There are apparently around 85 million moms in the United States. Maybe you are one of them.

Did you know that it only takes one mom? That could be you. You could be the one mom using your voice on behalf of the world’s poorest. But in reality there were 10 social media moms who went to Kenya as part of a “movement to promote education, engagement and activism on behalf of the world’s poorest. #ONEMOMS is an initiative of ONE, a grassroots organization cofounded by Bono and other activists that fights extreme poverty and preventable disease. ONE is backed by 2.5 million members and a series of partners.

Like #ONEMOMS, every mother counts believes that each and every mom is important. Led by Christy Turlington and a group of partners, this initiative is increasing education and awareness around maternal and child health, which includes the launch of a film called No Mother, No Cry.

But maybe one mom isn’t enough to tackle the issues of every mother. Maybe we need a million moms. Thankfully, there are many millions of moms, because it seems they have different priorities, sometimes shared, sometimes divisive.

The original (?) million moms descended on the National Mall in Washington, DC in 2000 for the Million Mom March in support of tighter gun control. This is an initiative of the Brady Campaign to prevent gun violence.

Then, the Christian American Family Association came along with its One Million Moms to fight the “filth many segments of our society, especially the entertainment media, are throwing at our children.” I may agree with them on some issues, like the objectification of women and girls in the media. But I want to distance myself as far as possible from these million moms when they start protesting the possibility of Ernie and Bert getting married on Sesame Street or objecting to Chaz Bono being on Dancing with the Stars because they might have to explain to their children what transgender means. Or when they present Sarah Palin with the Faith, Family and Courage Award.

Next, there is the Million Moms Challenge, being organized by ABC News and the UN Foundation, as well as Johnson & Johnson and BabyCenter, and an online community powered by BlogFrog. Their goal is to engage “a million Americans with millions of mothers in the developing world around issues that directly impact pregnancy, childbirth and children’s health” and to “raise awareness and funds to help women and children everywhere survive and thrive.”

Finally (I think), there is the Million Mothers March (not to be confused with the Million Moms March) being organized by Breastfeeding Mothers Unite (not to be confused with Breastfeeding Moms Unite, my friend Melodie’s great blog). The march is being planned for August 2012 in Washington, DC (at the National Mall) to fight increased incidences of harassment of breastfeeding mothers when they are nursing in public.

The one mom, every mom, and the many versions of the million moms have websites, facebook pages, twitter accounts, hash tags, campaigns, petitions, mailing lists and ambassadors. It all starts to blend together after a while. The good and the nasty. The important and the ridiculous.

My head is spinning. Is yours?

I want to be involved. I want to help. I want to look underneath these organizations to see who they are supporting and who is supporting them. But it is getting difficult. With so many initiatives and organizations and cross-pollination, yet separation, I must admit this one mom is getting lost in the shuffle.

I found the past couple of weeks of Up All Night to not be good enough or bad enough to write about. There were some funny parts and some parts that made me roll my eyes, but nothing that drove me to my keyboard.

But this week’s topic was birth and I have had a few requests to write about it. Overall, it did a pretty good job of reinforcing every myth, stereotype and unfortunate reality of giving birth in the United States. I do recognize that some of it is intended as over-exaggerated humour and not to be taken seriously. However, it wasn’t over-exaggerated enough in most parts which, in my opinion, simply serves to reinforce myths and stereotypes.

What stood out?

• The birth plan is 18 pages+: Reagan has an incredibly long birth plan. That, plus a few statements she made about needing to be in control, reinforced the stereotype of the crazed pregnant woman who needs to control every single little detail of her birth and thinks that is possible too. I’m glad I had a smart doula who looked through my two to three page birth plan and helped me reduce it to a one page birth plan that could actually be read by the nurses and doctors who attended my birth.

• Not allowed to exercise while pregnant: Reagan rattled off a list of things she wasn’t allowed to do while pregnant. One of them was that she couldn’t exercise. Unless you’re on medically indicated bed rest, exercise is an important part of a healthy pregnancy. I continued playing my regular sports through the first trimester and then swam, walked, did prenatal cardio/strength classes and prenatal yoga classes.

• Birth is completely disgusting: Reagan and Chris watch a birth DVD, which they find absolutely disgusting (both because of the birth and because of the “hairy” woman in it). They also ask to have the mirror taken away when Reagan is pushing because they can’t stand to look. The whole “birth is scary” and “birth is gross” mantra is one of the reasons that women have trouble relaxing and believing in themselves and their bodies. It is one of the reasons why people need to see women giving birth, just like they need to see them breastfeeding.

• “Are you going to give up your identity to stay home and change diapers?”: This is the question that Chris’ colleague asks him when he mentions his plan to take paternity leave. It is, unfortunately, the same thing that is asked of many, many women and men who make the decision to stay home temporarily or permanently. Is there no room for children to become part of our identity rather than it being one or the other? I’m happy to share my life with my children and to have them share their lives with me. The statement uttered by Chris’ colleague also puts  “changing diapers” on a lower level (less important) than his “real” work, this reinforcing the lack of value that our society assigns to caring work.

• Rushing to the hospital: As soon as Reagan realizes that she is in labour, they are in a big rush to get to the hospital as quickly as possible. There is no discussion of how far apart her contractions are or of waiting until it is really time.  Ava asked whether Reagan would like to give birth at a hotel instead (because of Ava’s desire to avoid going to the hospital) and for a moment (not having seen the previews), I hoped that maybe she would go for it and have a non-hospital birth.

• “No pain killers, good luck!”: As Reagan and Chris arrive at the hospital, they run into their neighbours who have just had another baby. The mom says “No pain killers, good luck!” when Reagan mentions that she wants a natural birth. This is certainly something that does get said (I heard it many, many times and also heard people telling others “whatever you do, get the drugs”), but it is too bad that no opposing view was ever shown (she did end up with the epidural eventually).

• Sitting down or laying on bed during labour: In every scene at the hospital, Reagan is either sitting on the couch or lying on the hospital bed. Perhaps her labour would have advanced a bit more quickly if she had been walking around the room.

• Stoned on the epidural: Once Reagan did opt for the epidural, she acted like she was completely stoned. I did have an epidural for my first birth and don’t remember being stoned. There are certainly some valid concerns about the impact on the baby, but I’ve never heard of a mother acting like she is stoned after having the epidural.

• No choice, no discussion c-section: After about four hours of pushing, doctor says they have to do a c-section because the “baby’s head may be too big”. When they ask if they have any choice, he simply says “no”. While it is true that c-sections are necessary in some scenarios, the doctor should always explain the pros and cons of proceeding with surgery and explain the rationale for the recommendation. Unfortunately, however, the scene in ‘Up All Night’ may in fact be what way too many women experience — i.e. the doctor simply dictating the direction to be taken (which may or may not be a good decision), without engaging the woman and her partner in the decision.

What do you think? When a television sitcom portrays birth in this way, is it simply light humour that is not to be taken seriously, or does it reinforce myths and stereotypes in a way that sets women up for failure?

Were you ever scared of child birth? I know I was with my first baby. Although I’d read a few pregnancy books, birth seemed so foreign and so strange to me. I don’t spend a lot of time in hospitals and like it that way, so the idea of going into a hospital to push out a baby when I’d never even seen another woman give birth was a frightening. I wish I had been more educated at the time. I wish I had access to more options in terms of a birth attendant and birth location. I wish that I had spent more time researching instead of simply trusting.

Seeing Birth Can Calm Fears

Dr. Nancy and her family

Nancy Salgueiro, an Ottawa birth coach, chiropractor and mother of two, is planning to broadcast her upcoming home birth live on the Internet. People are invited to invited to watch Dr. Nancy give birth live on the Internet in order to help women overcome their fears and uncertainty about birth. She wants women to know that “they can do it and that they are powerful.” Please read my post at Care2 about the need for prospective mothers to see childbirth and breastfeeding before they experience it and learn more about Nancy and other women who have chosen to make their birth available to the public online.

Ontario Needs Better Access to Midwives

Ontario Association of Midwives

Sometimes birth is a political issue. I saw that last year when I attended a rally in support of midwives in Germany. I am also seeing it now as Canadians advocate for better birth options.

Part of empowering women in the birth process is ensuring that they have access to a range of different options for the location of their birth and their birth attendant. Currently, in Ontario, too few women have access to midwives. Making midwives more accessible to Ontarians, both in hospitals, in midwifery-led birth centres, and in their homes, will help give women a more complete range of options for a normal and natural birth close to home.

With the election coming up in just a few days, the Ontario Association of Midwives (AOM)  put a series of questions to the parties (can you guess which one didn’t respond?). You can find their questions and answers on the AOM website: Where the parties stand.

A new study was just published in the Journal of the American Medical Association about a blood test that can predict the sex of a fetus using a non-invasive procedure (blood test) at 7 weeks pregnancy. My colleague Kristina wrote a post explaining more about the procedure and technology at Care2. I have mixed feelings about it, just as I did with the expanded prenatal genetic testing that I wrote about in January.

On being pro-choice…

I am pro-choice. I trust women. I trust women to make good decisions about what is right for themselves and for their bodies. While I do not think that I could get an abortion, that is just me trusting myself to make the right decision for myself and my body. In the same way that I trust myself, I trust other women to make the right decisions for themselves, which may mean getting an abortion.

I understand that a lot of women get pregnant at a time in their lives when they are not ready for it. Whether they feel like they are too young, too poor, or simply not ready, I’m okay with that and realize it is simply none of my business. If they were raped or are in an abusive situation, I completely understand the decision to have an abortion. In fact, I cannot say that I with certainty that I wouldn’t choose that route too in an abusive situation.

I support women. I trust women. I am 100% pro-choice (even if that sometimes surprises my readers).

On shopping for the “right” baby…

I understand people wishing for a baby of a particular gender. We wanted to have two children and had a boy first. With our second child, I definitely wished for a girl (and I got my wish). If we’d ended up with a second boy, I would have welcomed him into our family and we would have then had the discussion about whether we want to try for a third in order to have a girl. We would have talked about how that would change our lifestyle (would need a bigger car, bigger house, may not be able to afford some of the thing we can now, etc.) and we would have talked about the risk of having twins or triplets and ending up with more children than we bargained for. I don’t know what we would have decided, but the discussion definitely would have been about whether to try to conceive a third child, not about whether to abort the fetus that was the wrong sex.

Because I am pro-choice, I would support another woman’s choice to have an abortion because the baby didn’t have the sex that she hoped for. But I would cringe inside. Is gender really that important? Couldn’t the family just love the baby no matter what? What happens if she aborts a baby for having the wrong sex, only to get one that has the genitals she hoped for, but that turns out to be transgender? How would she treat that child?

On societal pressure for gender selection…

I trust women. I support women. That means that I am pro-choice, but it also means that I believe they deserve to be protected from patriarchal power systems that seek to control their bodies and their decisions. If a woman truly wants a baby of a particular sex, I will cringe but support her in her decision.

My bigger worry, however, is that women will be forced to abort female fetuses because the patriarchal society that they live in places higher value on boy children than it does on girl children.  Ultimately, I worry that this early sex detection will be used as a tool to control women, rather than as one that gives them more freedom.

What do you think?

How do you feel about this new test? Would you have used it to learn the sex of your fetus? Would it have impacted your decision about whether to carry the baby in any way?

Image credit: lumaxart on flickr

One of my favourite natural parenting bloggers is Lauren from Hobo Mama. I’ve been following her tweets and posts about her pregnancy with Baby #2 and know she has been doing a lot of thinking and researching. When I was planning my March guest bloggers, having Lauren post about her preparations for bringing a second child into their family came to mind immediately. I knew that she would be great at covering this topic and she more than came through on that. Her guest post is both a wonderful story of their family’s journey and a resource rich library for any parent going through this same experience. Please welcome Lauren to the blog.

I am in the third trimester of pregnancy, awaiting our second baby. Our first child, Mikko, will be turning four years old just about the time our baby arrives. Since we’re planning a home birth, we’ve spent a lot of time prepping Mikko for what to expect, and making our own plans for how to arrange the logistics of the birthing time.

Here are some of the aspects of birthing we’ve gone over with Mikko, along with the resources that have helped our family prepare. Many of these were suggested to us by others (some very frequently and passionately), so my thanks to Annie of PhD in Parenting, her friend Elizabeth, and the commenters, Tweeters, and Facebookers at Hobo Mama.

Explain pregnancy in general

No matter what age your children are, pregnancy is a fantastic time to talk about where babies come from and what they can expect when you’re expecting. I’ve been glad to have such a natural segue into early sex education. At three years old, Mikko was ripe for talking about genitalia and learning new vocabulary. Sometimes he learned it very loudly. In public. But his enthusiasm was undeniable.

You’ll have to tailor your lessons to your audience: Young toddlers might grasp only the basics. Preschoolers like Mikko will find the whole process fascinating but not understand it completely. Older children (I was 9 when my brother was born, for instance, and my older brother was 13) will appreciate more advanced knowledge and perhaps some frank talk about their own sexuality. And if your baby was conceived or will be born in a less conventional way, this is an opportunity for you to talk about the specifics of your family’s experience, also at a level that works for your kids.

Here are some books that helped spark discussions of conception, pregnancy, and birth:

• Babies Don’t Eat Pizza, by Dianne Danzig & Debbie Tilley — a fairly comprehensive preparatory book for older siblings, showing a variety of family and birth situations.
• Mommy Laid an Egg, OR Where DO Babies Come From?, by Babette Cole — the adults in the story present all the possible wrong ideas about where babies come from, and the children correct them. Some think the sex-positions spread is beyond the pale; I thought it was funny, and Mikko was nonchalant.
• How Was I Born?: A Child’s Journey Through the Miracle of Birth, by Lennart Nilsson & Lena Katarina Swanberg — the beautiful in-utero photos help children visualize what’s happening beneath the skin.
• Where Did I Come From?, by Peter Mayle — this is one of the books my mom gave me when she became pregnant when I was eight years old. I found it humorous and informative and couldn’t believe my parents were letting me read it.
• Where Willy Went, by Nicholas Allan — comical story about one determined sperm.
• My Mom’s Having a Baby!, by Dori Hillestad Butler & Carol Thompson — I love that this book goes month-by-month through a pregnancy from the big sister’s perspective. It also mixes in a lot of sex ed and shows, non-graphically, a vaginal (hospital) birth.
• Baby on the Way, by William Sears, Martha Sears & Christie Watts Kelly — being part of the Sears Children Library, this is a very attachment parenting-focused book that has some good ideas for parents and caregivers to smooth the transition from younger sibling or only child to older sibling.
• Everywhere Babies, by Susan Meyers & Marla Frazee — a book that just shows babies in action, being cute and doing what they do, which makes it fun reading for toddlers on up. Unlike most older-sibling books I could find, this is one that shows babies in pleasing diversity, with a variety of parenting styles, skintones, and family arrangements.

Start talking about the birth

Since we’re planning a home birth, the possibility that Mikko would want to be present meant we needed to prepare him for the sounds and sights of labor. Even if your birth plans include not having your children present, they’ll still likely be curious exactly how that baby gets out, so you can talk about your particular situation.

Since we’d introduced the vocabulary of pregnancy, it was an easy step to continue explaining vaginal birth. I’ve explained the work and possible noise involved to Mikko in a way he can connect to — it’s like pooping. I think he got that analogy!

You might also try role playing the birth with a doll and a playful attitude, mimicking and laughing together over the silly sounds you might make in labor, and showing your children their own birth videos and photos.

For us in particular, Mikko unfortunately had a bad dream about birth right before I was planning to start talking about it with him. We had been at my in-laws’ when he first asked, and I felt awkward saying “vagina” around my father-in-law so hedged and decided we’d talk more when we got home. Too bad I was squeamish, because Mikko had a dream about bubbles and a big gash, and now anything I say about birthing probably doesn’t sound any more reassuring! I would advise talking about birth early, then, so you can put in positive messages before they imagine their own scenarios.

Here are a couple books that helped describe or show birth. I would love to find more that are geared toward children, if anyone has suggestions!

• Welcome With Love, by Jenni Overend & Julie Vivas — this was highly recommended to me by several people, and I now know why. It’s a charming and realistic story of a home birth with midwife and several siblings in attendance.
• A Child Is Born, by Lennart Nilsson — this is similar to another book my parents gave me when we were expecting my little brother. I haven’t read this updated version, but I understand many of the same photos are there, including explicit ones of vaginal birth, which fascinated me as much as the photos of life inside the womb. You’ll have to gauge if the birth photos are too graphic for your children.

Watch some gentle birth videos together

To try to assure Mikko that birth can be satisfying and calm, I sought out birth videos of gentle, natural birth — the kind of birth we hope to have, and that we (for the most part) had with Mikko. I use Hypnobabies birth hypnosis, so I was pretty mellow during my long labor with Mikko and hope to be again this time around. If you’re a screamer and really want to prepare a child, you might need to find some more active, vigorous births to show. With a sensitive kid, I thought it was best to aim for soothing — to show the function of birth without added drama. Note that very few mainstream television shows or movies tend to show birth in a positive light, and internet videos vary greatly in birth outcomes and helpfulness, so you’ll want to screen your selections carefully to make sure they won’t unintentionally disturb your children.

Here are some videos we enjoyed. I enjoyed them more than Mikko, but he was still intrigued by it all!

• Birth Day, a DVD by Naoli Vinaver Lopez. I was fortunate our library had this short documentary — this home water birth in Mexico is absolutely radiant and serene. One older son is present for the birth, and the other comes into the tub afterward.
• Gentle Birth Choices — this one was more “educational” and a little dated so probably a better choice for older kids, unless you want to fast forward through the boring talking parts.
• The Business of Being Born is a pretty easy documentary to get hold of. Again, you’d need to pick and choose which parts to watch with your kids.
• I haven’t seen Orgasmic Birth, but I’ve heard it shows a variety of raw and real births. This is another one where you’d want to cue up specific scenes for younger viewers.
• “Leo Hart” (home water birth, nothing explicit), “Peaceful Homebirth” (home water birth photo montage, nothing explicit, two older siblings present and helping the mother), “Meadow Ophelia’s Homebirth” (home birth photo montage, explicit, older sibling present during early scenes), “Bridget’s home waterbirth” (photo montage, not especially explicit, oldest daughter in birth tub catches baby), “Natural Childbirth: The Baby Place Birthing & Midwifery Center” (upright birth at birth center, explicit and very gentle, young older brother in jammies clearly fascinated), all via Bellies and Babies, who has a long list of gentle birth videos to check out.
• “Mother Directed Pushing at Home” — two home births using Hypnobabies childbirth hypnosis, only vaguely explicit. The mothers are naked below the waist but positioned so that it’s hard to see anything. There’s a lot of vocalizing in the second birth.
• “Fiona’s Home Waterbirth” at Living in Harmony — nudity but not graphic, vocalizing but gentle overall, toddler sister present and comes into the birth tub afterward.
• “The unassisted birth of Logan Westley” (unassisted water birth, not overly graphic, vocalizing), “Anya’s home/water/hypno birth” (astonishingly quiet Hypnobirth, not graphic), “Twins – A Homebirth With Video” at Homebirth: A Midwife Mutiny, all via Stand and Deliver.
• If you’re having a C-section, an older child who’s curious might appreciate “Alex’s cesarean section” — the music is soothing, and all of the surgery is filmed but it’s hard to see details of the incision because of the bright lights.
• For a combination of still photos, text descriptions, and videos, Birth Story Diaries has a compilation of many families’ birth stories, and you can filter them by how explicit they are and by what type of birth: vaginal, cesarean, homebirth, hospital, and birth center. Again, you’ll want to prescreen any of these for more sensitive children.

See how other mammals do it

One thing I found immensely comforting during my pregnancy with Mikko was to watch animal birthing videos. Animals tend to be very quiet and matter-of-fact about birthing — at least, in the videos I’ve seen. As you’re explaining that birth is normal for all mammals, your children might enjoy seeing that truth for themselves — either in video form or, if you have the connections, possibly even firsthand at a farm or with a pet.

Here are some of our favorite animal birthing videos online:

• “An Elephant Giving Birth”
• “Birth of a dalmatian puppy” (while the other puppies nurse!)
• “Birth of a Giraffe” — for some reason, it cracks me up that the mother giraffe allows the baby to drop from quite a height onto its head. This technique is not recommended for human births!
• “Dolphin Birth”

Tell your children their birth stories

One way we’ve tried to make birth real and personal for Mikko is to talk about his birth. This hasn’t worked so well for us, because Mikko insists he’s a big boy and doesn’t want to go back inside my belly. Oh, trust me, Mikko, not going to happen! For him, then, I’ve focused on just the feelings I had when he was born — I’ve told him how happy we were to meet him for the first time, and how it felt so good to push him out (because it did!).

And for children old enough to understand that their birth happened in the past and you’re simply recounting it, a detailed but positive birth story might be just the thing they need to see that every birth is special.

Here are some books that relate birth stories and might give you an idea for how to make a ritual out of the telling:

• Tell Me My Story, Mama, by Deb Lund & Hiroe Nakata — the older sister excitedly helps her mother narrate the tale of her pregnancy and hospital birth as they await the arrival of her new sibling.
• The Baby on the Way, by Karen English & Sean Qualls — a grandmother, born to a farming family, tells her birth story to her grandson, who lives in a city.
• Catching the Sun, by Coleen M. Paratore & Peter Catalanotto — a tender story of a mother-son tradition that would appeal to elementary-age kids

Figure out your birth plan — for your older children

Mikko has made me numerous signs lately, with cryptically written but pointed messages. “This one say ‘Baby stay in,’” he says, pointing to a random scribble. Well, OK, then.

Given his resistance at the whole idea of seeing a birth, we’re honoring his requests not to be present. This means setting up a series of childcare and backup plans, starting with family and moving on to those friends who might not mind being woken up in the wee hours of the morning.

If you’re having birth in a different location and don’t expect to have your other children present, you’ll need to arrange childcare, as well as some backup possibilities, at your home or your sitters’ home.

If you’re having a home birth, as we are, you’ll need to talk over with your children (if old enough to have an opinion) whether or not they wish to be present — and then create backup plans that will allow the opposite to happen if they have a change of heart.

Even if your children say they want to be with you during the birth, or they’re young enough you think they won’t care either way, it probably is best to have someone there to support them in particular — perhaps a grandparent, other close relative, or trusted friend — in case things become intense and in case your partner, if you have one, is busy caring for you. You’ll want to be able to focus on giving birth, so having someone around for them can be invaluable: someone who can answer curious questions, offer activities or a walk outside, give them a place to watch from where they’re out of the way (and possibly out of the line of sight of anything too graphic), and potentially even remove them if you or they decide it’s necessary. Some people can go inward during labor and birth and not mind any distractions — and some people become agitated if the atmosphere is not in perfect calm. Your children, in particular, are apt to distract your focus, since you’re used to paying attention to them. Try to gauge beforehand whether a busy or a quiet birthing appeals to you, and make arrangements for that scenario — as well as a backup or two in case it turns out you’re mistaken!

Since Mikko definitely doesn’t want to be present, our current intention is to keep him with us in the early stages of labor, before he would start feeling uncomfortable, and then have Mikko’s aunt come over for the rest of the birthing and keep him occupied downstairs while the action takes place upstairs. That way, my partner can stay with me most of the time but can check in with Mikko occasionally. And, if Mikko decides he needs Mama in particular, he can poke his head in and see if the birthing environment is as scary as he thought. Plus, he’ll be around to see his new sibling right after birth, which makes me weepy just thinking about it. (Then again, I’m pregnant.)

Our backup plans include having his aunt take him to her house, having a list of friends on call who could come over here or take Mikko with them, and — if circumstances and middle-of-the-night timing allow — having Mikko sleep through the whole dang thing. Our childcare backup plans will also apply if there’s an unexpected hospital transfer.

If you don’t have family and friends nearby, another idea is to hire your childcare. A suggestion given to me on my post asking for advice on just this topic was to consider hiring a doula. I had no idea doulas would consider babysitting, but I like the thought: A doula would certainly be used to being called at all hours and staying put for a long labor. Plus, if your partner takes a break from tending to you to tend to your other children, the doula could easily pinch hit as an alternate birth partner during that time. If cost is a problem for your family, consider asking a midwife for recommendations of a doula in training, who might offer a reduced rate. (Of course, doulas are worth every penny if you can afford one!)

Speaking of partners, that’s another possibility. I prefer to have Sam stay with me during the labor and birth, because he was so supportive last time. However, if you have a partner who would do better staying with your other children rather than you, that could be a very simple way to handle the childcare. If you need birthing support, you could then hire a doula or invite a friend or family member over for yourself.

The only sure thing to remember in all this planning is that things rarely go to plan. So do what you can beforehand to prepare, but then stay flexible, and trust that you and your support team will make the right decisions as they come up.

Hear what others have done

Sometimes the best thing is to hear from other parents about what worked and didn’t work for them. Ask the other families you know what arrangements they made, and whether those arrangements worked as planned. Ask for their tried-and-tested suggestions of ways to prepare children for childbirth as well.

To that end, please leave your own stories and suggestions in the comments. What did you do or would you like to do with older siblings during a new baby’s birth? How did you and your children prepare beforehand?

To get started, you might check out PhD in Parenting’s own series on preparing for a second baby.

Lauren blogs at Hobo Mama about natural and attachment parenting and is the co-founder of Natural Parents Network. She lives and writes in Seattle with her husband, three-year-old son, and a baby speedily on the way.

Image credits, from top: Paul Hart on flickr, Danny McL on flickr, Chris and Jenni on flickr, Jeff Moore on flickr, Christy Scherrer on flickr

It can be devastating to learn that your child has a disease, whether it is a deadly one, a potentially deadly one, or one that will impact her daily life for the rest of her life. There is already a lot of controversy around prenatal screening and diagnostic tests that can be used to test for possible congenital, genetic or chromosomal conditions because of the fact that some parents may choose to terminate the pregnancy because of the test findings.

But what if you could find out much earlier?

The developers of a new test, described in the NPR article New Gene Test Screens Would-Be Parents, will allow couples to be screened for up to 580 disease genes to find out if they are carriers or not.  Apparently the average person carries two or three mutations that could cause a severe childhood disease and if their partner carries that same gene, then the risk of having a baby with that disease is much higher.

The developers of the test are promoting it as something that couples would use prior to trying to conceive a baby.  Apparently in some instances, there are measures that could be taken to ensure that the couple won’t have a baby with a particular disease (this has apparently been successful in eliminating Tay-Sachs in people with Eastern European Jewish Ancestry). In other cases, I guess the information would allow people to consider options like adoption, egg or sperm donors, or opting to remain child free.

But will it go further than that? Will tests like this  one day play into our choice of a mate?

To some extent, genes probably already consciously or unconsciously play a role when people choose a mate. People may look for a mate who is equally attractive or equally intelligent and certainly genes play a role in those types of things. But will people soon start requesting this type of genetic testing before things get too serious? Why not go for testing for sexually transmitted diseases and genetic conditions all before the third date? Or will we one day use an iphone app containing our DNA profile so that it can alert us of potential good genetic matches or warn us of potential bad genetic matches before we even say hello?

Is this taking things too far? I’m not a religious person, so concerns about humans “playing God” don’t really concern me. However, I do believe there is a lot of value in the plurality of the human experience. I think that our world gains a lot from the different type of people who grace the earth and I think it would be our loss if we started eliminating certain types of people because they are less genetically desirable. I’m sure there are many parents of children with genetic conditions who wish that they didn’t have those conditions and that they didn’t have to suffer. However, if the alternative was not having ever met that child at all, how many would choose that option?

I’m an early adopter of technology and I support medical advances, but I find this a bit scary. What will happen to us if people start choosing a mate because of their genetic profile rather than because they want to wake up next to that person each and every day for the rest of their lives, even if it does mean waking up to care for a child with a genetic condition?

What do you think?

Image credit: shannon abigail simbulan on flickr

Today I am welcoming my friend Kristine as a guest poster. I have been following Kristine (@KristineBrite) on twitter for quite a while and have been inspired by the way she turned her personal tragedy into incredibly important advocacy work that will save the lives of infants. Kristine blogs and shares important information on her cause on her website Cora’s Story.  I’m pleased to share her story here and I hope you will help spread the word too.

Cora’s Story

I gave birth to my daughter Cora in November 2009 after a healthy pregnancy and a delivery free of medical complications. I took her home and spent the next three days cuddling and rocking.

Breastfeeding Cora made me feel so happy, just so content. Early one morning, everything changed. Cora latched and was feeding happily. I looked up for a split second to tell my husband how cute she was, looked back down, and Cora was dead.

The coroner called a few days later and told me Cora died of a congenital heart defect. I’d never heard of it and thought it must be rare. While pregnant, I read everything I could get my hands on. I scoured websites for evidence-based safety recommendations and read about other birth defects and conditions.

Congenital heart defects, or CHD, are not rare. They strike 1 in 100 babies in the US according to the CDC, as reported by the March of Dimes. This means congenital heart defects are by far the most common of all birth defects in the United States.

A hidden disease

Sadly, Cora was not alone. Congenital heart defects are one the most common causes of death in infants under one year of age in the United States. Birth defects remain the leading cause of death, and the majority of those deaths are from congenital heart defects in particular. Every day, 9 babies die from a congenital heart defect.

I’m still in shock that I found out about this from the coroner. I wish for even more awareness for other conditions that also kill or affect babies such as SIDS or Down’s Syndrome, and don’t want to take away from those efforts. I’m thankful I could read up about both and that other conditions are so well known. But, congenital heart defects affect more babies than many other conditions I did know about. The letters “CHD” need to be known and recognized by everyone, especially parents and parents-to-be.

I thought maybe I’d somehow just overlooked information about congenital heart defects. But, so often others find out about CHD from Cora’s Story as well. And, I read notes from other mothers that learned about heart defects as their child was rushed to emergency surgery or in heart failure almost every day. I’m not the only one blindsided.

Thankfully, even though CHD remains a leading cause of infant death, most infants survive. Of the 40,000 infants born with congenital heart defects each year in the United States, a majority live to adulthood.

Learn about CHD, save lives

I was even more shocked to learn that as a pregnant woman and mother, knowing about CHD could have saved Cora’s life. We’ll never know for sure, but through prevention efforts, more screening, and knowing the symptoms of congenital heart defects, I might be nursing her now rather than saving others.

I’m working closely with other organizations, and started one of my own, Cora’s Story, to make sure no other mother ever finds out about the most common birth defect from the coroner.

We have an easy way to all work together to save babies, and improve outcomes. Early diagnosis is important and can save babies from developmental delays, organ damage, or death.

The exact cause of congenital heart defects is not known. Research has linked a gene to some defects, although CHD can happen to anyone. No one in my family or Ben’s family has a known heart defect. I say known, because heart defects can go undetected into adulthood.

Researchers have found links to CHD, folic acid, not smoking, and maternal weight to name a few. The heart develops in early pregnancy before a mother knows she’s pregnant so taking extra folic acid if trying to conceive can be helpful. I take extra folic acid all the time, even though we aren’t trying, just in case, as recommended in this medical journal article.

Finding heart defects

Detection is like a puzzle because nothing finds these defects all of the time. Ultrasound, especially the routinely conducted around 20 weeks finds some of them. Other in utero testing not routinely done like fetal echo and a level ii ultrasound also catches some of them some of the time. I’m going to insist on both with my next pregnancy. Knowing family history is key so you can speak to your health care providers about testing. Sometimes, you might not be aware a relative has a CHD. Over 30 types of CHD are known and relatives might call the condition by something else.

Other defects are found at birth or shortly after birth. The baby might present with one of these symptoms:

• Trouble feeding (falls asleep all the time while feeding)
• Labored breathing or fast respiration
• Turning blue, or dusky coloring
• Frequent respiratory infections
• A heart murmur (Heart murmurs are often innocent, but not always)

Sometimes a baby has no symptoms until it’s too late. I don’t remember Cora having any of these symptoms. But, my mother says she breathed “funny.” Being a first-time mom, I didn’t think anything of it.

Of course echos and EKGs after birth are a great tool for diagnosis, but aren’t routinely done, and are expensive and a bit more intrusive for some parent’s liking. I advocate strongly for pulse oximetry screening. Pulse oximetry measures oxygen saturation, and I had one on most of labor, so it’s already used quite commonly. Babies in the NICU or that present with health problems are routinely monitored. It costs less than a diaper change and is non-invasive. Efforts are away in the United States to make pulse ox part of the newborn screening panel. I also like this type of testing because it doesn’t interfere with bonding. A parent can even hold the baby while it’s being done. For best results, it should be done after 24 hours of life.

I believe this screening will become routine soon, a big step forward happened earlier this month when the Secretary’s Advisory Committee for Heritable Disorders in Newborns and Children (SACHDNC) unanimously agreed to recommend the addition of screening for Critical Cyanotic Congenital Heart Disease to the panel for universal screening of all newborns in the United States. The type of defects picked up by pulse oximetry are generally the most lethal. Some refer to pulse oximetry as the “fifth vital sign.” Until it’s routine, asking for it to be done on your newborn after 24 hours of age while baby is calm could save your child’s life.

…

Thank you Annie for helping me give Cora a voice, and helping her save lives. I know it’s not an easy subject. I know Cora’s story is exceedingly sad, but I hope you’ll all remember it, and share it. Help us save lives.

I have a list of 10 things all new parents should know.

Jessica has a list of things she should not tell new/expectant parents.

What do you think expectant/new parents should be told?

What do you think we should let them figure out on their own?

Image credit: Emery Co on flickr

On May 5, International Day of the Midwife, the kids and I attended a protest in Berlin in support of German midwives.  Midwifery care in Germany is currently threatened due to significant increases in the liability insurance premiums that midwives have to pay. According to the Deutscher Hebammen Verband (German Association of Midwives), the premiums over the years have gone up significantly and have tripled in the past three years:

• 1981 – 30.68 Euro
• 1992 – 178.95 Euro
• 2007 – 1,218.00 Euro
• 2009 – 2,370.48 Euro
• 2010 – 3,689.00 Euro

The increase in insurance premiums is not due to increased risk during births attended by a midwife. In fact, an there are fewer birth complications now than in the past. The increase in premiums comes from increasingly higher payouts being awarded by the courts in individual cases.

Midwives in Germany earn around 237 Euros for a birth in the hospital, 445 Euros for a birth in a birthing centre, and 537 Euros for a home birth. But this is not sufficient to cover ever-increasing insurance costs. As compensation for the increase in the liability premiums, the health insurance plans provide midwives with an additional 4.39 Euros per hospital birth and 14.19 Euros for a non-hospital birth. This is not nearly enough to cover the cost of the ever-rising insurance premiums and midwives end up working to pay the insurance, rather than working to live.  The annual salary for midwives (before taxes and other required fees) is around 23,300 Euros. After all costs are taken away, a midwife earns around 7.50 Euros per hour.

As a result, birth centres are closing, midwives are being laid off, and some midwives are opting only to offer prenatal education and postnatal support, rather than helping moms deliver babies. This not only threatens midwifery as a career option, but also threatens the access of mothers to a midwife as their birth attendant. Currently, about 1/4 of German births are attended by a midwife (compared with between 2% and 5% in the Canadian provinces where public health care covers midwifery services ref: Canadian Institutes of Health Information). If the situation remains as is, those numbers will certainly drop. A drop in the number of midwife attended births in Germany, not only means fewer midwife attended births, but also greater pressure on other birth attendants (i.e. obstetricians).

In an attempt to find a solution to this problem, the German midwives have organized an e-petition and are collecting signatures in an attempt to force the Budestag (German Parliament) to discuss this situation.

For any of my readers in Germany who are interested in supporting the practice of midwifery or passing the information along to their friends in Germany, please see:

• Information on how to sign the E-Petition
• Facebook page for the Hebammenprotest
• Twitter account for the Hebammenprotest

Sources for information on German Midwife Protest:

• Hintergrundinformationen zur E-Petition des DHV – Deutscher Hebammen Verband
• Hebammen – In anderen Umständen – Suddeutsche Zeitung

A 2009 study called Social disparity and the use of intrapartum epidural analgesia in a publicly funded health care system by Ning Liu MB, MSc et al concluded that in Canada “the use of labor epidural analgesia is decreased with decreasing neighborhood economic and education levels.” Or, in plain language: rich highly educated women are more likely to get an epidural than poor less educated women. Those are facts which are supported by an excellent data set. I won’t argue with the facts [edited to add screen capture of basic results set].

However, I take issue with some of the study’s assumptions and the conclusions drawn by some of the researchers involved. From the start, the study presents the use of epidurals as the smart choice, referring to the increased use of epidurals as “1 [sic] of the most significant achievements of modern obstetric practice.” The whole study seems to question whether women of lower socioeconomic status are just not smart enough to understand how great epidurals are.

Education level could influence a patient’s acceptance of epidural analgesia.26 We speculate that in our study women from a high-education neighborhood may have had more knowledge about labor epidural and considered that it could alleviate pain more effectively. These women could then be more likely to accept epidural when clinicians recommended it to them, or they request the service themselves.

Despite conceding some cultural reasons for some women refusing epidurals, ultimately, they seem to conclude that if you are educated about epidurals you will make the smart choice and get one. If you are not educated about epidurals, you will not know what a wonderful thing you are missing out on.

The pros and cons of epidurals

I think the first mistake the study’s authors made was to assume that getting an epidural is a smarter choice than not getting an epidural.  There are both pros ans cons to epidural use during birth. According to Sam Leeson, a doula with babyREADY in Toronto in her post on epidurals:

PROS
May offer pain relief
May offer mom the chance to rest
May be medically necessary

CONS
May not work the way mom wants
Mom will be unable to get up to urinate
Some moms complain of long-term back ache at the epidural site**
May slow labour
May drop mom’s blood pressure (an IV will be administered)
May increase the need for surgical interventions (i.e. vacuum, forceps, episiotomy and/or caesarean section)
Will increase the risk of tearing
May give mom a spinal headache
May affect the baby
May result in an allergic reaction to the narcotic (mom would need more medication)
Is cumulative (results in increasing physical disconnection the longer it is in place)
Limits options of positions for pushing in second stage labour

There is a detailed examination of the pros and cons of epidural use, giving a full explanation of these factors, in Weighing the Pros and Cons of the Epidural by renowned childbirth education expert Penny Simkin. In her article she concludes that:

The childbirth educator’s duty is to inform, not to talk women into or out of using an epidural. Many women will choose an epidural, when well informed of benefits, risks and alternatives; others will choose to avoid it if their labor allows.

When women are well informed, they will consider the information, along with other factors – such as their fears, self-perceptions, their goals for their birth experiences, their support system – and make the most suitable decision.

This is a reasonable, balanced conclusion. Assuming that an epidural, which has many risks including increasing the likelihood of need for other birth interventions (each of which carries its own risk), is a better smarter choice is inappropriate. Assuming that the decision to refuse an epidural is something that only uneducated or unaware women do, is insulting.

A brief tangent on inductions, epidurals and c-sections

One of the key risks of epidurals that is mentioned above is the likelihood that an epidural will result in the need for additional interventions, like a c-section. But often the story doesn’t start with the epidural. Experts say that a lot of women are induced unnecessarily just because they have passed an arbitrary date by which the obstetrician thought they should have given birth. In an article about Canada’s increasing c-section rate, this logic is questioned:

Today in Canada, one in five women who gives birth in hospital is induced.

What doctors fear are stillbirths. But alarmed by the rising rates of inductions, the Society of Obstetricians and Gynecologists of Canada recently urged doctors not to consider an induction until a woman is at least one week past her due date.

Claudia Villeneuve says that women are getting induced “if they’re two, three, four days overdue.”

“Inductions are rampant,” says Villeneuve, president of the International Cesarean Awareness Network of Canada. “You have a perfectly normal mom who comes in with a perfectly normal baby, and now you put these powerful drugs into her system to force labour to start.”

The “humane” thing is to offer an epidural, she says. With an epidural, a woman can’t feel pain in the lower half of her body. But epidurals slow labour, sometimes so much that labour stops. “Now you have to get this baby out,” Villeneuve says. Two-thirds of first-time C-sections are done for “failure to progress.”

Interestingly, despite this logical explanation for part of the increase in the c-section rate, one of the authors of the study this post is about (the one about how smart women get epidurals), Dr. Mark  Walker, is quoted in the same article as saying that “We don’t know what the ideal rate [of c-sections] is. I think it’s fair to assume it’s lower than where we are now.” (note: the WHO says it shouldn’t be higher than 15 percent and Canada’s c-section rate is 29 percent).

An alternate hypothesis

Back to the epidural study. In addition to rejecting the authors’ assumption that an epidural is a smart choice, I also reject their conclusion that education level is what causes women of higher socioeconomic status to  have a higher epidural rate.

**WARNING: Evidently from the comments so far my attempt to facetiously poke fun at myself and my socioeconomic cohort in the next paragraph was a complete failure. Please take it with a grain of salt or feel free to join in telling me what a jerk I am while I ponder whether I want to keep writing at all if there is no room for a bit of sarcasm and creative license here and there to make a point (going to keep writing…and keep learning). **

Instead of saying that rich educated women are making the “smart” choice by getting an epidural, I’d be more likely to say that women with perfectly manicured nails, pretty shoes, and a white collar job in the city who have never done a day of manual labour in their lives or endured any type of hardship are more likely to be unwilling or unable to endure the pain of childbirth than rural blue collar working women with practical shoes, callouses on their hands and whose life experience has taught them how to fight and endure. That is, of course, a generalization since not all rich educated women chose to have epidurals and not all poor uneducated women refuse them. However, I think it is a more likely explanation for the difference in epidural rates across socioeconomic groups than the one the authors of the study put forth.

Or, if I am wrong and women of higher socioeconomic status are truly choosing epidurals because they think it is the smarter, safer choice, then we need to seriously reconsider how women are educated about epidurals and find ways to ensure more of them learn about the risks of epidurals and are given the confidence in their body’s ability to birth a baby and to endure the pain of childbirth.

My experience: I had an epidural for my first birth because I was “educated” about the “benefits” of the epidural and scared of the pain. I ended up spending a very uncomfortable night, lying on my back, waiting for my baby to be born. I needed a nurse to tell me when to push and for how long.  They had to use the vacuum extractor to get my baby out (and I’m very lucky that is all they had to use). For my second birth, I refused the epidural because I was educated about the risks of an epidural. I was able to labour in whichever position was most comfortable for me, which mostly meant standing up and using gravity to help move things along.  I was able to feel when it was time to push and knew how long and how hard to push because my body told me and not because a nurse was counting for me.

Image credit: mangpages on flickr