What YOU Can Do To Have A Healthy (and Happy) Birth

A few of you read my post on how the medical community could lower rates of infant and maternal mortality. A couple of my friends very rightly pointed out that women need to educate themselves more  in order to have a birth that is both safe and happy. When I right my post on the medical community, I had a ton of ideas whirling around in my head, so I just started writing and what came out was that post. I decided to just focus on the medical community so that that particular post wouldn't stretch out into the world's longest birthing rights post, which this alone is in the running for. I have since been meaning to do a sequel on how parents can create a safer birth, but I've gotten side-tracked onto subjects such as birthing a baby with a birth defect, pants on LDS women at church, a ridiculous and preachy evangelical Christian movie on marriage, and Christmas candy. But I'm back now. On topic. (Wait! There went a squirrel...)

So in my extensive research, here are some things that you can do to lower your risks of problems cropping up during the birthing process:

• Find a qualified attendant you feel comfortable with.  Whether you choose an OB-GYN or a midwife make sure that he/she is competent. Certification or med school alone doesn't mean someone can handle an emergency effectively. You can have a hospital birth with a doctor and your baby can end up severely brain damaged from a birth injury. (Before you scoff at this, please note that I have an uncle on my mom's side who is severely brain damaged from a birth injury. He was born at a hospital with a doctor. In the ward my husband grew up in, there was a boy his age who was severely brain damaged from a birth injury sustained at a hospital birth with a doctor in attendance.) On the other hand, I've seen Direct Entry Midwives who have been delivering babies for 30+ years who have seen it all: cord prolapse and malpresentation, meconium in the water, mother in shock, baby in respiratory distress, twins, breeches, VBAC's, etc. and have never lost a mother or baby and have c-section and transfer rates under 5%. Then there are midwives who mess up and cause birth injuries and OB-GYN's who are gung-ho for natural birth. It's a mixed bag. Questions you might consider asking a midwife:
• What is your c-section and transport rate? Have you ever lost a mother or baby? Have any of your babies had a birth injury? Some midwives are very forthcoming with this information and even have it on their websites. If she has lost a baby, inquire about the circumstances. There are some midwives who have delivered babies who have terminal birth defects, for example, and I don't think that should be counted against them.
• How would you handle a cord prolapse? Cord prolapse is rare, but is one of the most serious things that can happen in a home birth. Well, even in a hospital birth it can be very serious. Basically, this is when the cord is coming before the baby and the baby is lying in such a way as to compress the cord and cut off oxygen flow. It requires a c-section ASAP. If a cord prolapse happens, a competent midwife usually put the mother on all fours and hold the cord up to take the pressure off of the cord and provide oxygen flow to the baby and call the ER and have them set up the operating theater right away so that the mother goes into surgery as soon as she arrives at the hospital. The mother will stay in this position until she goes into surgery. A few babies have died from cord prolapse in transit. On the other hand, many others have born alive and healthy from a successful transport. If you are in the hospital, you may be able to get a c-section more quickly, but on the other hand the operating theater still may have to be set up or your doctor may be sleep deprived and moving slower. If you are on your back during the time it takes to set up the operating theater the risks to the baby increase. Nothing is for sure in birth, even in a hospital. But if an emergency arises at home and your midwife is prepared, it can save your baby's life and health.
• What if I decide I want pain medication? Or I don't want to get in the hot tub? Or I want everyone out of the room? Your midwife is any good at delivering babies, she should be pretty accommodating. The birth suite I went to for Duckling's birth had a policy of "if mom wants to go to the hospital and get pain meds, we go". When I was in labor and starting to get too hot in the hot tub, it was the supervising midwife who asked me if I wanted to get out of the tub. I've heard of other midwives who have told moms that it's OK if they want to labor more by themselves and have the midwife just standing by in the next room to keep an eye on things. Labor, especially transition, does strange things to a woman sometimes and you really need someone who can flow with it.
• Questions you might consider asking a doctor:
• What is your c-section rate? Have you had a mother or baby die? Brain damage in a baby from a birth injury? Most OB's will probably be taken aback, but as a patient, you do have a right to know what an OB's history is, just as with a midwife. Inquire about circumstances if there has been a death.
• What would you do if there is cord malpresentation? Cord malpresentation is relatively common, and actually pretty fixable if done properly. This is one where midwives often have better skills, as they usually handle it by unwrapping the cord from around the baby as he comes out so that oxygen flow isn't cut off. Doctors often have a practice of rushing in and cutting the cord immediately before the baby comes out, which cuts off oxygen flow and can cause the baby to go into distress.
• What are your thoughts on induction with Cytotec? Cytotec (Misoprostol) is a drug for treating ulcers. Because it causes abnormally strong uterine contractions, it is also used to induce abortions for elective purposes or for missed miscarriage. It is commonly used by doctors to induce labor because it works faster than pitocin, though it has never been approved by the FDA for such use. When it first hit the market the label read that it was contraindicated for usage by pregnant women. After an alarming number of reports of uterine rupture and infant and maternal deaths where Cytotec was used to induce labor, Searle, the manufacturer of Cytotec, distributed a letter warning doctors not to use the drug for induction. The American College of Obstretrics and Gynecology there isn't enough evidence to conclude that Cytotec is unsafe and maintains that it is safe for induction. You can find the full text of Searle's letter of warning here, if you are interested. Obviously every woman must decide for herself if she is comfortable with the use of such a drug during labor.
• How many unmedicated births have you attended? Many OB-GYN's have little experience with unmedicated birth, which means that they are very unfamiliar with a basic biological function of the female body. Since they don't know what natural birth even looks like, even normal occurrences in the birth process seem like emergencies and are treated as such.
• Birth in a place you feel safe- Seriously, this is a big one, and you have to be really honest with yourself about where you are comfortable. In nature, if an animal feels threatened during labor, a stress hormone catecholamine will stop labor so that the mother can flee. We humans are the same way. If you feel threatened and overly stressed during labor, your body will start releasing increasing levels of catecholamine and stop labor. If you're at home or a birthing center, this may mean a transport to the hospital. If you are at the hospital and labor stalls, you will probably receive labor induction medication or a c-section. If you feel safest at a hospital, then without a doubt, you should choose a hospital birth. If you really don't feel comfortable in a hospital, then an out-of-hospital birth will probably be best unless you are especially high risk.
• Don't rush off to the hospital too soon- Folks, I hate to be the bearer of bad news, but real life  labor and birth are not like what you see in the movies and on TV. (And just being a ship captain isn't enough to legally give you authority to marry people. Sorry.) In the movies and on TV, a woman's water breaks and everyone starts running around like mad to get her to the hospital right away. In real life, that's usually not the best course of action. Reasons why:
• Policies on time to delivery- Hospitals have time limits on how long you can be at the hospital from check-in to delivery. Your body and baby haven't read those policies and will move at their own pace. It's also very common to have slower, irregular contractions, and even stalls during early labor, just as a natural part of the labor process. Early labor can often go on a while and the thing is, you don't need to be at the hospital until active labor hits and you are close to delivery. For all the talk from OB-GYN's and anesthesiologists about how "things can change very fast", when the body is left to do its thing unhindered, they usually don't. (Now if you put a laboring woman on her back, a position which reduces oxygen flow to the baby and decreases the size of the pelvis, use drugs, and deprive a woman of food and water for several hours, then yes, things can go wrong very fast.)
• Policies on eating- Hospitals also have policies forbidding the laboring woman from eating or drinking until the baby is born so that if medication or surgery are administered there isn't any chance of a reaction. It sounds good in theory, but labor is very athletic and hard work, which increases the body's need for glycogen (glucose) and even a few hours without food or water can send the laboring woman's body into ketosis, which causes the muscles- including the uterus- to function less efficiently, slowing or even stalling labor. And this is one problem with inductions is that you have to be at the hospital from start to finish.
• Continuous electric fetal monitoring- I talked about this in my post on the American medical community and the high infant and maternal mortality rates in this country. There is no evidence showing that continuous monitoring is safer or more effective than intermittent monitoring, and there are plenty of problems with it. The longer you are on your back during birth, the greater the chance that you will have difficulty pushing the baby out or that the baby will go into distress.
• And if you do have a "Hollywood" labor where your water breaks- Your greatest risk is infection if your labor kicks off with your water breaking, however, as long as you don't put anything in the vagina, this is a very, very, very small risk. But if multiple dilation exams are being done on you, there is a greater risk of infection
• Okay, so when am I supposed to go to the hospital? The general rule is, of course, when the contractions are about a minute long and five minutes apart. It is possible that you could "hang out" in that type of timing for a while and the baby could still be a ways off. The late Dr. Bradley talked about the emotional signs of active labor being crucial in knowing when to leave for the hospital. Indecisiveness, inability to focus or carry on a conversation, not being able to smile or laugh, not wanting to move around much, are all signs that it is time to go. If mom can smile, laugh, walk around the mall, or pay attention to a TV show, it's too early to leave for the hospital. A tastier litmus test is suggested by nurse midwife Pam England in her book Birthing From Within: when you are in labor, start baking chocolate chip cookies. When the cookies start to burn because you are getting lost in labor land, it's time to go to the hospital. (Just make sure to turn off the oven first.)
• Know the circumstances under which you really do need a c-section- Let's just say that if you are a highly athletic woman who teaches fitness classes and your doctor tells you that your ab muscles are just too tight to push the baby out (I kid you not, I heard this one), you can be pretty sure he just doesn't want to stick around and wait...
• Position of the baby- Though most doctors are saying all breeches should be c-sections, breeches of all kinds have been safely delivered vaginally in hospitals and even at home with experienced midwives. (And as one couple and Illinois state trooper found, even a footling breech previously scheduled for c-section can be delivered safely by the side of the road.) In the US, if you are lucky, you may be able to find a doctor who will do a vaginal birth for a frank breech. In Canada and Australia, complete breeches are also considered safe for vaginal delivery, provided the baby has no other risk factors such as prematurity. If you really want to avoid a c-section for a breech and you live in America, you may have to find a midwife with lots of breech experience. I find it really sad that so many women are losing options on how to birth their babies here in the US. It's not so much a matter of how you end up delivering, it's more a matter of being able to choose, from my perspective. Transverse lie of a singleton or Baby A twin require a c-section.  (Transverse lie is not uncommon for Baby B twins. They tend to go head down once their sibling comes out.) There are risks associated with a vaginal breech birth, but there are also risks associated with a c-section. It's up to every mom to decide what is best for her and her baby. If you find out that your baby is in breech or transverse, take heart! You have options. Spinning Babies.com has loads of information on how you can prevent and turn breeches and transverse lie. ICPA.org has info about using the Webster Technique to turn breeches. The American Pregnancy Association has stated that the Webster Technique is highly effective and turns about 82% of breeches into vertex.
• Placenta previa- It's pretty common for the placenta to float around during the first trimester and cover the cervix, but if it persists into the second or third trimester and is accompanied by severe vaginal bleeding, an emergency c-section with a classical scar must be performed to save the mother and baby. Sometimes the bleeding starts pre-term and isn't severe and goes away with bed rest, and then the baby can be delivered full-term via c-section.
• Pre-eclampsia, eclampsia, HELLP syndrome- These require an emergency c-section to save the baby and mother. Knowing the symptoms of pre-eclampsia and related syndromes could save your life or the life of someone you love. Women with access to great health care are still dying from this disease here in America because it often goes unnoticed by medical professionals. If you are having symptoms of pre-eclampsia, you may have to be your own advocate to get the care you need.
• VBAC after 2+ cesareans- Think you're out of the running for a VBAC because you've had multiple c-sections? Not necessarily. Medical reports show that moms who have had two, three, and even a whopping four or five c-sections can still successfully VBAC.  (You'll have to scroll down to the VBAC section). Repeat c-sections may increase the likelihood of uterine rupture or a repeat c-section with a VBAC. On the other hand, repeat c-sections carry their own set of risks too. Classical (vertical scars) are a rather mysterious thing. What I know is that the general consensus among doctors and midwives is that a VBAC should not be attempted with a classical scar because they have a greater chance of rupturing than low incisions (10% as opposed to 0.3-0.7%). What I have heard are rumors that it can be done and has been done, especially since classical scars used to be the only types of scars used and were what the first VBAC advocates had. Again, every mother has to make the decision about what is best for her and her baby.
• Multiples- Roughly half of all twins and about 99% of triplets are delivered via c-section in the U.S. If you start researching, you'll find that many moms have had perfectly safe, full term, vaginal deliveries of twins (and even triplets) in and out of hospital- even as VBAC's. Apparently there is a Dr. Tate in Atlanta who believes in VBAC's so much that he helped a mom deliver her triplet girls (two vertex, one footling breech) vaginally and spontaneously at 38 weeks gestation. This woman delivered triplets as a successful VBA2C. Another story to knock your socks off, one mom who had genital herpes did a successful VBAC of triplets at home at- are you sitting down?- 41 weeks. So yes, you can make it to full term with multiples and do a natural birth!
• Cephalo-pelvic distortion- If you genuinely are too small and the baby is too big, then you will need a c-section. CPD was much more common when abnormal bone development from rickets was widespread. However, when you are lying down, your pelvis becomes much smaller and it makes it much more difficult to push even a normal sized baby out. A good article on CPD is here under the "Can I have a home birth if..." link.

So there it is. My advice on how to get the birth you want. In closing, from an evolutionary perspective,  if birth really were so dangerous that there was a likely chance of death for every mother and baby who gave birth without several high-tech interventions, the human race would have died out a long time ago.  From a religious perspective, I believe that God designed our bodies and that He knows far more about the birthing process than any doctor or scientist. Either way, I believe that obstetrics needs to work with and not against the biology of the female body.

Ketosis

I went in for a prenatal late last week. They did the typical urine test, I've done them a several times before with Duckling. But this time the midwives told me that they had found ketones in my specimen, which meant that my body is in a state of ketosis meaning that I haven't been consuming enough food and so my body has started dipping into its emergency fat stores just to keep going. Well that explains why I was feeling lightheaded all the time. And why I was 16.5 weeks pregnant and had gained only two pounds.

It really didn't have anything to do with the way we eat. (In fact we actually eat more meat and cooked food in the winter. We feel better that way.) You can even eat 100% raw vegan and still have a healthy pregnancy. (Raw advocate Jinjee Talifiero has had five healthy, all-raw pregnancies resulting in healthy babies.) The problem was that I needed to eat more. Lots more.

I knew I wasn't doing the best. My appetite goes a little crazy when I'm pregnant and certain things I loved before become nauseating to me when I'm carrying a baby. But on top of that, I was putting a lot of pressure on myself to only eat things that my husband could eat with his food sensitivities because I didn't want to make him feel bad- which limited my food choices. And I'm still nursing some. And I was keeping up our walking and hiking schedule. I was putting a lot of pressure on myself to keep up a vision of what I felt like was perfect. I've had a history of food issues from picky eating as a kid because I hated almost everything my mom made, to going hungry as a teenager when there wasn't enough money for food, to the immense nausea I experienced with my pregnancy with Duckling.

At first I was hungry all the time, but soon, even though I wasn't eating anywhere near enough, I felt like I didn't need to or wanted to eat anything. I thought I could handle it and get through it. But I was starting to really lose a grip. I was getting really anxious and depressed and irritable. I thought I could take care of everything and became obsessed with trying to keep everyone happy, but I was just making my husband and son more miserable.

So when the test showed I was in ketosis, I got my wake-up call. Malamute and I talked a lot about it. In researching, I found out that the latest research into eating disorders has found that many people who suffer from eating disorders often share similar traits of perfectionism, anxiety, obsessive-compulsive tendencies, being overly rigid and closed to change, and difficulty seeing long-term consequences- like me.

Remember those junior high and high school health classes where they talk about eating disorders? Don't they always make it sound so simple? Girl sees lots of actresses and models who are thin and/or takes up modeling or ballet. She stops eating or starts a cycle of bingeing and purging, then realizes how she's killing herself, sees the light and starts eating again. Then everything is OK. Turns out, the reality is actually much different than that:

• For many with eating disorders, media images have nothing to do with their eating disorder. If media messages were solely to blame, then all of us would have an eating disorder since we are all seeing the same thin actresses and models. Eating disorders are preached about in secondary schools across America. Even magazines like Seventeen and Cosmogirl regularly run features warning about the dangers of anorexia and bulimia. A recent article in Seattle Woman talked with several women who described how eating disorders were not really about maintaining a certain appearance for them, but about exercising control, about how they feel, many even described it as an addiction. Behavioral tendencies, differences in brain chemistry, and possibly even DNA have been found to be contributors. The psychiatric community has also started to find a greater correlation between sexual trauma and eating disorders than previously thought and therapeutic approaches that emphasize dealing with underlying trauma are being encouraged.
• It's not just about starving or purging. Many people don't realize that Binge Eating Disorder- where an individual goes through cycles of food over-indulgence and guilt- is just as much of a problem as anorexia or bulimia. People with BED are addicts, but their drug of choice is food. BED can also kill because of complications related to obesity, diabetes, and heart disease.
• It's not just "starving girls". Most estimates are that 1-5% of all men have some sort of eating disorder, with a majority of those men have Binge Eating Disorder. Many researchers are even looking into the phenomenon of steroids and obsessive bodybuilding as being a type of eating disorder.

As for me, I've been eating a lot more (regardless of whether Malamute can eat it or not) and allowing him to help me more instead of trying do everything myself. I am feeling a lot better. I've even found myself being happy again. Since it's still pretty early on, I have a lot of time to change things. But things are looking up. =)

Our Healthier Christmas Treats!

Every Christmas since we've been married, Malamute and I have said that we don't have money for Christmas. We've never really gotten each other real presents. We did get a small tree for Duckling's first Christmas and threw a few decorations on it and felt guilty the whole time for the money we spent. This year, we decided to actually have a Christmas. We can't go into debt for anything, but we decided to get Duckling some nice presents and to buy some presents for each other. We got a small tree and I have been adding more homemade ornaments throughout the month and I think it looks lovely. (We also found a hippopotamus ornament at Target! We bought it and added it to the tree too.) We even bought a small tree topper. We also decided to spend some money on our dream Christmas treats.

Buying Christmas treats isn't quite as easy when you love someone who has multiple food sensitivities. But there are options. We bought a nice sampler of dates from Oasis Date Farms. If you think all dates are the same, you are sadly mistaken as there are several different varieties, each with their own taste and consistency. We had a good time sampling all the different types. We can particularly recommend Barhi and Medjool dates as our favorites. Barhis are oh-so good with a caramel-like flavor and nice chewiness. Medjools are nice and big and chewy.

The other thing we decided to do is have chocolates. I LOVE  chocolates and always have. Since going healthier though, it's been harder to come by ones that have better ingredients. Add to that the fact Malamute is extremely sensitive to dairy and chocolates seemed we nigh impossible to come by. Then I found Sjaak's Chocolates. They're a family chocolate company in Northern California that make their chocolates using traditional Dutch methods, but offer a wide selection of vegan chocolates. It's definitely on the pricier side, so we can't get tons, but they are DELICIOUS! We eat them a few at a time, with all of  us taking a bite so we can try each flavor. (Duckling would like to gobble every one of them down all by himself.) Another great thing about Sjaak's is that their chocolates are fair trade, which means that their chocolate comes from farms which are certified as using humane practices for the environment and their workers. Unfortunately, most chocolate that is sold in stores comes from cacao farms that basically use slave labor. Often, the workers on these farms are children who have been sold into servitude by their parents because of poverty. So fair trade chocolate makes Christmas merrier. =) If you're not looking for exotic truffles or don't have food sensitivities, you can easily find fair trade chocolate bars at most health foods stores and even a few regular grocery stores.

Another treat we've discovered is Panda licorice. This is the best licorice candy out there. It tastes great and the ingredients are ridiculously simple and wholesome. If you're not a black licorice fan like me, they make raspberry, cherry and blueberry chews as well. These are probably going to end up in stockings with some of Sjaak's bite-size chocolate candies, a Pro-bar, and an apple.

The "Fireproof" Rules For A Successful Marriage

One night, Malamute and I were upstairs making some snacks and he started channel surfing for something to watch. He came across Fireproof an independent, super low-budget Christian film that went on to gross over $33 million in 2008, making it the highest grossing independent film of that year. Well, we had wondered how good it was, and now was a chance to see.

We were astounded. And NOT in a good way.

"Appalled" is actually a more accurate definition of our reaction to this "save your marriage" film purporting Christian values. So here are the Fireproof lessons for building a lasting marriage:

• Men must be completely faithful to their wives, but if you are a woman and your life is difficult, you do not need to be faithful to your husband. This movie makes a big deal over how looking at porn is infidelity and how God considers it adultery to lust in your heart. But Catherine, the wife, has begun seeing a doctor from her work and no one bats an eye. She and her husband aren't getting along and her mother had a stroke, so that makes it OK for her to lust after another man. Try as I might I have yet to find anything in the Bible that says that women who are having problems are exempt from the seventh commandment. Maybe the Sherwood Baptist Church where the writers hail from is using a different edition than I (and the rest of the Judeo-Christian world) are unfamiliar with. Furthermore, the first person our hero Caleb confronts about the affair isn't his wife, it's the doctor, but I guess in a world where women bear no responsibility for their actions, this makes sense because obviously the infidelity all the mens' fault.
• Being a good husband means giving your wife everything she wants- but wives are under no obligation to do anything for their husbands. As part of a "Love Dare", Caleb sets about tidying up the house and doing all the odd jobs that Catherine has complained about in the past. He also brings her flowers and plans candlelit dinners. He even spends the money he was saving for a boat ($24,000) on buying Catherine's mother a special wheelchair like she wanted him to. And she responds with sarcasm, an affair, criticism, and divorce papers. Wow. Here I was thinking that marriage was more than indentured servitude. I thought marriage was supposed to be two people both sacrificing their selfish desires to help each other. Apparently it's enough for just the man to sacrifice his selfish desires.
• If you can just get rid of the computer, you will be able to avoid lusting after other women. Ah yes, the big porn scene. Of course this is handled by Caleb taking the computer out and smashing it with a sledgehammer. Because we all know that if we could just get rid of those nasty computers, then no man would ever have lust in his heart again. Ever. Even though lust, adultery, and porn have been around since the beginning of time. No, there's no need to get into why a man is looking at porn, since issues like molestation and an unhealthy and uneducated attitude about sex that is often cultivated in conservative religious environments are irrelevant. Just get rid of the computer and pretend that there are no other computers anywhere in the world.
• You only need to have one conversation with your wife to save your marriage- just make sure you reveal that you've spent an enormous amount of money to give her her little heart's desire. Here I was thinking that communication was foundational to a good marriage! Apparently all the deep, meaningful, and sometimes even painful conversations Malamute and I have had were some how crucial to our relationship. Apparently, we've been flapping our gums for no reason. Catherine and Caleb only have one real conversation to save their marriage, and that's the one where Caleb reveals that he sacrificed his boat money to pay for Catherine's mom's medical expenses. Then she believes that he really wants to save their marriage and isn't putting on an act of some kind. Don't get me wrong, the idea of helping her parents with their expenses is great, but especially at $24,000, it's something I would want to discuss very seriously together. All the other issues this couple has like money problems and sex are never discussed. And apparently there's no need as long as a man sacrifices his boat money.
• You don't actually need to have anything in common- except the judgement of your family, friends, and fellow church congregants- to stay happily married. What even brought this couple together besides the fact that Caleb is a firefighter and in a (really weird and rather creepy) first scene it is established that Catherine wanted to marry her Daddy when she was a little girl and he was a firefighter? What the heck are they going to do for the rest of their lives besides talk about Sunday sermons and Bible study? In fact, the biggest reason that they have for staying together seems to be that their family, friends and church are against divorce in general. Where is the love? You know the love of two people who are best friends and can rely on each other and really connect?
• "Unconditional love" always means staying married. And of course, they begin trotting out the homilies on how Christ had unconditional love for us and so even if your spouse doesn't love you and treats you badly, unconditional love means staying with her. Let me be clear that far too many couples do call it quits too quickly and expect marriage to be all sunshine and roses. But the unfortunate reality that this movie never addresses is that some spouses- even Christians- are abusive, violent, or bad influences on children. There are a number of very difficult situations that people face after marriage and staying married isn't always the best or most compassionate answer. While there are many couples who break up on whim, there are far too many people who sacrifice their dignity and even their health and safety and that of their children to stay in a marriage- often using the excuse that divorce is against God's plan to change themselves from cowards to martyrs. Sometimes, unconditional love means saying "no".

There you have it. The Fireproof guide to holy deadlock- I mean a "happy marriage".

My Thoughts on Pants in Church

First off, if a woman wants to wear pants to church for whatever reasons (practical, philosophical, emotional, whatever), it's really none of my business and I'm not going to say anything about it. In fact, my MIL is a temple worker at our local temple and a few years the temple presidency made it a policy that if a woman showed up to the temple wearing pants, no one was to say anything about it. They decided that it was more important that everyone feel welcome and come to the temple than to hassle people about what they are wearing. Pants are becoming more accepted as nice dress for women in the rest of the world, but traditionally skirts and dresses have been the accepted type of best dress amongst Mormons.

All that being said, I don't think my equality with men has anything to do with what I'm wearing (or my major in college, marital status, masculine and feminine deities, or <gasp!> whether or not I hold the priesthood). For me, being equal to men has nothing to do with dressing like them or having the same types of callings. Yeah, I'll never be a bishop or elder's quorum president, but Malamute is never going to be Primary or Young Women's President. (And for those of you out there saying, "Well who's excited about serving in Primary or nursery?" Let me say this: I'm not that broken up about never getting to be bishop or stake president. I'm more than willing to let someone else take that on. All callings have a special challenge in store those willing to go the extra mile.) Not to mention that Malamute will never have the chance in this life or the next bear children, something I feel is a special privilege. If Duckling wants to take ballet lessons and his sister wants to study astronomy, we're not going to get them both ballet slippers and a telescope. We'll get ballet slippers for Duckling and a telescope for his sister. We love both of our kids, and want them both to have what they need to succeed. That's equality to me. (As a side note, this is NOT an announcement of gender for the next baby. We're guessing a girl, but those of you who are dying to know will have to wait until spring to find out!) =)

I personally don't think equality has anything to do with what I wear and everything to do with where my head is at. If I consider myself an equal to men, I don't think it truly matters what anyone else thinks. I disagree that the Church has a history of oppressing women. Utah Territory was the second territory in the US to give women the right to vote- something we had to forfeit to get statehood. Women were granted divorces when asked, even from polygamous marriages, and education was strongly encouraged for women amongst the early Saints. Being a midwife was actual considered so important that it used to be a calling. We are a people of women poets, scholars, and health professionals, long before it was considered mainstream for women. Long before Ms. Magazine, affirmative action, the Worldwide Organization of Women, government subsidized contraception, and the widespread wearing of pants among women, people of both sexes and all races made astounding scientific discoveries, wrote amazing works of literature and music, and inspired great social change. They didn't do these things because everyone else thoughts of them as equals, they did them because they thought of themselves as equals. If you view the world as hostile to you, it won't matter what you're wearing. You'll never feel like an equal.

When You're Expecting the Unthinkable

Having a special needs child can be a lonely experience. For all the talk we get about "preparing for the birth of the baby", nothing ever really can prepare you for having a baby that doesn't quite fit the mold. There really just isn't a lot of talk about actually birthing a special needs baby.

Often doctors and parents equate "special needs" with "automatic c-section", but the reality is that vaginal births and sometimes even an out-of-hospital birth can be great options depending on each mother and baby's particular situation. So why look at your options?

Recovery- It's often easier to recover from a vaginal birth than a c-section. If your baby is going to need surgery or spend time in a specialized NICU, being able to get up and get around easily is a huge benefit. Many small hospital have NICU's for babies who need extra care, but aren't critical or don't require surgery and these often have accommodations for parents making recovery a bit easier even if you do have a c-section. But if your baby is going to be at a large children's hospital- especially one that is several hours away from you- you will most likely have to figure out your own living situation. We only slept about five hours a night and had to commute to see our son and for a while I was solely pumping for him. I was really glad that I wasn't recovering from major surgery along with everything else. And we considered ourselves lucky because we lived within 30-45 minute drive from the hospital. A lot of other parents there were from out-of-state! A vaginal birth also means that you have less risk for complications. A girl I lived next door growing up also had a baby with myelomeningocele. She had a c-section which was complicated by uterine infection. Ouch. Something else I'm glad I didn't have to deal with during the whole thing. Now that I have a toddler to take care of too, if I were to do it all over again, I personally would be even more adamant about avoiding a c-section if it all possible.

Bonding- One of the most devastating things that can happen to expecting parents is to find out that the baby isn't going to live long. With certain birth defects, the baby may not live more than a few hours. For moms who are able to go natural, this might be a consideration so that they can experience that precious time without feeling "foggy".

Privacy- While babies who need surgery and have a good prognosis may be better off at a hospital, for babies who have a birth defect that is incompatible with life, a home birth may be an option provided (as is the case with any birth) that the midwife is qualified that the pregnancy is otherwise uncomplicated. Though it is rare because home birth is so uncommon in America, there are cases of couples who have birthed a baby with a fatal congenital abnormality at home. I did meet a midwife once who had attended a couple who found out on the 20 week ultrasound that their baby didn't have any kidneys and would only live for a few hours. Since nothing could be done- even in a hospital setting- they decided to go forward with their plan to have a home birth and the midwife was fine with that. They were able to hold their baby girl right after birth and all through the couple of hours she lived. She died peacefully in her parents' arms without any interruptions- just as the parents wished. I have heard of cases of babies with severe Edward's syndrome (involving defects that were incompatible with life) who were born and peacefully died at home. This is obviously a very personal decision, but for some families this has been their choice of handling an extremely difficult situation.

Stress reduction- I'm a big believer that moms need to give birth wherever they feel comfortable. Obviously, if your baby is going to be in the NICU or need surgery, this may not be an option. But again, if the baby has a fatal congenital abnormality, the setting may not make much difference in the actual outcome, but can be a big factor in the experience for a grieving family. I think that especially in a situation like this, parents need to decide what setting will help them feel safest- whatever that is. One option that more and more parents are turning to lately is the pre-natal hospice. Sometimes these are actual facilities where parents who are expecting a baby that won't live long can go to receive care and give birth in a supportive environment. Sometimes it's a network of resources to help parents of special babies to cope and support them in making the most of their baby's short life. I think it's wonderful that we live in a day when these sorts of options are available.

One of the biggest recommendations I can give after having given birth to a special needs child is that parents really do their own research. Sometimes, the recommendation for a c-section is made on out-dated ideas that aren't supported by current research. In the case of myelomeningocele, for example, doctors used to think that a vaginal birth would harm the lesion on the baby's back and destroy their chances of having any leg mobility. But even with a c-section the lesion can still be damaged and research shows no advantage in walking ability for babies who were born via c-section. More doctors are starting to leave the decision to the mother, but many health care professionals have been very slow to accept this. While the input of doctors and nurses can be helpful, at the end of the day, we as parents are the ones who have to live with the consequences of the decisions. Whatever your circumstances are, you are your own best advocate for your family, and the more you know, the better you can take care of yourself and your child!

Everything You Never Wanted To Know About Birth In America- But Probably Should

"A good obstetrician needs two things: a big, round bottom and the sense to know when to sit on it."

- Husband Coached Childbirth by Dr. Bradley

• In the United States, roughly 1% of all births are planned home births, birth centers are slightly more common, but the overwhelming majority of births for both low-risk and high risk women take place in hospitals.
• The Cesarean section rate in the United States is over 30% with elective c-sections being only a very small percentage of all c-sections. A 5-10% c-section rate is considered optimal.
• The United States has one of the worst rates of neonatal mortality in the developed world at 6 deaths per 1,000 births. (On par with Croatia, Bosnia and Herzegovina, and Lithuania.)
• There has been much debate about whether the Netherlands is, in fact, a good case study for the safety of home birth. What is true is that planned home births attended by a doctor or midwife are very common in the Netherlands (most sources place it at roughly 1/3) and that the Netherlands rate of neonatal deaths is 3.73 deaths per 1,000 births. They are by no means in the "top ten" of low infant mortality (those spots belong to Monaco, Japan, Bermuda, Singapore, Sweden, Hong Kong, Macau, Iceland, Italy, and Spain, in that order with rates ranging from 1.8/1,000 to 3.37/1,000), but their infant mortality rate is still almost half of what America's is right now.
• The United States has the worst maternal death rate of any developed country. In 2007, the maternal death rate was 12.7/1,000 in the United States. In 2009, it jumped to 16.1/1,000.
• Approximately 19% (roughly 1 in 5) low-risk mothers end up with a c-section in U.S. hospitals.
• A 1998 report from the CDC found that maternal deaths from obstetrical causes are widely underreported, estimating that they are missing about 2/3 of maternal deaths from the currently reported rates of maternal death. A 2005 Massachusetts study estimated a 93% underreporting in maternal deaths for that state.
• For all American women the maternal death rate is 5 times what it should be and for black women, it is 10 times what it should be.
• The United States spends more on hospitalization and health care than any other country in the world.

Wow. Not the rosy picture we're used to hearing. What can be done to fix the abysmal state of maternity care in America? The general consensus seems to be that we need more and new laws, more contraception availability (is it just me or does that seem to be the answer we get for all women's health issues?), and of course more money from the government. I really don't think that any of those will actually solve the problem. Here are my thoughts on what the medical profession can do to save the lives of more mothers and babies:

• Focus more of doctors' education on natural birth and low-intervention techniques...  Medical organizations point with pride to the fact that doctors may attend as many as 20 births a week. But most, if not all, of those are births with medications, other interventions or c-sections. Since that is how most women in America give birth right now, that is what the average intern or resident thinks birth is. Medical schools don't train doctors on how to deal with natural birth, they train them how to use medications, forceps, vacuum extraction, and c-sections to get births accomplished in the time limits the hospital mandates for second-stage labor. The reality is that most OB-GYN's have no idea what a physiologically normal birth looks like or what to do during one. By educating OB-GYN's about what normal birth is like, they will be able to give better care to low-risk women.
• ...while educating them to better spot and handle true emergencies. One of the things I often hear people say is that the vast majority of problems with American obstetrical care concern poor and minority women. Maybe this is comforting if you are white and live in a middle or upper class neighborhood, but it isn't actually true. (See the above statistic about how all women in the U.S. are at a 5 fold risk for death.) Pre-eclampsia, for example, can and does kill thousands of babies and mothers  every year, and one of the biggest reasons why is that doctors and nurses often fail to notice the symptoms or excuse them as hypochondria or even healthy signs of pregnancy. I really recommend that you read Jamie Grumet's experience with HELLP syndrome at her blog I Am Not the Babysitter. Jamie is a white woman living in Beverly Hills, California with great access to health care. She was seeing both a midwife and an OB, plus a slew of doctors and nurses at the ER and by the time she was finally able to get a life-saving c-section, it was almost too late. In fact, the nurses accused her of being hypochondriac and told her that her sudden weight gain was healthy because skinny women need to gain more weight during pregnancy. This is just one example of how lives could be saved by better educating doctors and nurses recognize and effectively intervene in genuine emergencies.
• Reserve c-sections, medications, forceps and vacuum extraction for emergencies. I know this is really tough for us women to hear because in America we are so used to being told that we can't get through labor without an epidural or that we need to be induced or that a c-section is the safest way to get the baby here, but in countries like Japan that have really low rates of maternal and infant deaths, medications, surgery and mechanical extraction are reserved for emergencies and women are encouraged to deliver naturally. (I think I understand where you're all coming from, up until a few years ago, I thought women who gave birth naturally were pretty much nuts. Why put yourself through unnecessary pain?) All these interventions have their place. My mother-in-law, and by that token my husband, are here today because she was able to have an emergency c-section for placenta previa with her first baby. I think we as Americans tend to look at technology as being a solution, and if a little is good in certain situations, then a lot in all situations is better. But the more interventions you start adding, the more chances you have for something to go wrong. In a life or death situation, the risks are worth taking, but these are rare and most problems in labor can be solved through simpler, less invasive means. There are women who have died when a bag of another medicine was accidentally injected into them instead of an epidural or an epidural was improperly administered. C-sections increase the risk of hemorrhage after the birth and deadly blood clots- and the risk goes up with subsequent c-sections. C-sections also increase the risk of hysterectomy, uterine infection, and placenta previa. So, I know that many of you have had c-sections, I don't think you're bad mothers, I don't think any less of you, all I'm trying to do is call attention to an issue that is affecting the lives of mothers and babies across the country.
• Do away with continuous electronic fetal monitoring for most mothers. EFM gives a false sense of security to doctors and parents. "We can monitor the baby's heart with every contraction and never miss anything!" The problem is that EFM requires that mom lie on her back throughout labor which puts the baby in danger. Remember how you're not supposed to lie on your back after 12 weeks because it will cut off the blood flow and oxygen supply to the baby? Well the same thing goes when you're in labor, which may be why EFM has been found to lead to higher emergency c-section rates. But how, ask OB-GYN's, will you detect fetal bradychardia (drop in baby's heart rate)? Well, I will now share with you my ultra-dramatic fetal bradychardia story. Malamute and I had been at the birthing suite for about two hours and I had been lying on my side laboring and doing a little pushing for about a half hour-ish. The midwives were using a handheld doppler to monitor Duckling's heart rate about every other contraction. And then it happened. Duckling's heart rate dropped. Did the midwives start freaking out? Did they start rushing me to the hospital for c-section? Nope. They had me switch to an upright position. That was it. I know, loads of excitement. Duckling's heart rate went right back up and holy cow, my labor really accelerated! Within about 15 minutes or so of moving upright, I had a baby in my arms! Unfortunately, when you're hooked up to a machine, that really isn't an option. The other problem with EFM is that it puts mom and baby in an unnatural and far more difficult position for labor. Medical professionals love the lying down position because it makes it easier to give medications,  utilize EFM, and perform forceps or breech extractions, but unfortunately women are not physiologically designed to give birth lying down. (Have you ever been told to "push like you're having a bowel movement?" during birth? Have you tried to poop lying down? Not so easy...) And lying down in a hospital bed compresses your tailbone and narrows your pelvis so that you're baby is now having to fight gravity to get out of the birth canal. So, imagine you're on a hike to the top of a mountain. There's a beautiful vista up at the top, but it's definitely some work getting up there. Now imagine that someone has just added several large stones into your pack in addition to the water and snacks you've brought. That hike just got a lot harder. That's what happens when you labor on your back! This is why so many babies "get stuck" in the birth canal. EFM has not been found to improve the outcome of the birth or the health of the baby.  The biggest reasons that doctors are still using EFM is that they don't know how to monitor intermittently and they're afraid of being sued for malpractice if they don't use EFM.
• Rethink working hours for doctors and nurses. This may come as a surprise to the medical community (who are very well-versed in anatomy, biochemistry, and physiology), but the human body has not evolved to perform well without regular, restful sleep. There is something appealing about the idea of the doctor who sacrifices everything- including sleep- to care for her patients. Television dramas glorify it, and within the community the ability to go for long hours without sleep and keep working seems to be a point of pride. But as attractive as this archetype is, it has no grounding in research as a safe or effective way to care for patients. In fact, the idea of working extremely long shifts is nothing more than a tradition dating back to the 1890's. It was originated by William Halstead, the first chief of surgery at Johns Hopkins, who required that his residents be on-call 362 days a year. (History has revealed that Halstead was able to put up such a manic schedule because he was using cocaine. Studies show that as many as 1 in 10 medical professionals- including anesthesiologists and neurosurgeons- are following in Halstead's  footsteps by abusing drugs to get through their day.) Sleep research shows that missing one night of sleep causes as much impairment as a legally intoxicating blood-alcohol level. So, chances are that by the time you get to the hospital in labor, at least some of the nurses and the newer doctors are already operating with the capabilities of a drunk driver- and that's if they're clean. Even the decrease in residents' hours from 30 hour shifts to 16 hours hasn't been shown to be enough to prevent sleep deprivation slip-ups- some of them very serious. In the case of sixteen year old Jasmine Gant, the nurse who administered the lethal bag of penicillin instead of an epidural was very experienced but had been working two consecutive eight hour shifts. I really think that health care professionals (both doctors and nurses) need to be limited to one eight hour shift per day. If that means extending out the actual number of months that it takes to complete a medical residency, I think it's worth it to protect the safety of patients and the health of doctors. Just like other businesses that need to be open 24/7, the eight hour shifts can be any time of the day or night, preferably on a regular schedule for each individual, but only one eight hour shift in a 24 hour period.
• No more time limits on second stage labor. No, it's not a good thing to have a long second stage of labor, but imposing an artificial time limit really doesn't help the problem- especially since a lot of couples rush off to the hospital way too soon, sometimes even in first stage labor. Research indicates that time limits on second stage labor don't actually improve outcomes, and that using a more woman-centered approach actually is more beneficial.