get a few contractions but I can't feel them. If I rest my hand on my tummy I can time them but there is no physical sensation. We head back to the MW on Thursday. I've decided that I'm going to be pregnant forever and there's nothing I can do about it.

I'm still me

I'm still one people and not two. I ended up taking the Castor Oil, but alas, all I did was poop. I did my chocolate shake starting at 9 a.m. The Castor Oil didn't take effect until after 2 p.m. The midwives arrived around 3 p.m. and I was feeling dandy. I was a little cleaner inside and my hemorrhoid was upset with me, but otherwise thats it. My head MW examined me and my BP was still up more than what we wanted, so she stripped my membranes to get things started. That didn't do anything either. I had some bloody show but no contractions. Her stripping the membranes was uncomfortable, but it was manageable. It made me have to pee. We sat around and watched movies until 10 p.m. with the midwives (they've all taken to calling one another "Edith" for some reason). I sent my friend home around 8 so she could take care of her brood. By the time they left I was dilated to 3 cm, baby was at a 0 station and I was still 90% effaced. I'm all lined up ready to go, it just depends on when this little diva wants to make her appearance. The MW started me on niacin for my BP and we'll go see her on Thursday which is my actual due date. DH was right, this baby just isn't cooked yet.

Notes on Castor Oil:

First off, putting it in a chocolate shake does not make it any better. Its still gloppy and oily. The only difference is you have to manage to swallow big gulps of thick shake with it. I got several brain freezes out of the deal because I wasn't going to screw around with it. Second, I think part of the reason it didn't work is because I have an iron constitution. I always have. Instead of working in the 2 hours it was supposed to, it took 6 hours to take effect and even then it wasn't as violent of a reaction as I was lead to expect. The Castor Oil does turn anything on your insides to lava. Pooping lava isn't fun. The Desitin helped a little, but not much. Today my bottom is much better, the effects of the lava are apparently short lived.

I don't suppose my experience with Castor Oil is any different than any non-pregnant person's experience. It cleans out the pipes. I don't find it as terrible as some people have said. I no longer believe that its as big of an intervention as every one said it would be. My midwife was right, if the body or the baby isn't ready, then it wont work. My body seems pretty ready, but baby must be content to hang out where she is. I'm fine with that. Because everything points to labor commencing on its own in a few days, we're not going to try this again. I'm not interested in pooping lava unless I absolutely have to. The MW says I'm to call just as soon as I have any thing resembling a regular contraction pattern. DH says this baby is coming on the first Sunday in May. Thats his father's intuition. I'm starting to get the feeling that he's right.

Reflections

Today could be the last day of my life as the me I've known up until now. Tomorrow afternoon my midwife comes for our home visit and depending on how things are going with me and the baby, we may induce. That means today could be the very last day that I sit in a quiet house on a Saturday morning with only the kitties around. This could be my last day as not-mother. How do I feel about this? I don't know.

One part of me is mourning the loss of what our family has been up until now. So far its been me, my DH and the kitties. This morning before he went to work, DH and I got as much snuggling in as possible. It helped that it got cold last night and we forgot to close the windows. I know that we wont be giving it up, but once the baby arrives things will never be the same. We will have another person as part of the love that up until now has been only ours. Tonite we're going out on a date. Afterwards I'm going to go see our good friend Terri, (we call her the mommy-unit, one of these days I'll do a post on all of the wonderful mother surrogates DH and I have had over the years.) She always helps when I need to get myself sorted out and its because of her that DH and I are even where we are today.

DH and I have been texting back and forth all morning. We're both kind of in a dither. I'm very lucky that I can sit and talk about these things with DH. He's also mourning the loss of us as just us. As he put it this noon, "I can't wait to meet her, but I'm going to miss it just being us." We feel so blessed to be given the opportunity to grow, birth, and raise a baby, but now that its right around the corner, its suddenly become scary.

I've been pretty much fearless this entire pregnancy, but yesterday it hit me. I'm not sure what I'm afraid of. Labor doesn't scare me, I've got good control over my physical body. I know that I can birth a baby and keep it alive after that, its just the thought of parenting a child and helping that child grow into a responsible human being. It seems too monumental a task to fathom. How does anyone do it? The responsibility is almost overwhelming. So many people go into pregnancy thinking they want a baby so they'll have something to love, or that they want to be a mommy or a daddy. DH and I decided to have a child because we felt that we could contribute a good and reasonable person to society. Of course we're all gooey about having a baby to love and being a mommy and a daddy, but this baby is a person, a human being, and with that comes all of the philosophical trappings of humanity.

I am so anxious to hold a squirming thing in a onesie. I can't wait to have her in my arms. Even so, in the back of my mind I have a voice that says, "Hold on, what are we thinking? We can't have a baby! Can we?" I'm assuming its perfectly natural, mainly because its not causing undue distress. This is one of those "jumping off a cliff" moments. You just do it and you trust that either the good Lord will break your fall or he'll give you wings before you hit the bottom. I've been through these moments before: When I left home, when I got divorced, when I started school, when I graduated school, when I got remarried, and here we are again. So far so good, but that doesn't change the feeling that one gets when standing at the edge and staring into the abyss of the unknown.

Its hard to believe that soon I will be somebody's mother. As I've explored before, I don't even really know what it means to be a mother, or how one does it. I'm worried about how my relationship with DH will change. Everything I've read has at least one chapter on how new dads can feel left out of the mother/baby relationship. I don't want that. My DH thrives on love and attention. Without it he would wither like the beautiful flower he is. (Nobody freak out, he knows thats what I think of him and he's not the least bit threatened by being compared to a flower.) I know everyone says that there will be enough love to go around, but its still scary. He tells me he'll be ok and that everyone will be loved and cared for. (He's a much stronger flower than I am.)

I think that its probably healthy that we're having these thoughts and discussions now. I'm always wary of going into something without at least a few doubts. If you don't have doubts then you're probably overlooking something that you shouldn't. I think part of my ambivalence is the fact that I don't know how tomorrow will go. I don't know if I'm going to drink the proverbial kool-aid (actually its a chocolate shake in my situation). I don't feel I'm ready to be a mother, but upon examining every aspect of that feeling, I don't think I'll ever feel as ready as I think I should. We've known this was the right decision since we made it and even though I don't feel ready, I have no desire to have my decision undone. The birth of one's first child isn't just the birth of a baby, its the birth of a new mother, a new father, and a new family. Its the big-bang of family life. When that little girl comes wailing into the world she'll bring with her a whole new future. Tomorrow could be the first day of the rest of our lives . . .

Christening Gown

This is the Victorian inspired christening gown I made for our baby. I used an old damask table cloth for the gown, second hand lace for all the trim and inserts. The slip is made from a crib sheet and old lace off of a night gown. I hand embroidered the baptismal symbols, working off clipart I found on the net. I used this pattern I found at Heirloom Sewing for Children. I love their website. They have tons of vintage patterns for all ages.

This is the gown.

Sleeve detail

Neck Detail

This is the slip

Neck detail

Trim Detail

How Wide is the Birth Spectrum?

Over the past several months I've been learning and only recently blogging about birth. I've learned about something that I've begun to call the "birth spectrum." At one end you have those that forgo all medical care. They are the women and families who choose to have unassisted pregnancies and childbirths. They either do their own prenatal care, or they just trust that their bodies will do what is right when the time comes. At the other end of the spectrum you have the women and families who choose to have every test available and then schedule their c-sections at the desired time. All other kinds of birth seem to fall somewhere in between these two ends of the spectrum.

At the beginning of her pregnancy each woman has an idea of what sort of birth she will have. For the vast majority of women in the United States, it is expected that she will give birth in a hospital. Many plan on having an epidural. One third of these women will end up with a c-section. It is estimated that half of those c-sections will be "unnecessary." A small minority of women choose to give birth in a free-standing birth center. An even smaller minority choose to give birth at home.

Within the rainbow of choices of the birth spectrum there is an ambiguous dividing line. It seems to divide natural birth from unnatural birth. So what is a natural birth? It depends on who you talk to.

I love dictionaries. Even if one doesn't agree with the definition of a word, it gives a person a great jumping off point. This is from Merriam-Webster online:

Main Entry: natural childbirth
Function: noun
Date: 1933

: a system of managing childbirth in which the mother receives preparatory education in order to remain conscious during and assist in delivery with minimal or no use of drugs or anesthetics

For myself, I find this definition to be adequate. Others would argue that any time you intervene with the birth process you remove it out of the realm of "natural." That includes everything from taking blood pressure to having an attendant present. Others feel that out of hospital birth is more natural and that only non-pharmaceutical measures should be taken during birth. This would include using herbs, homeopathics, position changes etc. to alter the course of birth. In our current medicalized culture, a natural childbirth often simply means a vaginal birth.

There seems to be no end to the hairsplitting in the natural childbirth community. Rixa at Stand and Deliver has explored her experience with the various divisions over here. I would encourage you to read the comments. In the post, the woman Rixa quotes says of her move from UC to a midwife:

I find I am getting a lot of crap from my natural childbirth groups, because they all think I've become a "hypocrite" to the cause. That is completely ridiculous. It's not like I'm having a hospital birth with an epidural. It's still a HOME BIRTH! Same team! Same team!

There are two things that really stick out to me in this quote the first is "It's not like I'm having a hospital birth with an epidural." The suggestion here is twofold. First there is the suggestion that a hospital birth with an epidural is inherently unnatural. In the purest sense of the term it is, however, if it results in a vaginal birth, it is certainly more natural than a c-section. The naturalness/unnaturalness of a choice can only be discerned in relation to other choices. The second suggestion is that a hospital birth with an epidural is somehow a less valid choice than a home birth. This leads me to the second thing that sticks out in this quote: The woman feels the need to assert her continued support of the natural birth team, as though birth were a competition.

Now this is no means an attack on the woman who emailed Rixa, but rather an example of how the birth spectrum is fraught with division. Like so many things that women have to deal with, it is based around competition with other women. I think this is bad. And that is the most simple sentence I can compose on the subject.

So what does this birth spectrum have to do with me? Well, I'm trying to figure out where my beliefs lie on the spectrum. I have chosen a home birth. I have done so for many reasons. Most of them due to my belief that women were designed to have babies and that birth is for the most part safe. My goal is to have a vaginal birth with as few medical interventions as possible. There are roughly four paths to childbirth in this country. The most common is a hospital birth. As most women can attest, the chances of getting out of the hospital without at least some medical interventions are slim to none. The second most common choice is a free standing birth center. This likely would have been my choice except for that 1) There aren't any for hundreds of miles and 2) I likely would have been risked out because of my blood pressure and weight. The third most common choice (if you call less than 1% of births common) is a homebirth with a CPM. This is what I have chosen. The least common yet most "natural" is the unassisted birth.

I chose not to have an unassisted birth because its just not for me. I want someone there that has walked the path before. I chose not to give birth in the hospital because I didn't want IVs and continuous fetal monitoring with the accompanied loss of movement and increased risk of having a c-section. I opted for a home birth not because it is the most natural path to giving birth but because I felt that it was right for me. It gives me the chance to birth under my own power while at the same time using the knowledge of an experienced assistant to achieve the best birth possible.

There are many misconceptions about women who choose to give birth at home. The first is that we're all crunchy liberal hippies that want nothing to do with the medical establishment. The second is that we just don't understand how dangerous birth is and if we did we'd have the baby in the hospital. There are those out there who believe any homebirther that allows an intervention isn't staying "true" to the spirit of home birth. There are those who believe that homebirthers that don't utilize the medical system are putting themselves and their babies at risk. For me, choosing a homebirth has been about getting the best of both worlds.

My midwife is a CPM with 20 years of experience. She has 11 children of her own. I am absolutely confident in her judgement and her abilities. Because she allows me to question her every move, I trust her. Because I am not having a freebirth, I have chosen to accept a certain amount of interventions. I don't believe that interventions are inherently bad, but rather their misuse is what renders them undesirable. Each time I go to my midwife she takes my blood pressure, listens to the baby, and measures and palpitates my uterus. All of these things are by nature unnatural because they would not occur without outside interference, however, thats what I'm paying her to do.

One of my midwife's requirements was that I secure a backup OB to be available in case complications arise. Even when one trusts their bodies, unforeseen circumstances can arise and we have decided to add another layer to the birth process by following the midwife's direction to secure a backup. In my adventures with OB's I have written about how they require even more interventions. I have had four sonograms, various blood tests, and a group B strep swab. We agreed to some tests and have refused others. On this blog I've explored our reasoning behind questioning some tests while immediately agreeing to others. Our governing principal has been whether or not a given test or intervention will contribute to the ultimate well being of mother and child. Early on that meant having a sonogram because I had been spotting and it was better for me not to stress over that. Later in the pregnancy that meant agreeing to a biophysical profile to reassure Dr. Dick. We have questioned every motive until we've felt comfortable that what we're doing is the best path for us.

That brings us to our current situation. Do we want to induce labor or not? When I brought up the subject to my father this morning (how many women can talk about their vaginas with their dads?) he reminded me that there is no such thing as a natural induction. He blames the fact that my mother had to transfer during my birth on her use of castor oil. He is very much against hurrying birth. His advice was to leave things as they are. Yesterday at the midwife's we had a long discussion about where I was in my pregnancy and where we were headed. Regardless of my insistence that I have white coat hypertension and my midwife's admonishments not to worry about my blood pressure, realistically we can all see that my BP has crept up in the past few weeks. We've chosen not to be alarmed about it, but we do need to accept that I am showing signs of pregnancy induced hypertension. Ignoring reality does not change it. She asked if I wanted her to do an internal exam and I said "why not." She doesn't normally do internal exams, but in my case, we were staring to wonder if we needed to have the baby sooner rather than later. We found out that I have a favorable Bishop's score and she gave us the option of inducing labor by using Castor Oil this Sunday. She also said that if we choose not to, nothing bad will happen, we'll just check things again at my appointment next Tuesday. Its totally up to us.

Some people would see this situation and think that this is just another example of a first time mom being bullied into something she doesn't need by an intervention happy medical provider. I would like to clearly state, that isn't the case. I have a good midwife. She reserves the more intrusive interventions for those who actually need it. I'm a first time mom who is showing signs of PIH. If I were under the care of an OB I would already have been induced at 37 weeks and likely ended up with a primary c-section for failure to progress. If we choose to induce I will be 39w3d. I am aware that is possibly up to three weeks early if one allows a pregnancy to go to the extreme end of postdates. However, as with all things we need to do a personal risk/benefit analysis.

We have not decided to induce as of yet. It honestly depends on how I feel, what my blood pressure is doing, work schedules, and all sorts of miscellanea that many natural birth advocates cringe at. Would I agree to a c-section tomorrow? No. What about pitocin induction and amniotomy? Not likely. So why consent to castor oil? We're not sure yet. I am not comfortable with inducing just for the sake of having a baby. I can't say I'm not just a little bit impatient, but I need a better reason for inducing than that. Thats why we're reading everything we can, talking to others, and once again going through the decision process we've been perfecting over the entire pregnancy.

We have been preparing my body for labor for nine months. I've been eating well and exercising. A few weeks ago I started taking my evening primrose oil again. I took it while trying to conceive and I know it can help the body do what its already going to do. I don't think I've told my MW that I've been taking it. DH and I have been giggling about our nightly "prostaglandin injections." He's such a good husband, always thinking of his wife. If I'm too tired he'll remind me to think of the baby and then he'll take one for the team. *Please understand this is completely tongue in cheek, our bedroom can get a little silly at times. Its hardly drudgery in there.* I've been playing with the breast pump mainly out of curiosity. I'm totally amazed that I can pump a half ounce of "stuff" prior to even giving birth. Like I've said before I'm a body explorer. I've not found any information that would suggest any of these things are dangerous, though to someone who believes them to be interventions, the thought that I am doing this to alter the birth process would be abhorrent.

What it seems to come down to is that every woman takes her place on the birth spectrum. Some are where they are by choice, others are where they are because they fell out of place and were forced into another. I chose homebirth because it was right for me, not because it was more or less natural than any other choice. I am comfortable in my decisions because they have been well researched. We are taking responsibility for our birth. The main point is that it is our birth. That automatically takes it out of the realm of any one else's philosophy or belief. In the past 24 hours I've been told that it is both irresponsible to forgo interventions as well as irresponsible to consent to them. Those beliefs belong to the people that believe them and thats fine. I absolutely support any woman in her decision to decide for herself. Whether I agree with her decision or she agrees with mine is not part of the equation. We still don't know what we're going to do on Sunday, but either way it will be our decision and we'll cross that bridge when we come to it.

There IS a baby in my future!

Today I had my *hopefully* my last prenatal with my midwife. I am 38w5d. My fundal height was 40 cm, thats an increase of 3 cm from last week! Baby is still active and her heart tones were good. I had my second internal exam and I'm only dilated to 1.5 cm BUT I'm 90% effaced! Thats a nice and ripe cervix. I've been taking evening primrose oil, using the breast pump, and DH and I have been having nightly "prostaglandin injections." Baby is sitting at a -1 station. My MW says that if we want to, we could take some castor oil this weekend and have a baby.

I'm not sure how I feel about inducing. The MW doesn't want me to go over due because of my blood pressure (its not super but its also not bad enough to freak over) and because (insert big baby card here). The sonographer said our LO was "borderline small" but the increase in my fundal height combined with manual palpitation says she's probably baby sized. On one hand my cervix is nice and ripe, which means that castor oil would likely do the trick. The MW doesn't strip membranes or break the waters unless we're staring down the barrel of 42 weeks. On the other hand, babies will get here when they're supposed to. I can't say that I'm not anxious to have this baby, but I don't want to induce just because I want her here. Just because we would be using castor oil and having the baby at home doesn't mean its any better/different from inducing in the hospital with pitocin. Right now the jury is out. She has told us that its up to us, we can do it if we want, but there is no pressure for the moment.

Please do not try this at home! This is the advice I got from my midwife who has been following me throughout my pregnancy. She knows me, my baby, and my general state of health. Using this advice outside of the confines of a good relationship with a medical provider could result in harm to you or your baby!

My MW's presciption is 6 oz. of odorless, tasteless castor oil in one large chocolate milkshake. (She says it has to be chocolate) Mix in the castor oil and separate the shake into three equal parts. Drink/eat one portion of milkshake per hour for three hours. I am also supposed to have Original Desitin on hand to apply to myself before the castor oil takes effect. Its to protect the bottom from the "caustic substances" that will be coming out. I'm supposed to reapply after each BM. She says the castor oil will take effect in an hour or so and there will usually be about three "rip roaring" bowel movements. After that there may be one or two little movements. She says that if I start at 8 a.m. I should be in a pretty good labor pattern by noon. She wants to be notified if I decide to do this, and what time on which day I'm going to do it. That way she can get herself and her posse on the road. It doesn't sound very pleasant. I'm worried about my butt. The MW says she's only had one case where this didn't work and she thinks its because the mom was holding back. She said that this method results in "very effective" contractions, and that when she used it (on baby number 6 or so) that it was her favorite labor.

So, are we going to induce? I don't know. I need to check the numerology for this coming weekend. We need to see how we feel about this. Is it the right thing to do? Is it going to make life better for me and baby or are we just getting impatient? DH is leaning towards induction and so is my labor assistant. Ultimately its up to me. I'm going to hit the midwifery archives and read up on castor oil inductions. I'll probably decide by Thursday or so. If we don't do it, our next appointment is next Tuesday and I'll be 39w5d.

My thoughts of Vaccination

Mom's Tinfoil Hat did a short piece on childhood immunizations today, and it inspired me to organize my thoughts on the situation. First, just a little background information on my thought process. Forgive the lack of links to studies: This isn't a post that is meant to debate one side or the other, but rather one to give insight into the jumbled thought process of a mother who is 10 days from her due date.

I did not start out anti-vaccine. I guess I didn't start out pro-vaccine either. It was just one of those things that you do, like going to the hospital to have a baby. (We all see how that worked out for us.) I'm still not sure that vaccines are the cause of all the things that people claim they are, good or bad. I feel that my life is better for having never contracted diphtheria or lock jaw. Like the vast majority of those in my generation, I've never had polio. My great Aunt Birdena had braces on her legs as a result of a bout with polio in the 1940s. My father has gone through life completely unvaccinated. Having grown up part of a more traditional Quaker family, my father was born at home and he rarely went to the doctor. He had measles and mumps as a child. He's still here. My mother was fully vaccinated and she's still alive as well. My brother, myself, my husband, and most of the people I know were fully vaccinated. We're all alive and healthy. I don't know anyone with a vaccine injured child, and I only know a handful of people who are either not vaccinating or are holding off on vaccinating their children.

Given all of this, why would I question the safety and efficacy of vaccinations?

When I was a kid in the early 1980s I was given the MMR, DTP and Polio vaccinations. I think that worked out to about ten doses before I was allowed to enter school. Given the schedule at the time, I wouldn't have received more than two doses of vaccine at one time. I have no idea what was in those vaccines, but I'm sure they were chocked full of mercury and other toxic goodies. I know the DTP shot I was given has been taken off the market in the United States because of safety issues and that it has been replaced by the modern version, the DTaP. I remember getting a fever after my last set of shots before entering kindergarten. My experience with vaccines has been pretty mundane, so I didn't understand the hype behind the modern vaccine schedule. Then I looked at it.

Whereas DH and I got 10 shots before entering kindergarten, they want my child to get poked more than 30 times before she will be allowed into public school. Not only that, but some of the things they want me to vaccinate for seem dubious.

First there is the Hepatitis B vaccination. They want my child to have that right away. If I was giving birth in the hospital, there would be little chance of getting out of it. Now, there are some instances where you would want the child to be vaccinated. If the mother were infected with HepB or any of the close caretakers were carriers, then it would be a good idea for the baby to be protected through vaccination. At that point the benefits out weight the risks. However, in my situation, there is no one nearby that is HepB positive. That means that I need to weigh the risks of my newborn becoming either sexually active or an intravenous drug user against the risks of any adverse reaction. I'm not sure what the numbers are on HepB vaccine reactions, but I suspect its more than the number of newborns out there shooting up with prostitutes. I've had the HepB vaccination without problems, but I was 16, sexually active, and working in a nursing home where I was exposed to bodily fluids from people whose HepB status was unknown. It made sense for me to take the shot. It doesn't make sense for me to give my baby the shot.

The chicken pox vaccine is another shot that I question. Its one of those childhood diseases that on occasion can cause serious problems. The older you are when you get it the worse it is. I know, I was a teenager when I had the pox. I was miserable and I ended up with skin strep. I was sick for more than a month. I have permanent scars on my face from my ordeal. Why on earth then would I want to doom my child to such a horrible fate by not vaccinating against chicken pox? For one thing, my situation was fairly rare. I'm not sure why I never got the pox when I was younger, but it probably had something to do with my mother's paranoia about having us near any sick child. Secondly, chicken pox is not like the other childhood diseases we vaccinate against. Measles, mumps, and rubella can kill tens of thousands of people in a year. With chicken pox, the number is somewhere around 100, with half of those being children. The chances of my child being one of those 50 is pretty slim. There are also questions about whether the pox vaccine confers lifelong immunity. By going through what I did, I know that I will have lifelong immunity, but if I vaccinate my child, there is a reasonable chance that she will get to adulthood and her immunity will be compromised. That means unless she gets boosters (when was the last time you topped off your MMR?) she will be at risk for developing a more serious version of the disease. I'm just not convinced that vaccinating for chicken pox is the right way to go.

After HepB and Chicken Pox there is the flu shot. I don't take the flu shot, and I'm not getting it for my child. Each year there are big pushes for everyone to get vaccinated, then after flu season, a report is issued that says, "our best guess at the flu strain this year wasn't so good, the vaccine was only about 20% effective, but don't worry, we'll get it next year." That shot is so hit and miss with its effectiveness that I can't understand why anyone gets it at all. Nevermind that it is one of the few vaccines that still contains mercury.

That brings us to the question of whats in vaccines. We've all heard about the thimerisol debate. I'm not a scientist, I don't understand the intricacies of making vaccines work, but I do understand a few basic things. I know that mercury is poisonous. Any time someone opts not to put a poison into their body is a good thing. When the government takes steps to protect its people from others putting poisons into their bodies, that too is a good thing. So, thimerisol free vaccines = a good thing. Then there is aluminum. Of course there are no studies out there that say aluminum in vaccines = bad, there are some reasonable questions being asked. Mainly, how much aluminum at one time is too much? We know that aluminum can cause problems in large doses, but there haven't been enough studies into how much a tiny child can take without problems. Dr. Sears has an interesting article on it here. I'm pretty sure I would not knowingly give myself, my husband, or my cats aluminum toxicity, so I'm not sure why they think I should do it to my child. Again, I'm not convinced.

Having mentioned Dr. Sears, that brings up the modern debate. Of course there are those like Jenny McCarthy out there with Generation Rescue, but even though I admire her dedication to her cause, she's not a scientist or a doctor. For me, the debate about vaccines is best characterized by what has been going on between Dr. Robert Sears, and Dr. Paul Offit. On one side is Dr. Sears who, as a pediatrician, has seen many parents asking the same questions I am. Because Dr. Sears is both pro-vaccine, he finds real benefits in the vaccination program, and sensitive to his patients needs, he has developed an alternative schedule that allows parents to space out vaccinations without leaving any out. That means his patients are still fully vaccinated, just not on the same schedule as the CDC. Then there is Dr. Paul Offit, an M.D. and patent holder of one of the vaccines that the CDC recommends. His line is "Zere is nossing wrong vis the vaccines! Nossing bad ever happens! You are a crazy voman, krank in der kopf!" (I know he's not German, but every time I see him on TV its just what my mind does) Offit represents the majority of the medical community in that he tends to dismiss the questions of parents and likes to pin everything in mass hysteria. For someone like me, that doesn't help me see his side, it only makes me question his motives. Is he trying to protect his profits? I dont' know.

Researching vaccines is exhausting. Its hard to find reasonable people to talk to. Even though there are lots of informed moms out there, I'd like to find a medical professional that's willing to give me something other than the party line. In a perfect world, I wouldn't have to worry about how safe the vaccines were. I wouldn't have to worry whether those who told me they were safe were just protecting their profits or their reputations. I wouldn't have to read articles about real families whose teenage daughters have been permanently damaged by a vaccine meant to protect them. I wouldn't be scared by the fact that one in 150 children has autism and no one knows why. The only stake I have in the debate is this child I'm carrying. I have no agenda to further other than the health and well being of my new family. Because the discussion gets so polarized so quickly, its difficult for people like me to sort it all out. As a result, I'm likely not going to vaccinate. Until the picture is clearer and I'm more comfortable with the situation, I cannot in good conscience put my child in that kind of danger. Yes the diseases we vaccinate against can be deadly, but the chance of dying or being damaged from the diseases seems dwarfed by the numbers of vaccine injured children out there. In time, we might change our minds, but I've got to see some better research first.

Is there a baby in my future?

I woke up at 5 a.m. with an insatiable urge to clean the kitchen. I just couldn't get comfortable in bed no matter what I did. I've been kind of hot-flashy all morning. After cleaning the kitchen, I contemplated ironing the table cloth again but before I could decide I started throwing up. I feel absolutely fine for the most part. Could these be signs that there is a baby in my future?

GBS update and other stuff too

I got a call this morning that my GBS test came back negative. Thats a relief in that I don't have to do anything special and given all of the drama surrounding doctors the past week, I'm glad that there is no reason to continue on the medical path for now.

Today I'm 38w1d and I'm getting impatient. Baby has slowed down quite a bit. She still moves regularly but she's not be-bopping around like she once did. I think she's running out of room. I got all of the test results in the mail from the other day and had a chance to look them over. In the pictures from the biophysical profile you can see that she still has her left hand up next to her cheek. Its been there since 18 weeks (I'm sure she's moved it, but thats where she likes to put it). I keep dreaming that she comes out with her hand grabbing her ear, so I'm preparing for the possibility of a nuchal hand during delivery.

I keep getting crampy down low. The other day it was strong enough that I had troubles walking. I have a hard time discerning a starting point or an ending point for the feelings so I know its not "the real thing." I haven't had any of the standard signs that labor is approaching so I figure I may be in this for the long haul. I'd love to have her by Sunday. That way she would still be an Aries and on Sunday, her numerology would match DH and me. We were both born on a Sunday. I'm a Leo, he's an Aries. We are both a 7 for our personalities. If she is born this coming Sunday, she'll be an Aries and a 7. A perfect match! *Ahh the joys of growing up in a Unitarian household*

Yesterday DH and I planted 200 privet hedges around the perimeter of our back lot. We have two crazy neighbors and we decided that a gigantic hedge was more environmentally friendly than a line of dead boards treated with arsenic. The completion of the hedge combined with the fact that DH finally got the bedroom doors on means that he is one of the few men in the universe to ever complete a honey-do list. Those two projects were the big ones that I wanted done before the baby could arrive and bless him, he got them done. Thats worth like a million husband points.

I've lounged enough today, my ankles are looking pretty good, so I'm going to go cause them to swell by cleaning the kitchen and catching up on laundry.

Am I a Mother?

I am going to be a mother. What does that mean? What does it mean to me? I’m not sure that I know.

We thought long and hard about becoming pregnant. I remember when it started. Jake went to Germany for his summer session. It was the first time that we were really “apart.” Of course we had each left the other for several days or a week at a time to attend to individual family, school, or business but something about having several time zones in between us that changed things. It was during that summer I decided I wanted a baby. I was just turning 25.

When Jake returned from his sojourn I told him. I wanted a baby. We had been engaged for a few months and were planning a wedding for the spring. I think it was a surprise to him. I had never mentioned wanting a family, we were pretty focused on school and career. To his credit he listened to me without freaking out like I imagine some men do. We talked about the pros and cons of becoming parents at our age. Biologically, it’s the perfect time. Socially and financially; not so much. We did the basic hashing out of ideas on parenthood and babies, and then we tabled the discussion.

When we were married in March of 2008 we talked again about starting a family. I had a decent job with health insurance (that was one of our requirements for pursuing the baby making). I was due to graduate in May and we had settled into our new house. We figured that with my job (I was working for the local county government) my benefits would be good enough to get us through maternity leave and that baby could go to daycare after my leave was up. All that was left to do was throw out the birth control. When in late May I went through another “I want a baby” crying jag, DH just held me and asked, “Well why don’t we have one then?” I threw out the birth control pills on Memorial Weekend of last year.

After some research (you would think that’s all I do) we decided that temping and charting would be the best way to find out if I was ovulating and also the most efficient way to make with the baby. I had my last period the day before my 26th birthday.

Because I had been temping, I started peeing on sticks long before it was humanly possible to actually get a positive test. When that first positive test showed up it was so faint you couldn’t see it unless you took a picture of it and reversed the colors. Either way, I had my positive test, and I wasn’t able to keep it under my hat long enough to find a creative way to tell DH. I was grinning like a Cheshire cat when I picked him up from work. He guessed what had happened.

We ended up telling everyone right away. Screw waiting until the first trimester is over. So what if I miscarried. I had a baby growing in me and I was excited. I had always wondered what it was like to be pregnant. At first nothing changes. I never had morning sickness. It was pretty early on when I started spotting and thus started freaking out. I had my first ultra sound at 6 weeks. The thing looked like an olive and we named it “Squish.” Two weeks later, the spotting had stopped and we went back for another scan and our olive named Squish had turned into a baby shaped thing named Squish.

I was absolutely attached. Seeing that little baby shaped thingy be-bop around in there with a little fluttering heart totally amazed me. Was I a mother? Was Squish my child? My embryo? My soulless lump of cells that has no legal right to existence? I have no idea.

How do I define a “mother?” A mother cares for her child. She sees to its daily needs. She loves her child. She nurtures her child. She educates her child. A mother is a woman. So am I a mother? During the pregnancy I have cared for Squish. (At 18 weeks we found out that Squish was in fact a she and after much deliberation [Well mainly Jake shooting down the awful names I was coming up with: Ethel, Prudence, Euphemia, Hortense] Squish became Oriana, though I still like Squish) Over the past 37 weeks I’ve taken care of her daily needs, though mostly in a passive sense. I make sure she has what she needs by making sure that I’m eating good things. I don’t put things I don’t want her to have in my body. I love her. I don’t know when it happened. From the start I knew I didn’t want to be without her, but now the thought of waking up tomorrow and having her gone destroys me. Pregnancy has taught me that you can unconditionally love a stranger. I don’t know if you can nurture a child in-utero. I’m not sure what it means to nurture. I don’t know if you can educate a child in-utero, though I’m looking forward to teaching her all about the universe once she “gets here.” So, am I a mother right now at this very moment? Maybe.

I always talk about when the baby “gets here.” Jake thinks its funny, she’s already “here.” She exists. She’s sitting inside of me, on this couch, while I am writing this post. Right now I can feel her playing with her feet and I can see her pushing out my tummy. At this point its more than a little uncomfortable. Even though I have all of this evidence of her existence and I have a real and ongoing relationship with her, she is not yet “here.” I am not yet a mother. I don’t have a baby. I have a fetus. I look at babies born just a few days ago and think, “That’s what I have inside of me.” She is no different from them, except that she is in there and I am out here. I can’t see her. I can’t hold her in my arms. Her only cradle is my pelvis. I can’t look into her eyes.
I don’t “feel” like a mother yet. I can remember thinking early on, “I just don’t feel pregnant.” I had no idea what that meant because I had never been pregnant before. When I was finally able to feel her moving about I allowed myself to identify as “pregnant.” Pregnant, but not a mother. Why are the two separate in the beginning?

At what point does a woman become a mother? Is it when she conceives? Was I a mother to that olive I named Squish? Is it when the baby is born? When it takes its first breath? People always muse over when that olive becomes a child and therefore subject to the rights of a child. What about a mother? At what point during those 40 weeks of gestation does she become a mother? Is a woman who aborts a child in the first trimester a mother who has done away with her child or is she a woman who has rid her body of a lump of cells that threatened her lifestyle? Is a pregnant woman a potential mother in the way that olive was a potential child? I honestly don’t know.

I’m not distressed about the fact that I’m not sure if I’m a mother yet. I know that once this baby is in my arms I will definitely be a mother but it’s the gray areas of life that intrigue me. DH keeps saying that he is “going to be a daddy.” He uses the future tense. To him, he is not yet a father; he is the husband of a pregnant wife.

I keep thinking about how these questions will be moot next time around. They’re only valid with your first child. Once you have a child you are absolutely a mother and nothing can change that. Afterwards you are only adding to your brood. I keep wondering if I will feel differently. I am me. I keep close tabs on me and how I feel about me. Each year on my birthday I make a point to look in the mirror and say, “This is me today, how do I feel about that?” On my next birthday I will be a mother. I don’t know what that means.

Sharing

I just wanted to share this blog I found. Its written by a very sensible L&D nurse, God love her.

Nursing Birth

Yesterday at the Midwife

Yesterday I had my 37 week appointment with the MW. I was 37w5d, my fundal height was 37.5 cm and so far I've gained 24 lbs. Blood pressure was fine (duh) and my UA came out normal. (Double Duh)

Because this appointment wasn't really planned (Dr. Dick insisted I be seen, didn't she know how sick I was?) DH wasn't able to go, so I took one of my oldest friends and the woman who will be with us during the birth.

I've known M since we were in the second grade. We've gone through most trials and tribulations of growing up together. I was there with M for the birth of her first child. I detail the experience here. Ever since her "elective" repeat c-section, M has been searching for a way to get out of another "elective" surgery. When she heard I was having a home birth she was ecstatic. She has been holding off on having another child because she doesn't want another major surgery and because they told her they would have to tie her tubes after her third c-section. They said it would be too dangerous for her to give birth again after that. Her experiences with birth have left her feeling broken. Its hard a on a woman when she is told her body can't birth a baby; that she needs a man savior to extract her babies for her. She fought the uphill battle of exclusively breastfeeding her children after c-sections where she was under general anesthesia, and in an environment that causes her to need two jobs. (Take that Hannah Rosin) She is a wonderful mother but she's had to struggle against a system that makes her job of being a woman more difficult.

When we got to the MW's house we buzzed through my exam and then M had a chance to visit with the MW. She told her about how her first birth ended in an unnecessary surgery and how when she got pregnant again she couldn't find a doctor to do a VBAC. She had done the research and she knew that there was no reason she couldn't have a vaginal birth. She told about how even though she didn't buy the exploding uterus card, the dead baby card, or the dead mommy card, her husband bought it all hook line and sinker. Her greatest fear is that her husband wont "let" her have a VBAC.

The MW explained to her that there was nothing wrong with her. She could birth just like any other woman. Yes there are risks, but there are always risks in birth. She explained that with good nutrition and proper care, there was no reason she couldn't have her VBAC or HBAC if she wanted. I think that was the first time M had ever heard those words. She spontaneously hugged me.

M and I are alot alike. She's a strong, capable woman. We're Amazon women. She has two children and two jobs. She and I are sewing buddies. She wanted Scarlet O'Hara's barbecue party dress as her prom dress, so two weeks before the dance we set up shop in my parent's rec room and we sewed the dress out of red satin. It was hell, but it looked awesome when we were done. The main difference between M and I is our relationship with our men. DH and I are an equal partnership. We each do our own thing and support the other in whatever crazy endeavor they embark on next. M and her husband seem less balanced. He seems to get the final say in most matters. I cringed yesterday when she gave me a bag of awesome clothing she had, but he had "vetoed" their use. She wants me to talk to him about homebirth and all of the thought that goes into the decision. I'm not sure if he would listen to me, or even be open to it. What it comes down to is the fact that its her body and she needs to find the strength to assert control over it.

Thats part of the reason I want her at my birth. I want her to see birth in all of its glory. Together we have this sense that she needs it. We both still need to heal from that original birth trauma that was her daughter's birth. Even though I've never been experienced birth myself, I have this naive sense that its hard, sweaty, potentially painful work that can be empowering and fulfilling. I've decided that some people choose mountain climbing to challenge their bodies and minds, whereas I've chosen a natural home birth. I want M there to experience birth as a normal process devoid of machines that go BING! She has never had that and I know she's searching for it. We've talked about it countless times and I hope one day she will get to have the birth experience she's been searching for.

OB Update

After the whole mess with Dr. Dick the other day I really didn't want to go back to another doctor. At this point in the pregnancy I'm tired of being poked and proded by strangers. I found a doctor about the same distance from me only this time in a town to the south. I made an appointment for today. Even though I didn't want to go to another doctor, I feel its irresponsible to show up at an emergency room in full blown labor with complications when you can have a doctor standing by that already knows your history. So, I sucked it up and went to the appointment.

This doctor is a private practice OB. He was an MD first and later got his OB/GYN. He's not affiliated with any hospital but he uses the hospital across the street from his office to deliver babies. When I got there the nurses were very nice. They let me explain to them that doctors offices make me nuts and any blood pressure reading they took would be out of whack.

The doctor was very nice. I explained to him that I was planning a home birth and I had a backup OB but I was no longer comfortable with that doctor taking care of me. I provided him with all of my records from my MW and OB. After looking everything over, he said that he wouldn't go on record as supporting a midwife because of liability issues, however, if I showed up at the hospital and said I was his patient, he would come and take care of me. He said that he wouldn't encourage home birth but "This is America, its your body, your decision."

*Gasp* I love you.

After that, he had me. We talked about the tests I'd had, and in about an hour, yes, an HOUR with an OB, we went our separate ways. He said there was no reason for him to see me again unless there were problems, but he would appreciate a call when I had the baby just so he knew everything was ok.

How incredibly awesome is that.

I was so nervous all weekend about this appointment. After the Dr. Dick situation I was done. I prayed constantly that this would work itself out, and thank God it did. I have a backup OB that is kind and understanding. I wish we had more time to get to know one another. By the grace of God there will be more babies and I will go back to him.

Tomorrow, its off to the MW again for my 38 week appointment. Last night DH was snuggled up to me and he asked, "Why can't I feel her moving?" I said, "because she's asleep." I poked around until I woke her up and she started squirming around. DH got his fill and I asked him why he was so interested, he said "I just wanted to make sure she's still there." Up to this point he's been really iffy about talking to a stomach. After the sonogram the other day where we saw her playing with her toes, and caught a glimpse of her hair, he has been dreamier. He said he's getting anxious to meet her. I'm anxious too, our lives are about to change, and I can't wait.

Monday Fluff - LuLu, My Delicate Princess

The spring my precious Jo turned one, not-yet-DH and I felt that our lives were complete. Our little house was just right for us two humans, Jake's Wilfred and my precious Jo. Two peoples, two kittehs. One morning in early May, I walked out the front door and lo and behold there was a piece of fluff laying on our garden bench. I thought it was a baby bunny. I couldn't imagine how a baby bunny had gotten up on the garden bench. It was sort of gray and mottled in appearance. I touched the piece of fluff and it made the LuLu noise - prrrrp! It was a baby kitteh.

I thought to myself, "this will never do." I couldn't leave it there. It was a nice kitteh, kind of skinny, but we had our family. I decided to take the fluff to the local humane society. I was sure they would find it a home.

When I got to the humane society and told my story, the lady at the counter informed me that they were full. I could take it to one of the other vets where it would be put to sleep, or I could take it home. Maybe I knew of someone who wanted a kitteh.

So, I took the piece of fluff home and let it loose in the living room. It found the first toy mouse it could and played itself to exhaustion. Its attitude was one of "ok I'm home now." Jake came in and I explained the situation. He picked up the kitteh, (we knew it was a little girl by now) and it fell asleep. It turns out she was home.

We had a new addition to the family. All she needed was a name. We thought and thought and thought. Then we found out that the local Native American word for bunny was lulu. It fit. Her coloring still reminded me of a wild rabbit. We had a LuLu.

Over the next year LuLu became a full fledged member of the family. She got along well with the other two kittehs. Everyone loved everyone else.

Soon after LuLu turned one, we noticed that she was . . . well . . . expanding. We couldn't quite figure it out. The other two kittehs were quite fit. They all got the same amount of food and sharing bowls was out of the question. It simply wasn't done. We took her to the vet and she weighed in at a whopping 14.7 lbs.

So I bought her a MuMu. (Its a doggy dress for a medium dog)

Still not-quite-yet-DH didn't think it was enough that she be fashionably dressed. He felt she should be on a diet. We still didn't know why she was the way she was, but we thought perhaps it had something to do with her activity level. After all, few cats enjoy eating laying down.

It was decided that LuLu would go on a diet and we would try to exercise her more. We consulted the vet again, and we decided on the Sixteen-Dollar-Per-Bag-Catfood diet. LuLu was given a set amount of food, three times a day. She had a certain amount of time to eat it and when her time was up the food was put away. Because we had three kittehs, that meant the other two had to go on the diet with her. After a few weeks we had three very hungry kittehs. Wilfred and Jo were wasting away and LuLu was miserable. Our wallets were lighter too. The entire plan came crashing down when one day we returned home from school and LuLu had broken into the bottom cupboard in the kitchen. We found her laying on her back looking like a bloated goat (as she often does) in a pile of saltine crackers. The poor desperate creature was hungry enough to eat crackers. CRACKERS!!! The kitchen was covered in crumbs. I would give anything to have a picture of that scene.

After that we decided to love LuLu just as she is. Any kitteh desperate enough to pilfer crackers deserves a break. LuLu is now three years old and at last weigh in she weighs 25.3 lbs. Having a full-figured kitteh comes with its challenges. She has some personal hygiene issues. She can't quite reach all the places she needs to. Since becoming pregnant I can no longer do LuLu duty and DH has learned to fear the phrase "Honey, LuLu needs freshening up!"

LuLu is the most gentle kitteh in the whole world. She'll let you do anything to her. On Saturday mornings, LuLu and I take our beauty rest after DH goes to work. She snuggles up next to me in bed and I use her as a pillow. My 8-year-old SIL discovered her ability to transform into "LuLu, Queen of Sparkles"

DH loves LuLu, but he doesn't quite appreciate her nature. She's a delicate princess and he just doesn't get that. To him, she is our Meg. (He's a Family Guy fan) She's fat, she snores, and she needs "help." We've taken her to the vet off and on and his final diagnosis is that if she is happy, her coat is shiny and she seems well, then don't worry about it. Our other kittehs are still fit as fiddles, and LuLu is her magnificent self. The MuMu is a distant memory, she grew out of it seven pounds ago. LuLu loves to wrestle with Wilfred and Calliope. She has a sort of Sumo tactic she uses. She still eats laying down, though when DH sees it he will move her dish just out of reach so she has to get up. At this point we've given up on reducing her size. We just have to love her as God made her. My big, beautiful, delicate princess, LuLu.

Just a reality check

Reality time!

Babies are meant to come out of VAGINAS and suck on BREASTS for their FOOD.

Pretty simple eh?

OB, Oh Boy!

Well, yesterday was an adventure. I had my appointment with my backup OB for the GBS test. I have white coat hypertension. I told them that, but they still insisted on using the 138/90 reading to tell me that I have Pregnancy Induced Hypertension (PIH) and to use that as proof that my midwife was a nut and I was putting myself and my baby at risk. So, we get there, the doctor comes in the room, doesn't say hi, anything and announces "Well, you've got high blood pressure." He had my records from my midwife in his hands showing no history of hypertension, but that didn't matter. He started in on me about how I needed a sonogram and a blood test etc. etc. etc. I started questioning him on his reasoning and he got visibly angry. He asked me what he was doing there if I wasn't going to listen to him anyhow. I told him I was there to get a GBS swab and thats it. After about twenty minutes of him insulting my intelligence and me insisting he clarify his reasoning (all of this while I'm sitting pantsless on the table) he informs me he's scheduling the tests and bids me goodbye.

I called my midwife from the exam room. She told me just to take the sonogram and the blood tests "just to shut him up." So I did. I gave Dr. Dick (not his real name) the MW's phone number so he could call her. Well what do you know, the blood tests came back perfect, no toxemia here, and we spent thirty minutes with a sonographer, watching the LO play with her toes.

The MW and I were on the phone off and on throughout the evening. It turns out I managed to find a misogynist obstetrician. He told the midwife over the phone that he's just not used to women coming into his practice and telling him what they will or will not do! After all, he's a DOCTOR. Apparently he didn't get the "My Uterus, My Rules" memo.

My MW called me last night after they called her with the test results. I knew last night that everything was fine. The sono put baby weighing at 5lbs 2oz., which as we all know can be incredibly inaccurate, but even so thats still within the normal range.

Dr. Dick called me this morning to tell me the blood tests came back fine. (duh) But baby was boarder line small which to him is an indicator of early PIH. He made sure to impart to me that pregnancy was incredibly dangerous for all involved and that even though I'm fine now, BAM dead baby card. (Is there an OB Bingo out there?) He asked me if I would be coming back. I told him "Honestly, not if I can avoid it. I wasn't impressed with your bedside manner or your acceptance of pregnancy as a normal, physiologic process." He then informed me that I wasn't going to make him feel bad and that if I wanted to be abusive towards him then that was my business. He hung up on me.

What a great guy.

I went to see this doctor on the recommendation of a friend. She had three easy pregnancies and found him to be pretty hands off. At our first visit, I told him I was planning a home birth and I gave him all of the info for the midwife. He scheduled my 20 weeks sonogram and gave his blessing for me to go to the MW for the next several appointments. When my 20 weeks ultrasound came back without abnormalities, I cancelled my follow up with him and went back to my MW. I hadn't seen him since the first trimester. Yesterday was partly the result of me not going back to him after that sonogram. He was mad. Then it comes out that as a woman, I'm not supposed to question the Doctor/God's judgement. After all, what do I know, I've never had a baby before whereas he's delivered hundreds. In the end I got my GBS swab, they're going to call the MW with the results next week. All of my tests proved him wrong, my blood pressure was a fluke, but that wasn't enough. He had to play the dead baby card during my morning coffee. During yesterday's "exchange" he told me that I had made up his mind on this whole homebirth thing, he was never going to support another one. I thought to myself, who would want you to?

Midwife, GBS, Cross nursing, etc.

I had my appointment with the midwife today. My fundal height is right at 37 cm. Everything is boring and normal except that I have thick ankles. If I stand for too long they swell, if I sit for too long they swell. This just started but its not serious. I am 36w5d today which means this Thursday we reach term. The MW has basically given us the green light to have the baby whenever. Thats a relief given the fact that up until now every little cramp could be seen as potential pre-term labor. Its nice to know that if something starts then I can just go with the flow.

About the GBS test: MW really wants me to get the test. She said she has lost babies to GBS before and if we know that I'm a carrier then we can watch the baby very closely. She would also put me on Immunosupport and possibly some colloidal silver. I'm going to go ahead and have the test done on Thursday when I see my backup. My MW sees no reason why we can't go ahead with a homebirth even if I test positive.

There have been many posts about cross nursing floating around the blogosphere. I answered a poll the other day and said that if the opportunity arose, I would nurse another woman's child. Today, I asked DH what he thought about cross nursing. He said that if we knew the woman and were comfortable with her, then he had no problem with me nursing her child or her nursing our child. On the other hand, he felt that strangers cross nursing was like "eating a lollipop you found on the street." I can see his point, and it made me think of this:

To Test or Not To Test . . .

This coming Thursday I have an appointment with my backup OB for my Group B Strep (GBS) swab. This test is part of the normal pre-natal package for women in the United States. Somewhere between 35 and 37 weeks you get your vagina and perineum swabbed and the sample is sent off to the lab to be cultured for GBS. If it comes back negative its no big deal. If it comes back positive then there is a chance that you can pass GBS to your baby during delivery which can result in neonatal GBS disease. The standard treatment for a GBS positive woman is intervenous antibiotics during labor. The idea is that the antibiotics will pass through the placenta and reduce the chance of infection for the baby.

So, whats the big deal? Why not just get the test?

Its become apparent that I can't take any medical advice at face value these days. It seems I have this odd urge to look things up for myself. I went to the CDC website to get some facts about GBS. Here is what they say in their "Protect Your Baby from Group B Strep!" pamphlet:

• Your baby can get very sick and even die if you are not tested and treated [for GBS].
• In the United States, about 1 in 4 women carry this type of bacteria.
• Each time you are pregnant, you need to be tested for GBS.
• The medicine to stop GBS from spreading to your baby is an antibiotic given during labor. The antibotic (usually penicillin) is given to you through an IV (in the vein) during childbirth. If you are allergic to penicillin, there are still other choices to help treat you during labor.
  

Basically, what this pamplet says is that 1 in 4 women (25%) carry a type of bacteria that can cause her baby to "get very sick and even die." Sounds pretty scary. But surely not every woman who is a GBS carrier gives birth to an infected baby? I went in search of some hard numbers from the CDC.

I found some in the GBS FAQ. Here are a few snipits from that page:

• Group B strep is the most common cause of life-threatening infections in newborns.
• In the year 2001, there were about 1,700 babies in the U.S. less than one week old who got early-onset group B strep disease. (authors note: GBS infections are categorized as early-onset [happening within the first week of life] and late-onset [anytime after the first week])
• Premature babies are more at risk of getting a group B strep infection, but most babies who become sick from group B strep are full-term.
• Most early-onset group B strep disease in newborns can be prevented by giving pregnant women antibiotics (medicine) through the vein (IV) during labor.

That really didn't help much. It didn't tell me much more than the first CDC publication. It basically reinforced the idea that GBS is dangerous and scary but it can be taken care of with antibiotics. The fact that in 2001 there were 1,700 babies in the U.S. who were diagnosed with early-onset GBS disease doesn't help much either. It doesn't tell me how bad it was, if these babies died, or what the long-term outcomes were. Maybe my problem was that I was looking at information designed for the "general public." I decided to delve into the information for "professsionals." Here are some facts from the GBS Technical Overview for hospitals and healthcare providers:

• The rate of early-onset infection has decreased from 1.7 cases per 1,000 live births (1993) to 0.5 cases per 1,000 live births (2000). Since active prevention began in the mid 1990s, the rate of group B strep disease among newborns in the first week of life has declined by 70%. . . Since 1998, the incidence of early-onset disease has begun to plateau.
• Death occurs in 5% of infants

Now we actually have something. Prior to implementing universal screening and antibiotic prophalaxis there were 1.7 cases per 1,000 live births. By their numbers that means in a population of 1,000,000 infants there were 1,700 cases of early-onset GBS. Of that 1,700, 5% would have died. Thats 85 dead babies. That number doesn't tell us about those that were permanently harmed, but it at least gives us the death rate of GBS infection provided you don't do anything about it.

Thats the story from the CDC. GBS is scary and deadly but thanks to CDC guidelines they have been able to reduce the risk and save countless babies from death or disability. Now we all know that the United States lags behind several other countries in infant mortality rate and since GBS must be a contributing factor in those numbers, I thought I would check out how other countries are dealing with it. I chose the UK because we have similar populations and they rank 14 or 15 spots ahead of us in infant mortality.

My first stop was the Royal College of Obstetricians and Gynocologists. I found out that they had an informational pamphlet just like the CDC. Its designed for the "general public." Here are a few gems from that publication:

• About a quarter of pregnant women in the UK carry GBS in their vagina (same as the U.S.)
• GBS carriage is not routinely screened for during pregnancy in the UK. (!?)
• Out of every 2000 newborn babies in the UK and Ireland, only one is diagnosed with neonatal GBS, but it can be very serious. (thats the same as the U.S.'s numbers with our active prevention policy)
• Around one baby dies out of every ten who are diagnosed.
• Currently the evidence suggests that screening all pregnant women routinely would not be beneficial overall. You can be tested privately for GBS but the RCOG does not recommend this because a positive test may possibly result in unnecessary and potentially harmful interventions.
• It is important to be aware that a negative swab test does not guarantee that you are not a carrier of GBS.
• One of the potential harms of screening for GBS carriage during pregnancy is that large numbers of women would be given antibiotics during labour. The possible risks of this are: death or serious injury to a very few women from an allergic reaction(anaphylaxis) to the antibiotics, [and] strains of bacteria becoming resistant to antibiotics.

Wow. In the UK they have a lower rate of both infection and death from GBS and they don't routinely screen or treat for it. In fact, they think the risk of giving a large population of women antibiotics during labor could cause more problems than it fixes. I went looking for something that could put this together for me. I found an article on GBS at a mainstream women's health website that serves the UK. In the article the author states that "In the UK, ENGBSS [Early Neonatal Group B Streptococcal Septicaemia] occurs in 0.3/1000 neonates. In the US it is 3/1000." Because of this, "The difference in numbers between the US and UK mean that it may be worthwhile screening for this bacteria in the US, whereas in the UK because of its rarity, screening is unlikely to have a significant impact on neonatal deaths." Ok so, in both countries 1 in 4 women or 25% of them, have GBS present in their systems. Why then is the infection rate so different? Why are American women more likely to transmit GBS to their infants? The only thing I could find was in the Gentle Birth archives where an anonymous midwife states:

Any caregiver can introduce GBS also. I have watched docs and midwives when they do vaginals. They lube up and then do this little wipe of the vulva with their fingers (almost like foreplay) to lube up the woman. During that wipe they can easily pick up GBS and insert it with their fingers. And it is not unusual for anyone who has delivered in hospital to have GBS.

As everyone knows, docs do vaginals on the first visit of a pregnancy (for pelvimetry and STD checks). I believe that with that first vaginal they can introduce GBS to the cervix and all too often do.

If a caregiver is going to do a vaginal in early pregnancy (& even in late) then the vulva should be wiped first with a microbial swab.

Far better to avoid GBS then have to treat it.

Now that is far from scientific, but it makes sense. We know that every vaginal exam increases the risk of infection in any case. We also know that use of internal monitors provide a direct line into the uterus for bacteria. Its posssible that the over-medicalized maternity system in the US is partially responsible for the increased rate of GBS transmission. However, I have yet to find any scientific literature that addresses the discrepencies between the US and the UK. I am not positive that the birth system in the UK is any less medicalized than the US's, however I do know that midwives are more available and that they are less likely to engage in excessive vaginal exams or internal monitoring than are obstetricians.

The main thing that struck me about the UK policy was its view on antibiotics. The policy makers across the pond cite the concern that over use of antibiotics will result in resistant strains, as well as the concern about adverse reactions. What does all of this antibiotic use do? I found an article on MedScape (you have to register to read it, but registration is free) about GBS. It pretty much follows the narrative of the CDC but towards the end, the editor notes:

No strategies exist to prevent late-onset disease, although more than half of reported cases of neonatal GBS disease now occur during the late-onset period. In addition, concern continues among health officials that widespread intrapartum antimicrobial use might delay, rather than prevent, GBS disease onset, resulting in increased rates of late-onset disease. No evidence exists to suggest an increase; however, careful monitoring of disease trends remains a priority. (emphasis mine)

Thats pretty interesting. Its possible that giving antibiotics to all GBS carrying women is only delaying the infection until past the first week of life. Other studies I've found have suggested that widespread prophalactic antibiotic use for GBS women is resulting in antibiotic resistant infections from other sources. Another source found that more than one-third of GBS infections of the most common strain were resistant to the antibiotics used most often to treat the infection. Thats frightening. More superbugs. Then one has to look at the research showing that use of antibiotics by both mother and child increases the risk of things like allergies, eczema, and asthma. The choice starts to get more difficult than it was in the beginning when all I knew was that the CDC says GBS is scary and deadly.

So what is a woman to do. There are a few choices:

1. Get the test and take the recommended action
2. Don't take the test and wait until labor and see if any of the risk factors appear. Both the U.S. and the U.K. use the same guidelines for women in labor who are of unknown GBS status. If the woman has prolonged rupture of membranes (>18 hours), runs a fever (over 100.4), has had a previous baby with GBS disease, or has gone into labor before 37 weeks, she is considered at higher risk for transmitting GBS to her baby. The decision to treat with antibiotics can be made at that time.
3. Get the test and use alternative treatments like vaginal washing during labor if GBS positive.
4. Do absolutely nothing and if the baby presents with symptoms (fever, difficulty feeding, lethargy, difficulty breathing) any time after birth then seek immediate medical attention.

Knowing all of this, I'm still not sure what I'm going to do. I do know a few things. I know that if I take the test and it comes back positive, then I will refuse prophylactic antibiotics in labor. I am allergic to penicillin, ampicillin, clindamycin, erythromycin, and cipro. That pretty much covers the antibiotics available. In the rare event I have an infection that needs antibiotics I can only take bactrim and tetracycline, both of which are not recommended in pregnancy. I am very selective about when I use antibiotics because I'm slowly running out of options. I also have fairly severe asthma and other allergies. I've been doing everything I possibly can during this pregnancy to reduce the chances my child will go through what I've been through. The risks of using antibiotics during labor in my case are fairly high.

Given that I know I wont treat prophylactically if a positive result comes back, then whats the point in taking the test? I am having a home birth. In the event I present with a fever or prolonged rupture of membranes, those would be indications to transfer. Once at the hospital we can inform the attending of my unknown GBS status and I can be treated from there. I have an appointment with my midwife tomorrow and we'll discuss all of this at length. I'm not willing to do nothing. I'm not going to risk the life of my child. I think I would be more comfortable without the test and then treating if signs arise. I'm always skeptical of any medical recommendation that says "we should do this one thing to all of the people, all of the time."

I would really appreciate it if this post was spread around. I would like as much input on this subject as possible. Send me studies, criticise my logic, help me move on to a more perfect decision. I'll let everyone know what the midwife says about it tomorrow.

Just a disclaimer: I am not a medical professional, nor am I a statistician. None of this is designed to give anyone advice, its just an example of the thought process of where I'm going with my decision and how I got here. I'm still going to discuss all of this with my midwife and backup OB so we can decide what the safest course of action is. You, as a reader should do the same. Look at the available evidence and then work with your health care providers to have the safest, healthiest birth possible for you and your child.

What do you think they're for?

I just can't quite figure out whats going on here. Why is it that all of a sudden there seems to be a vocal group of . . . people . . . out there that have decided lactivism should be nipped in the bud? By now we've all heard of Hanna Rosin's article in The Atlantic that shall not be named here. Then there's Judith Warner at "Domestic Disturbances" who wants to "Ban the Breast Pump". The Feminist Breeder had a nice, light hearted response to the article here. A gentleman journalist at The Vancouver Sun asks "Breastfeeding vs. Formula: Are They Really That Different?". What these three pieces and the scads of people out there who agree with them have in common, is the idea that there are militant lactivists running about making any mother who does not exclusively breastfeed feel guilty. Mom's Tin Foil Hat has a post on this idea over here.

I can't quite figure out where this is really coming from. Most of this discussion is coming from upper-middle class, white women who aren't dealing well with the transition to motherhood. I can't pretend to understand their "plight." In Rosin's article she complained that breastfeeding was a ticket to coolness amongst the other urbanite crunchy mommies at the playground. Rosin, Warner and their co-horts blame breastfeeding for taking away their dignity and independence. In their minds the only reason to breastfeed is because if you don't then you'll feel guilty because of the evil lactivists.

Now, I'm not even going to get into the science of it all. Human milk for human babies = Duh. But where on earth did people get the idea that 1) Lactivists and breastfeeding mothers are some militant majority hell bent on running roughshod over the self-esteem of a bottle feeding, yet more independent minority and 2) Breastfeeding is something that only uber-mommies do, like Gucci diaper bags and organic juice.

For one thing, the vast majority of women don't breastfeed. Yes its claimed that 61% of moms initially breastfeed but that number drops precipitously as time goes on. A very small number continue to nurse for the recommended one year. Lactivists and breastfeeding mothers are vocal because they have to be. No one is going to ask you to leave the restaurant because you're giving your child a bottle. No one is going to suggest that you're abusing your two year old because she still sucks on a bottle for comfort. No one is going to insinuate that maybe you get some sort of perverse sexual pleasure out of feeding your child. Even if a woman overcomes the social obstacles of breastfeeding she still has to deal with crap like this. Just go read the site. You would think these women were being shamed into feeding their children in bathroom stalls.

The second thing that really gets me with this is the idea that breastfeeding is an upper-class fad. On the surface it seems that breastfeeding is limited to that crowd, but I know tons of women, like myself, that either are breastfeeding or plan on breastfeeding exclusively because we can't afford formula. My husband works at the local grocery store and he tells horror stories of families not paying their bills so they can shell out the $20+ per can of formula to keep their children alive. Nevermind the fact that human milk for human babies = Duh, deep down inside I almost feel that formula companies are another example of multi-national corporations preying on the poor and uneducated. Emily at Adventures in [Crunchy] Parenthood has a wonderful discussion on the topic of breastfeeding and class here. My SIL is one of those moms who refused to breastfeed because "thats what poor people do." In her mind, breastfeeding is a sign that someone can't afford formula and is therefore part of the lowest class of society.

What it comes down to is women who want to breastfeed are really trapped on both sides. We have educated career women telling us that it will never work because we'll never be worth as much as a man so long as we have a baby attached to our breast. We have moms at the bottom end of society that don't breastfeed because they see breastfeeding as a symbol of poverty. We live in a society where breasts = sexual objects not food for babies. Then to top it all off, just when we start getting the word out that yes, the breast is best, we have the vast majority of mothers in society screaming that what we're doing is making them feel guilty. Honestly, I don't care about your guilt. If you are part of the 5% of women out there that genuinely cannot or should not breastfeed then you have my sympathy. Otherwise I could care less how you feed your child, but I expect you to keep your mouth shut about how I want to feed my child. You have the strength of a misinformed, puritanical, judgmental society behind you. All I have is a smattering of state laws that promise not to throw me in jail for feeding my child in public. Don't go making a case against breastfeeding, or rant about banning the breast pump. Just because you can't mother and feel fulfilled as a woman in a man's world doesn't mean that I'm after the same thing. If you feel guilty for not being as committed to being a mother as you think you should be, don't blame me. Look within yourself, your marriage, and your family to understand why you're not doing the job you think you should be.