Hanging In There

Have you ever noticed that just when you think you have some sort of equilibrium, life goes completely sideways? Ah, but what would live be without surprises and changes anyway! How the heck else would you learn anything if you did nothing but the same old same old?

I won't go into details on my suddenly sideways life since my last post, but know I am learning an awful lot about trust, truth, integrity... and the law. I am so very glad for the incredible friends and family who have surrounded me and are supporting me. This journey is not one I ever thought I would be taking, but indeed I am here. Mistakes were made and we are moving on from those errors. I am hanging in there, trusting that the future will hold it's own reward.

Books I'm Reading...

In telling you the books I'm reading, I am giving you great insight into my life as it stands today. Some things in my life have changed incredibly and others I continue to hold steadfast to for my and my children's sake.

First up is the incredible second edition of It's My Life Now: Starting Over After an Abusive Relationship or Domestic Violence by Meg Kennedy Dugan & Roger R. Hock (2006). I am not going to explain myself here, just know that I am now separated from the father of my children for the very reason this book is about. This is a very, very difficult situation for me emotionally at this point, though I am doing well now and am feeling stronger. I am thankful for my family, friends and my counselor who have been so supportive through it all.

Second is Electrical Code Simplified: Residential Wiring, Alberta Book 1 by P.S. Knight (2002). In preparation for the future, I am helping my sister finish her basement in case I may need a place to live with the kids. Her and her husband have very graciously offered their basement (1400 sq ft) for us to live in for as long as we need, though it is currently only framed out. Having finished three prior basements (of our three homes we have owned over the years) I know well the work and can do it well. However, its always nice to brush up on the codes to ensure their inspection passes with flying colors. One more day and I will be finished all the electrical so we can have the inspector in and start drywalling. Lots of work, but manual work is good right now, I am feeling invigorated.

Third is Homeschooling the Teen Years: Your Complete Guide to Successfully Homeschooling the 13- to 18- Year- Old by Cafi Cohen (2000). I continue to be committed to homeschooling our children as my boys strongly want to learn at home (my daughter is three and not yet homeschooled). It is an exciting and diverse challenge with my oldest in Grade Ten and third in Grade One. We are having an awesome year thus far and I pray I am able to balance homeschooling again for this term. Which brings me to...

The forth and final book is FrontPage 2003 (The Missing Manual) by Jessica Mantaro (2005). To 'bring in the viable income' I referred to above, I am venturing formally into website design. I have been doing it for years already, having built 8 full sites, both for businesses and non-profit organizations. In the past I have turned down many who have asked me to design, build or improve their sites because of my time constraints and other priorities. Now the income potential of this career is far to lucrative for me to overlook... I may need to support my family as a single mother. I will be leaning on Microsoft FrontPage until I can afford and learn Adobe Dreamweaver... the ultimate website building software (and I love Adobe's other products which I lean on heavily for other applications).

With these great books in hand and my goals clear, the future is bright indeed!

A bit about moi...

The Basics

Month of birth: July

Any Siblings?: 2

Parents still married?: yes, 40 years this year!

Occupation: College Director/Instructor

Do you like your job?: love it!

Any pets?: no, but would love one

Hair color: dirty blonde

Eye color: blue

Shoe size: 8 1/2

Any Tattoos?: not yet

Any Piercings?: just ears

Current mood: peaceful, happy

Current wardobe choice: my fav jeans, layered white t and sweater

What are you listening to?: Nickelback's The Long Road cd

Who did you last speak with on the phone?: Cory

Last....

Movie you watched: Take the Lead

Magazine you looked at: Oprah

Thing you ate: Sushi

Book you read: Million Dollar Habits by Brian Tracy

T.V. show you watched: Ummm... Dora? lol

Time you cried: today

Took a shower: 8:00 this morning before class

Got a real letter (a.k.a Snail Mail): can't remember

Ate at a restaurant (not fast food): two weeks ago at Olive Garden

CD you bought: Nickelback

What is/was....

The best thing to happen to you today?: teaching my students (they rock!)

Your most prized possession: my fav jeans

Your first vehicle: Chevy truck

Your current vehicle: black Suburban

Your favorite quote: "What doesn't kill you will only make you stronger"

You bedtime (on average): far too late....

Your best trait/characteristic: compassion

Your worst trait/characteristic: impatience

Do You....

Store things under your bed: only extra blankets

Daydream: always

Have a computer at home: yes

Live in the city, suburbs or country: city

Live in a home, apartment, duplex or mobile home: home

Own a cell phone: yes

Have a good luck charm: nope

Collect anything: nope, hate dusting

Attend high school or college: high school and college

Make good grades: scholar

Have You Ever....

Had a surgery?: 3 c/s's, cholecystectomy

Had teeth pulled?: all of my #7's

Broke the law intentionally: does speeding count?

Ran away from home?: nope never

Broke a bone?: does cracked ribs count?

Cheated on a test/exam: hasn't everyone?

Had a friend pass away: not for a long time

Been issued a citation/traffic ticket: umm for speeding!

Been in an auto accident: several, none my fault

Lied to someone: to avoid hurting their feelings

Been lied to: don't know, don't want to know

Your Favourite....

Place to be: beach on a glacier lake in the Rocky's

Place to visit: Ville du Quebec

Place to chill: curled up with a soft blanket on my couch

Hero: My grandfathers, both of whom I miss dearly

Non-Alcoholic drink: cafe mocha

Alcoholic drink: Bacardi Breezers, Baja Tango on the rocks

Type of food: Chinese, Mexican & Italian

Meal/Food dish: a great steak and a baked potato

Dessert: anything lemon or chocolate

Shampoo & Conditioner: Pantene Pro V

Toothpaste: J.A.S.O.N.'s Seafresh

Salad dressing: Italian

Ice cream: hazelnut

Fast food establishment: yuck

Color: burgundy

Season: summer

Holiday: Christmas

Perfume/Cologne: Adrenaline

Video Game: don't have time

T.V. show: again with the no time

Smells: newborn babies, the wind after a lightening storm

Article of clothing: favourite jeans

Book: Roots is still my all time favourite

Children's Book: Dora, my daughter's favourites are my favourites

Candy: Aero

Car: 1997 Grand Prix GTP S

Sideways...

Sorry everyone, life has taken me on a really wild ride this summer and it's been an incredibly tough time personally. I wish I could say that it was over, but sadly it is far from over. I would like to blog about it, but this isn't a safe place to explore what I am experiencing right now... maybe sometime in the future I will be able to share.

Tomorrow is the turning point though. It is from that point that I either move towards a safe harbour where I can rest and heal with friends/family who will be there to buffer the tide... or I will continue to swirl in the vortex of emotional pain I am currently experiencing. Life is filled with choices and I have to explain and stand by the most difficult decision I have ever made (made earlier this summer) and deal with the consequences. Either way, I will be hurting someone and I cannot tell you how sad that makes me feel.

Catch you on the flip side.

Motherguilt

My sister and I had a wonderful visit today when she came over with her two children. The combined menagerie, which included several neighbour children, had a blast outside in the heat under the sprinkler while we hid from the heat indoors with her four month old.

Our conversation turned to the huge guilt mother's face with every decision made... birth options, vaccination, breastfeeding, home vs work, daycare vs dayhome, school vs home school... the list is endless. The reason we discussed this was because of her daughter's language testing today which showed her to be mildly delayed in hard sounds and my sister was given several pages of information on how to support her with these sounds. From my experience of having a son with severe receptive and expressive language delays and the incessent testing the so-called experts continue to want him to do, I encouraged her to realize that her daughter's delay in this area was only a very small part of who she was and not to be discouraged by this so that she continues to seek other's opinions about her daughter. She knew what her daughter needed best!

You see, I learned the hard way that my instincts and knowledge about my son were completely accurate... his delays in one area of his life as well as his gifts and talents in other areas. When I sought outside support to supplement my skills in parenting my son, I had no idea the pain it would cause as expert after expert, in their own way, made me doubt my parenting skills by insisting that a structured school environment was what he neede most. Their whole focus was to integrate him into a classroom situation yet their recommendations strangely pointed in the opposite direction... individualized support, calm and structured enviroment, etc. It was in realizing that school was their only paradigm and they could not see outside of that box that I realized the truth, I was doing what was best with my own parenting skills and our decision to homeschool him along with his older brothers who have always been homeschooled. So while we can indeed access outside support, we also have to realize where that expert is coming from and base the accuracy of thier input on that... and to know that we are our children's parents and it is our right to make the best choices for them, despite outside opinions.

A funny thing happened...

on the way to the awards gala on Thursday. My daughter ate my makeup. Well not quite literally, but she did break it all over my bed and carpet in my room. What a sight that was to find as I went to get ready! She sure looked well made up :-) Ah well, I still had samples from my two minute Mary Kay career last fall so I broke into those. Minus mascara, I was ready to go in no time.

The YWCA Women of Distiontion Awards Gala was fantastic and we thoroughly enjoyed ourselves. My friends Claudia Villeneuve, Chapter Leader of ICAN of Edmonton/Edmonton VBAC Support Assn., Anita Ferrie, a co-nominee in the Advocacy category, and I had a blast. The food was excellent, the people were wonderful and the music was perfect. Neither Anita or I won, we lost to a wonderful woman we met that night, Diane Bergeron.

"Dedicated to her community, Diane Bergeron is a leader and a passionate advocate for people with disabilities. As the co-ordinator for the Premier's Council on the Status of Persons with Disabilities, and founder of the Edmonton Guide Dog Users Group, she is looked upon as one of the city's experts on disability challenges. Working alongside the Executive Director for the CNIB, Diane recently helped draft an updated version of the Blind Persons Rights Act. Despite her being totally blind, Diane's vision has no boundaries."

Congratulations to Diane and all of the award winners and nominees. I was honoured to have been nominated with such an amazing calibre of women. Thank you Claudia for nominating me and all the hard work you did to submit my nomination. You are awesome!

Breastfeeding Length in Canada

The Globe and Mail's talented reporter Andre Pickard wrote the excellent article Most Mother's Quite Breastfeeding Far Too Soon.

The single most effective way of giving a baby a healthy start in life is breastfeeding.

As a public-health measure, breastfeeding is unparalleled. It is cheap, easy to understand, has no negative side effects and the method is tried and true -- as old as motherhood itself.

Yet, Canada fails abysmally when it comes to providing babies with mother's milk.

Things look good at first: Eighty-five per cent of Canadian women breastfeed their newborn babies, according to Statistics Canada. However, in the weeks after birth, that rate falls off precipitously.

Every major health group, including the World Health Organization, the Canadian Paediatric Society and the Public Health Agency of Canada, recommends that babies be fed breast milk exclusively for the first six months of life, and that breastfeeding should continue as long as possible after the introduction of solid foods. The reasons for this are clear: Breast milk provides all the nutrients, growth factors and immunological factors a baby needs for optimal growth and development (physical and neurological).

more>>

Cesareans in the News

New Jersey hospital Kimball honored for low rate of C-section births today:

LAKEWOOD — Sumayyah Simone stood in the back of the room, away from the podium, the speakers and the spotlight.

But Simone and pregnant women like her were the reason everyone gathered.

Simone, due to give birth to her second child next month, was the impetus last week for a group of doctors, nurses and midwives to pack themselves into a hallway in Kimball Medical Center's maternity ward and accept an award for good maternity practices.

All because women like Simone want a natural birth.

"There's a trust relationship which I think is really important with a caretaker," said Simone, a 37-year-old Plainfield woman who has a Lakewood doctor monitoring her pregnancy. "When you're in a hospital, you need to trust your doctor."

And when a natural birth is needed or wanted, Kimball Medical Center is among the hospitals of choice.

According to a review of recent state health statistics, the rate of Caesarean-section births at Kimball is the lowest in New Jersey.

more>>

And in South Carolina:

Multiple reasons account for rise in C-sections
By Mike Foley

Back in 1979, when Dr. Kenneth Trofatter began delivering babies in Greenville, the number of women having Caesarean births was about 16 percent.

Last year at Greenville Memorial Hospital, where Trofatter is now the director of maternal-fetal medicine for the University Medical Group, the hospital had 34.6 percent of its births via C-section, a surgical birth method where the baby is removed through an incision in the uterus. Across the country, the Caesarean rate rose to 29.1 percent in 2004 according to the World Health Organization, the latest year for which figures are available.

The end result is higher medical costs, for both private insurers and Medicare, and no end to the debate about the rising numbers of surgeries that some say aren’t always medically necessary. Among his colleagues, Trofatter said, there are two distinct feelings on the issue.

read more>>

Today's higher Caesarean rate raises concerns
Expectant moms must weigh risks, benefits for themselves and baby
By Mike Foley

Among his colleagues in obstetrics, Dr. R.E. Lattimore is an anomaly.

“I probably have one of the lower C-section rates in town,” Lattimore said. “It’s probably 14-16 percent over the long haul.”

The long haul in this case is Lattimore’s career as an ob-gyn in Greenville, now in its 21st year. During those two-plus decades, he’s remained conservative in his approach about unnecessary surgeries, including elective Caesareans.

“I’d prefer not to be on the wrong end of a lawsuit because a woman had an elective C-section and something went wrong,” he said.

While Lattimore said he sees lots of reasons for the ever-increasing number of C-sections, he believes that “everyone would like to see lower C-section rates.” But that’s not happening locally, in South Carolina, in the United States, or around the world.

more>>

Preterm Cesareans Double Uterine Rupture Risk

Interesting news in OB/GYN News today...

MIAMI BEACH — Women with a history of preterm cesarean delivery are twice as likely to experience uterine rupture during a subsequent vaginal delivery, compared with women who have a history of operative delivery at term, according to a large study.

However, the absolute increased risk of 1% may be acceptable to some women who are considering a trial of labor after a previous cesarean section, Dr. Anthony Sciscione said at the annual meeting of the Society for Maternal-Fetal Medicine.

"The 1% may be too high for some women but acceptable to others." Dr. Sciscione, chief of obstetrics at Crozer-Chester Medical Center in Upland, Pa., and his associates compared 5,839 women with a history of preterm cesarean delivery to 35,528 with a history of term cesarean delivery.

They found the preterm group twice as likely to experience uterine rupture on a subsequent vaginal delivery, compared with the term group (odds ratio 2.05).

The risk was still increased when the researchers controlled for emergency cesarean deliveries (OR 1.73).

"Rate of uterine rupture was highest among those who had a previous preterm delivery and subsequent full-term delivery," said Dr. Sciscione, who presented the findings on behalf of the Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development, Bethesda, Md.

A delivery between 20 weeks of gestation and 36 weeks, 6 days was considered preterm. The two groups were similar, but the prior preterm delivery group was younger (mean 28.6 years versus 29.2 years) and less likely to have private insurance.

Women with a previous preterm cesarean delivery were also more likely to experience earlier uterine rupture (mean 37.2 weeks) than were women with a previous term cesarean (mean 39.1 weeks).

A meeting attendee asked if the women who had uterine rupture earlier were also in labor earlier.

"That is a good question," Dr. Sciscione said. "We looked at that, but the data are not ready yet.

"Further study is needed to define those clinical characteristics which may accompany preterm cesarean delivery that may modify the risk for subsequent uterine rupture," Dr. Sciscione said.

Careforce Lifekeys

A friend of mine from Australia attends an excitingly dynamic church pastored by Dr. Allan Meyer and Helen Meyer, the founders of Careforce Lifekeys. She recently attended their 2006 Conference and came home supercharged. Her excitement has not only piqued my interest, I will be bringing their programs to our church counsel and the as-of-yet hired Pastoral Assistant who will be overseeing the Healthy Family Ministry program I created and currently coordinate.

Careforce Lifekeys is ground breaking. "Many of God's people struggle with issues that church life needs to effectively address. Lifekeys programs have a vital role to play in brining pastoral care and discipleship to God's people." Instead of avoiding or covering up problems, they instead tackle the very issues ordinary people struggle with every day and the root sources of marriage dysfunction, separation, divource, family breakdown, the destructive forces of shame and guilt, addictive cycles, co-dependence, insecurity, self rejection, grief, depression, chemical dependency, sexual abuse, sexual addiction, easting disorders and more. I am super excited about this and truly cannot wait to learn more about Lifekeys' programs.

VBAC vs ERCS Study

Kathleen Doheny from HealthDay News reported last week on the Annals of Family Medicine study (full text pdf), Vaginal Birth After Cesarean in California: Before and After a Change in Guidelines. "The number of women who gave birth vaginally after a cesarean delivery has dropped in recent years, but without the expected reduction in infant and maternal death rates, a new study has found." Well, that is indeed a no-brainer for those of us who have a clue about VBAC and Caesarean risks and benefits.

As all good reporters do, she found someone to refute the evidence... there is always someone who has an expert "opinion." Dr. Richard Frieder, an obstetrician-gynecologist at Santa Monica-UCLA Medical Center and a clinical instructor of obstetrics and gynecology at the David Geffen School of Medicine at the University of California, Los Angeles, said the new study has a major flaw. "It doesn't address maternal or fetal complications," he said. He is correct in this regard and goes on to add, "The main complication of VBACs is not death but morbidity, such as blood transfusions, hysterectomy, infection, heart attack, stroke, kidney failure, the baby having low Apgar scores or brain hemorrhage. All they are talking about is how many people lived or died. But they didn't measure complications. If they had looked at complication rates, there would have been a huge difference favoring c-section." Sure there are risks to vaginal birth, but saying that there is a "huge difference"... yeah right, and pigs fly. Please show me the evidence Dr. Frieder.

I have done a lot of research into this very concern and the evidence is clear. Don’t miss Childbirth Connection’s (formerly Maternity Center Association) What Every Pregnant Woman Needs To Know About Cesarean Section booklet for solid, evidence-based facts on cesarean risks.

The study concludes with, "Neonatal and maternal mortality rates did not improve despite increasing rates of repeat cesarean delivery during the years after the ACOG 1999 VBAC guideline revision. Women with infants weighing ≥1,500 g encountered similar neonatal and maternal mortality rates with VBAC or repeat cesarean delivery." Well done doctors, now could we please lean on the idiots at ACOG to reverse their inane butt-protecting VBAC guidelines that have essentially eliminated vaginal birth as an option for most post-caesarean women in the US?

Hospital Birth = Death

How ironic that after posting this earlier this week, a young mother has died from a magnesium sulfate overdose in Florida. Her son survived and is in another hospital's NICU. How devastating for her family, my prayer are with them.

Announcing...

I am very proud to announce the opening of my newest endeavour, a new and innovative institution providing comprehensive certification for birth professionals in Canada. Developed from the training workshops provided through Mother Care, Rosenthal Perinatal College was formed out of a need for respected, thorough, and comprehensive certifications for birth and postpartum professionals within Canada, based on Canadian families’ specific needs unique to our country.

Founded on the principles of integrity and strong morals, Rosenthal provides comprehensive, evidence-based certification and continuing education for those seeking careers in the perinatal field. A premier training and certification college, Rosenthal equips students with the knowledge and confidence to support and educate families during the perinatal year. Rosenthal takes pride in their professional standards; their certification requirements are the highest of any certifying organization.

Alberta-based Rosenthal College, with the approval of Alberta Advanced Education’s Private Institutions Branch and in accordance with their regulations, provides quality certification and continuing education. For more information, go to our new website at www.rosenthalcollege.ca.

Hospital Birth = Risk

Sunday, NBC reported on A routine epidural turns deadly which asks, "did a hospital infection turn the happiest day of their lives into a nightmare?" A mother, amidst the bare minimum of care during her hospital stay, contracted meningitis and died within hours of birthing her son.

What bothers me most is the lack of adequate care this family received, from obstetrical decisions to staff follow through, though this is not unusual. The lack of evidence based or even adequate care is almost universal across North America to families who subject themselves to a hospital birth experience. In their defense though, most don't know what the alternatives (like traditional midwifery care) are, the excellent care and proven safety of those alternatives.

Seriously though, has "modern" (allopathic) medicine not set themselves up to "have the answers" so to speak and then be completely and utterly unable to provide them? Physicians are so confident that they can "deal with the side effects" of so many obstetrical interventions, such as inductions and epidurals, that they have not only become commonplace, many women are not even told of their risks even when being subjected to them.

We as a society have been blinded by the rhetoric and sales pitch so completely that we actually allow modern medicine to provide inadequate and often dangerous care and accept it as normal. No wonder malpractice insurance rates are through the roof. Just to compare the care the above mother received to midwifery support is laughable. Would a midwife "subject" her clients to the same care and even hope to be in business? No she would be in jail.

But obstetrics is only part of this big mess. May 29th, Businessweek article Medical Guesswork revealed, "from heart surgery to prostate care, the health industry knows little about which common treatments really work." Anne, a good friend of mine blogged about this here. I grow more leery every day when I see physicians trained to treat symptoms and be completely oblivious to the causes. I mean seriously, how else could anyone justify surgery as a solution for asthma? Evidence-based practice is a vital and very worthy goal, it's frustrating to see modern medicine miss this by such an incredibly wide margin.

VBAC in the journals: the good, the bad and the ugly

Over the past couple of days, some interesting press has me thinking. For instance, the lastest Annals of Family Medicine includes a study showing Reducing post-cesarean vaginal births has no effect on mortality:

Although attempted VBAC deliveries fell significantly after the guideline revision, from 24.0 percent beforehand to just 13.5 percent afterwards, neonatal mortality rates per 1000 live births were no different for attempted VBAC deliveries from those for repeat cesarean among neonates weighing at least 1500 g during either of the two study periods.

Neonatal mortality rates for attempted VBAC among neonates weighing less than 1500 g were higher than those for repeat cesarean deliveries. Their conclusion, "We recommend that a balanced presentation of risks and the encouraging outcomes found in this analysis be included in discussions with pregnant patients who have had a previous cesarean section." Excellent advice. Too bad fear of malpractice in the face of ACOG's VBAC guidelines will skew any "discussion" physicians have with expectant mothers so badly that the truth will rarely be seen.

Meanwhile, over at Obstetrics & Gynecology, their latest journal includes Dr. James Scott editorial, Cesarean Delivery on Request: Where Do We Go From Here? in which he concludes with the advice, "Go slow on this for now, be cautious, don’t get caught up in the rhetoric, and individualize until better evidence is available and the ultimate consequences are well known. To do otherwise just might come back to haunt us." (Obstet Gynecol 2006;107:1222-3) To be honest, ACOG has made a lot of decisions that should be haunting them based solely on bettering their members malpractice insurance rates and wallets with complete disregard for maternal-child health or evidence-based practice. But I digress...

O&G also has a brand new study, Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries which is something anyone knows who works at all with caesarean/vbac mothers, I mean it's simple common sense. Their conclusion, "Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery." (Obstet Gynecol 2006;107:1226–32)

Last but not least, they have the National Institutes of Health State-of-the-Science Conference Statement: Cesarean Delivery on Maternal Request from March 27–29, 2006 outcomes. Their conclusion, "The magnitude of cesarean delivery on maternal request is difficult to quantify. There is insufficient evidence to evaluate fully the benefits and risks of cesarean delivery on maternal request compared with planned vaginal delivery. Any decision to perform a cesarean delivery on maternal request should be carefully individualized and consistent with ethical principles." (Obstet Gynecol 2006;107:1386–97)

Hmm. So ACOG's "decision" to essentially eliminate VBAC Trial of Labour as a viable choice for women in the US is coming back to haunt them. Despite the carefully worded conclusions above, it is becoming more and more obvious to even the ones who have turned a blind eye to the risks of major abdominal surgery for deliveries. The well-touted risk VBAC has of uterine rupture is pailing strongly in the blinding glare of surgical risks with many of them long-term risks in future pregnancies.

Mother's Day Delight

I know it's been a week, but I had an absolutely superb Mother's Day and have basked in the joy of it since then. Allan was not working (incredibly so, he seems to get all of the holiday shifts it seems) so we planned a day with our families, lunch with my parents and dinner with Allan's parents. However they took a great turn as lunch turned out to be with my Mom's entire family (her mother, her only sister and dh, along with nearly all of my cousins and their families) and dinner turned out to be with all of Allan's family (his siblings and their families). To top it off, it was my Mom's birthday so celebrations abound!

Because of the great turn out, we had lunch at a large restaurant which happened to be having a buffet for Mother's Day. I sat next to my dear Grandmother (furthest right), the matriarch of our family, and across from my favourite cousin-in-law. Originally from Portugal and having grown up in Australia, she is an incredibly fun and optimistic Mom of two sweet and very busy boys. We live in different cities and lean on our husbands to move closer to each other when we are together.

While we were waiting for everyone to arrive someone came up to me said, "Remember me?" It was one of the boys I used to care for in my dayhome which I had when I first started as a doula. He was one of the sweetest boys I ever cared for and though his Mom was concerned about his being "hyperactive" (because of comments from others), we both agreed he was truly just a very busy boy. He is a young man now, all of 12 years old. Sadly his Mom wasn't there, but his Dad and little brother were there... well not so little, he just turned nine himself. His little brother's birth was my first certifying birth! We had an awesome chat and he talked to my boys for a long time too.

No sooner had I finished lunch and was holding one of my cousin's boys when a beautiful young woman came up to me and asked if I knew who she was. Drawing a blank, she introduce herself and I instantly realized that she was one of my teen clients. Behind her were her parents whom I recognized immediately and her two daughters where there also. She had gone on to finish her education degree and is now married. I learned through our discussion that she teaches full time and lives not far from me. I chatted with her and her parents (who are the most wonderful couple), remembering her birth as her mother and I supported her. Talk about icing on the Mother's Day cake to see two of my "doula babies".

We had a BBQ at my in-laws that evening, a wonderful conclusion to the day. They haven't had a BBQ in years because my father-in-law doesn't BBQ, but they purchased one especially for the day so that we could all enjoy the day at their house rather than go to a crowded restaurant where the kids would be bored and the din would make conversation difficult (been there done that last year). One brother-in-law cooked all the hamburgers (including some great buffalo burgers), smokies and more while we all stood or sat around and visited and ate. Summer BBQ's are the best! Next up: Father's Day at another brother-in-law's beautiful place near Drayton Valley. I can't wait...

Can You Say Duh?

So this mama is concerned about noise pollution...

I am wondering if she has stopped to consider the much larger threat to her unborn of smoking? One of those things that makes you go, duh!

Family Ministry

I have been reviewing resources for our Family Ministry. Where once I was grappling with writing a whole ministry program while pulling ideas and information from other resources, I am now relaxing and enjoying the search for great ministry programs already in place. Two such programs are Heritage Builder's Family Ministry in Focus and Christianity Today's Children's Ministry both of which have amazing resources and ideas for slightly differing aspects of a family ministry. I want to do so much and am so excited about the possibilities in our church, yet patience is a virtue as we continue to seek a pastoral assistant who will be overseeing our family ministry programs.

Cesarean Art

Haunting, bold and riveting. Here are two images, with my thoughts below. Don't stop here though, go to Cesarean Art and see through one mother's eyes the effects of surgical delivery.

my first shower
Immediately postpartum, nurses push mothers newly out of surgery to "resume life."
never letting me go
The depression that haunted my every waking moment, every dream, was relentless.

Cesarean Artis the epitomy of how many, if not most, of women who have experienced a caesarean surgery for the birth of their precious children feel. Don't believe me? Ask one of your many friends who have experienced a cesarean.

Total Luxury Spa Package

For my birthday (which isn't for another two months) my sisters and my mother took me to the Marvel College Edmonton Campus for a Total Luxury Spa Package last week. It was amazing. Starting at 9 am with a spa manicure and pedicure, touted as "a facial for your hands and feet." In addition to treatment of callus and dry heels, nail shaping, cuticle treatment, a relaxing foot and leg massage, finished with your choice of OPI polish, you are treated to exfoliation of the feet and a moisturizing mask followed by a paraffin treatment. Next came a full facial with skin analysis, facial cleansing, deep exfoliation, relaxing face, neck and shoulder massage, facial mask, toner and moisturizer.

A break for a light lunch (included in the package) of our choice of sandwhich, salad and drink was followed by a one hour relaxation massage. Then I enjoyed a detoxifying and purifying body wrap to detoxify the skin, deep cleanse the pores and smooth roughness. Showered off in a wonderful, hot Swiss shower and dove right into a Vichy shower (picture below) touted to "stimulate the internal body systems, circulation, metabolism and enhances lymphatic drainage as well as promote a tremendous sense of relaxation." Wrapping up the afternoon was a detoxifying massage focusing on lymphatic drainage. I cannot tell you how luxurious that whole day was, I was being pampered for seven hours with my sister and mother beside me enjoying similar treatments!

My sisters have long wanted this to be an annual event, I am so ready to join them and tell all of my friends that they need to pamper themselves like this. This should be written into that motherhood contract we fall into when the pregnancy test turns pink!

YWCA Women of Distinction Nomination

I mentioned briefly here that I was nominated by a great friend for the YWCA Women of Distinction Award in the field of Health, Social Sciences & Social Services. It is moving from the surreal to reality as a wonderful woman from the YWCA of Edmonton called today to book my photo shoot with complimentary hair and makeup for the Edmonton Sun and the YWCA Gala Presentation promotional literature. I am taken aback as the Avonlea Photography Studio is among the most prominent photography studios in Edmonton and Elysium Hair Body Spirit is one of 20 salons in Canada that have become a Schwarzkopf Essential Look concept salon. Look at me, a homeschool mom!

The Awards Gala will be on June 15 at the Northlands Agricom... what on earth am I going to wear for the pictures and the big event?! I have to go call my sister.

Still Swimming

It has been a while since I blogged, a very long while for me! I have just been very busy with life and working to reduce my being overwhelmed. It's tough trying to save the world (or at least my corner of the world) with only 24 hours in a day! Let me catch you up on life.

I won't deny it, Brendan's assessment sent me reeling. I know I have a lot on my plate, I won't deny it for a minute, but being busy and focused is how I work. Anything less and I am walking around aimlessly trying to find things to do. But it was his assessment that has me re-evaluating me, who I am, how I parent, my other commitments which keep me sane outside of parenting... and then something changed.

Brendan's DS (developmental specialist) whom he works with on a half time basis in our home suddenly was called home (in BC) on a family emergency. We had a week of no support and this week we had a new DS come in to substitute. I cannot tell you how much Brendan's attitude (his behaviours) have improved in the last two weeks! Here we had her coming in to help with his language skills only to have him slide badly behaviourally, and I was blaming myself. Now we never see a temper tantrum (which happened several times a day only two weeks ago) as they declined dramatically in his DS's absence. I won't fault his DS entirely, it is all about personalities and he being a strong choleric was quite simply too much for his DS to handle effectively. She would be wonderful with say a sanguine or phlegmatic child, but not so much with my little livewire. We don't know when she will return and neither does she. His new DS doesn't let him call the shots and it makes all the difference... and I told her supervisor as much. I know we won't be able to keep our new DS (as she is a sub only) but it sure would be nice. Time will tell how this works out.

On the dh's career front, we are not moving and neither are we going into the construction field for the time being. Allan is settling into his new store and working out some major issues he was handed to test him... and he is doing superbly. We now have carpet in our basement (and my office) which I love! Trim and painting the trim... oh and finishing the basement bath and we are done this house, yay! Allan is getting itchy though, he is thinking we need to build again. It hasn't even been two years since this house was built! But he has a point, our house has appreciated almost 100,000 since we purchased it and that is a huge chunk of change we could put on another house :-)

On my career front, I taught two workshops since I last weighed in, the most rewarding job in the world for me! I have also been working hard as president of both the CDA and ICAN/AIIC Canada. Two amazing organizations that are growing so fast in this great country I live in. I know I am going to have to weigh my priorities carefully in working with both organizations, as I can only give so much of my time and energy to volunteer work. But it's so much fun and I love doing it... so I tend to spend more time doing this than I should .

Oh, and one last thing. I haven't mentioned this before, but I love RPG's (role playing games). I have finished Myst, several Tomb Raiders and lots of older ones (I have been a computer geek since I first laid my hands on a computer in high school when the computers were sooooo simpl!). Well my sons... and my husband... and myself, we are all having a blast with the online game Runescape. Be careful, it is highly addictive! If you do or plan to check it out, I am Norse Queen... hailing from my scandinavian roots. See you there when I am between parenting and working and volunteering.

Behavioural Assessments

In case you have not read my blog for a long time, my third son has language delays which we have addressed with additional support through a program called GRIT (Getting Ready for Inclusion Today) which provides him with a half time DS (developmental specialist) who works with him one on one and who is supported by a team of professionals (speech therapist, occupational therapist, etc.).

One of the concerns of the team leader was our son's behaviour when working with his DS in the beginning, which they have long since dealt with and they are working together well now. In addressing this concern, we were asked if we wanted a behavioural specialist come in and assess their working together. I didn't see a problem with this, our DS was fine with it and our son was used to these type of assessments by now so it wasn't an issue for him. I am always open to ideas too, anything to benefit my children IMO.

Anyway, this very personal and highly recommended assessor came and spent an afternoon unobstrusively watching them, ironically on a day when our son was not very cooperative. His DS and I saw it as an opportunity however to address some of his weaknesses...

Well his return with "answers" was interesting indeed. He basically said that our son had issues that we could not address at home (he knew we planned on homeschooling) and that it would be in his best interest to put him into school and that we should start looking for an appropriate institution soon, given that many open houses would be happening in the near future. At first I was feeling rather gloomy about this, then I realized something... he was hired by GRIT which in essence readies preschoolers with disabilities for school. I had been lead to believe that this assessor worked in the psychology field and in fact he told me he had obtained his masters degree a few year prior. Stupid me, I failed to ask in what field! He handed me his card and guess what? His masters is in education. No wonder he is wanting him to be "corrected" by an institution, he can't see outside of that box. Oh well, lesson learned, for us at least. Don't bother utilizing the professionals unless they are working towards the same goal as you and able to see your vision with an open mind. Otherwise you are wasting their time and yours.

Pre-eclampsia and Calcium link

How exciting that AJOG has published an article linking nutrition with pre-eclampsia. Of course the study was done in Switzerland (where they obviously see a bigger link between nutrition and the increasingly common problems such as pre-eclampsia, gestational diabetes and so on) as North American physicians have essentially no training and precious little knowledge about the impact of nutrition on expectant mothers.

Calcium supplements reduce pregnancy complications
Source: American Journal of Obstetrics and Gynecology 2006; Not yet available online

Investigating the effect of calcium supplements on pre-eclampisa, its complications, and death linked to the condition.

Calcium supplements could help prevent the serious complications of pre-eclampsia and, in young women, preterm delivery, research suggests.

Although a treatment to prevent pre-eclampsia remains elusive, a link to calcium deficiency has been suggested.

To explore this possibility further, José Villar (World Health Organization, Geneva, Switzerland) and co-workers recruited 8300 women who consumed less than half of the amount of calcium recommended during pregnancy. Half of the women were given a 1.5 g calcium supplement each day, while half received placebo.

The incidence of pre-eclampsia was comparable between the two groups, but rates of eclampsia, other severe complications of pre-eclampsia, and severe gestational hypertension were significantly lower in the supplemented women. The "severe maternal morbidity and mortality index" was also significantly reduced with calcium supplementation, as was neonatal mortality.

In women less than 20 years of age - those at highest risk for low calcium and pre-eclampsia complications - calcium supplements tended to protect against preterm and very preterm delivery.

"This large randomized trial in populations with low calcium intake demonstrates that while supplementation with 1.5 g calcium/day did not result in a statistically significant decrease in the overall incidence of pre-eclampsia, calcium significantly increased the risk of its more serious complications," the team concludes.

I hope that this study and others will not only continue to confirm the unflagging lifelong work that the late obstetrician Dr. Brewer has done on the link between nutrition (especially protein, calcium) and pregnancy induced hypertension (PIH), pre-eclampsia, eclampsia/toxemia and HELLP.

Auschwitz Midwife

I blogged about the rivetting book Night here and at the back of my mind I have been thinking about a story I read of an Auschwitz midwife the whole time I read it. The tireless work of a Catholic midwife in the depths of hell. I finally found the article, Midwife at Auschwitz. Here is an exerpt:

During her imprisonment, Stanislawa helped deliver over 3,000 babies. But there was something even more remarkable than her trying to cope amidst these hostile conditions. As she explained to her son, the Lagerarzt ordered her to make a report on the infections and mortality rate for mothers and infants. She replied, "I have not had a single case of death, either among the mothers or the newborns." The Lagerarzt's response was a look of disbelief. "He said that even the most perfectly handled clinics of German universities cannot claim such success. In his eyes I read anger and envy." In a self-deprecating manner, Stanislawa attributed this to fact that "the emaciated organisms were too barren a medium for bacteria." However, her children and fellow inmates ascribe this miraculous record to causes more than natural.

Holding Pattern

If I, no we, continue in this holding pattern I think one of us is going to lose it.

Allan and I have been hanging on here, wanting to provide a bit of stabilization for our children by not moving, again, in following Allan's career. We have turned down two transfer requests to Grande Prairie and instead Allan was moved to the Spruce Grove store, much to our dismay. I know that it sounds ideal because we are like four blocks from the store. But in the grande scheme of things Wal-Mart it wasn't a good move in terms of promotion.

We have been looking at other career options and the one we had been really interested in was construction. But then those of you who read my blog would know about that. We had almost been ready to jump off the big ol' Wal-Mart ship to dive into this opportunity, but Allan's potential employer is concerned that he won't be able to provide the income he wants to give us. He is an incredible man who has become a friend and knows clearly what it is like to raise a family with four children. He did it himself not too long ago, his youngest is in his early 20's.

So, the short story is, if we don't go the construction path very soon, we will be accepting the transfer opportunity to Grande Prairie and putting our eggs in that basket wholeheartedly, without a second job to interfere with Allan's focus on his career. To be honest, I don't care either way as long as the decision is made so we can move in a clear direction, one way or another. Sure I will miss Spruce Grove and all of our friends here if we do move... especially from our homeschool group and church (and Deanna!), but if that is the path, let us forge ahead!

The Horrors of Auschwitz

I just finished reading the riveting book Night (revised 2006) by Elie Wiesel. Once again I was brought back to Auschwitz and the stark horrors faced by those who were sent to the concentration camps, the work camps, the chimneys. The first time I learned of the attempted extermination of the Jews by Nazi Germans was when I read Corrie Ten Boom's The Hiding Place. It forever changed my perceptions of our world, of justice and humanity.

I still cannot fathom the depths of depravity those in charge were capable of. I am in awe of the strength their victims had and the horrible decisions they faced every day in order to survive emotionally and physically. On Thursday my great friend Deanna and I were talking about the concentration camps and of the opening of Sophie's Choice. As parents we contemplated the thought of having to choose between our children, who lived and who died. I cannot imagine what mothers, fathers, children, and grandchildren must have gone through, knowing their family were murdered by the most horrible means. Choking on gases, shot in the back of the neck, thrown into flaming trenches, and so much worse. I pray our children, our children's children and their children's children never face this evil. Let us ponder together the famous quote from George Santayana:

Those who cannot learn from history are doomed to repeat it.

Predicting Cesareans

Well, leave it to some bored researchers to try and find the crystal ball answers to why their cesarean rates are so high. Don't look at the obvious, prophilactic induction for postdate pregnancies which is clearly not evidence based, that would be to simple. No, let's look for reasons we can cause more iatrogenic cesarean outcomes!

New risk score predicts cesarean after induction
Source: Obstetrics & Gynecology 2006; 107: 227-33

Simple scoring system may help decision-making when considering induction of labor.

The risk of cesarean delivery after induction of labor can be predicted reasonably accurately using four simple measures, British obstetricians report.

Elisabeth Peregrine and team from University College London Hospitals sought to develop a clinical model for predicting the outcome of labor induction. They evaluated maternal and ultrasound parameters in 267 women at 36 or more weeks of gestation immediately before induction of labor.

The most frequent indication for induction was postdates, and 30 percent of the cohort subsequently required a cesarean delivery.

In logistic regression analysis, four factors emerged as significant predictors of cesarean delivery: parity (odds ratio [OR] = 20.56), body mass index (OR = 6.17), height (OR = 0.94), and ultrasonic transvaginal cervical length (OR = 1.07).

Peregrine's team used these to develop a simple risk scoring system, whereby a score of -65 to -55 indicates a more than 80 percent likelihood of cesarean delivery, and a score of -165 to -146 indicates a less than 1 percent chance.

The model has "reasonably good discriminatory ability," say the investigators, who conclude that it may allow more accurate counseling and better informed consent in the decision-making process when considering induction of labor.

Posted: 22 February 2006

I am receiving the study today via email from LWW because my online access is not working properly, but two of these are no-brainers IMO. Parity and cervical length (aka Bishop's Scores) are obvious. Primips have been proven to gestate longer than multips (average gestation 41 weeks), hello! As for BMI and height, this has piqued my interest greatly, especially in light of all of my maternal female relatives have all given birth very close to 40 weeks and my sister, the only one who is bordering on morbidly obese, who gave birth between 2 and 3 weeks postdates. Hmmm.

The Downward Spiral of Obstetrics

I have always enjoyed Red State Moron's blog as it is often thought provoking. Last week's posting on defensive medicine touched home as I have seen the ramifications of this in obstetrics. Indeed I commented on it, stating, "As a matter of fact, defensive medicine is seen in almost every facet of obstetrical care. So much so, obstetrics has become so perverse in it's treatment of a normal physiological process, it has obscured the entire birth process."

In my years supporting birthing women and focused on cesarean reduction, I have long pondered the causes for the climbing cesarean rates. I am not talking as much since 2000 when defensive medicine has indeed skyrocketed the cesarean surgery rates as I am in the 1990's when VBAC was a viable option for childbirth. Indeed it is the safest option, by viable I mean readily available to birthing women in North America. This option has quickly disappeared thanks to ACOG's decision to reduce its members liability concerns and make this option only available in high-risk hospitals.

It started innocently enough, physicians trained to save lives stepped into childbirth only when it became a life threatening to mother or baby. Then, as medical schools increased, this role slowly eroded with physicians not finding enough work so they started to see attending normal birth as a way to increase clientele. Putting anyone trained to intervene to save lives in charge of a normal physiological process naturally led to interventions, some believed needed, most only causing more problems. Pain medication, episiotomy and Friedmann's curve were the first red flags of this "support." Birth did not become safer because of this support, indeed it became riskier. Infection and medication side effects took many lives and actually afforded the need of specialists - pediatricians to care for the newborns grossly affected by labour medications and obstetricians to attend to the highest risk mothers.

Which brings us immediately to the next topic, fear. Women historically have not looked forward to labour. It is not a walk in the park and all women knew it hurt, for most it truly set the bar on pain. There was also the fear of death, though (with the noted exception of iatrogenic infection) that is something we face every day, and birth is truly as safe as life gets. Anyway, it grew from the kind of fear one faces when making an important decision (you know, that stressful "I don't know what to do" fear) to paralyzing fear, the kind that leaves you in your tracks, unable to move.

How did this happen? Because we moved from birth as being a normal process all women go through to have children to a "condition" that must be "treated" by a qualified physician. My mother believed that, as did her mother. To do otherwise was indeed not an option without the belief that is was risking the life of mother and baby. I too believed that, engrained as I was with the sales pitch of modern medicine. Congratulations on the marketing campaign, you have indeed captured your intended audience physicians!

Add to that the media who inundate us with the sensationalized perils of medically managed labours on popular reality TV shows, where physicians save all in a single bound after leaving viewers on the edge of their seats with, "will she survive? find out after these messages."

Let us top it off shall we? Almost every obstetrical intervention is not evidence based. Episiotomy, once almost universally done and touted as necessary, has only recently been devalued by physicians... though women have long known its risks and outcomes. EFM (electronic fetal monitoring) was touted to save lives and yet the evidence has only shown that it increases intervention and surgery rates, not benefited babies. Pinnard horns are as reliable, and indeed safer. Heck, there have been NO long term studies on the effects of EFM ultrasound waves on anyone, let alone fetuses. Thalidomide comes sharply to mind too. But we have not learned our lesson, we still have cesarean for breech, almost every induction (very rarely for life-threatening situations), GBS and GD managment during pregnancy and labour, prophilactic cesarean for prior cesarean, prophilactic cesarean for macrosomia... I could go on, but the list is endless. All of these are not based on evidence at all and often the evidence refutes these common interventions.

The fear of facing a medically managed labour is very real. I was naive when I had my first in 1991. I didn't have the Baby Story to show me the fallicy of this option or I most certainly would have feared childbirth much more. No wonder women are requesting elective cesareans!! The alternative to these to options is homebirth, but even that is not always known or even available. Homebirth midwives are too often constrained in their practices, not being "allowed" to catch breech, twin or VBAC babies. I have heard of many women who, in lieu of these options, birth unassisted or travel great distances to find the support they want.

No wonder there is a great fear today, there is a huge downward spiral of non-evidence based defensive medicine happening here. Where will this spiral end?

Exciting Projects

I need to focus, or at least I tell myself that at least twenty times a day. I also have to realize more fully that I am at heart an idea person and as such find it difficult to not have at least 10 lightbulb moments a day concerning the projects I am working on.

Today I am working on the first affiliation agreement for ICAN as they formally expand to include ICAN/AIIC Canada. As both ICAN International Director and ICAN/AIIC Canada's President, I very much have a vested interest in not only the success of this agreement, but the continued expansion successes of ICAN and the growth of ICAN/AIIC Canada. So many great ideas, enhanced by the input from our current board. I have to sit down and add them to the agreement for our next meeting on Friday.

I also just completed an expansion/renovation proposal for the healing centre and reception area of my church. This is after many hours of discussion with all involved, most of it informally, with awesome ideas as a happy consequence of "visiting." It is very exciting and now that I have the preliminary proposal finished, I can wait and see if it is accepted. Or not. I am more likely to start the interior design plans in anticipation of its acceptance.

There is also the mundane part of parenting life, a visit to our family physician for a referral to a podiatrist for my son, the continuing (and seemingly neverending) saga of potty training, heal insurance forms to be photocopied and submitted, meals to be made and homeschool to be taught. This is all flavoured with a dash of sitting down with son number two and having a heart-to-heart about friends and perspectives and a board game with son number three while daughter number one (child number four) "helps" while greatly hindering.

How is your day going?

You are Joshua!


Which Old Testament Character are you?
brought to you by Quizilla

Neural Tube Defect Cause

Again a new study, as I have been noting over the years, reveals nutrition is a critical key to healthy offspring...

Corn mold may have fed NTD outbreak
Source: Environmental Health Perspectives 2006; 114: 237-41

Investigating whether maternal exposure to fumonisin, a mycotoxin that often contaminates corn, increases the risk of neural tube defects in offspring.

Tortillas made from corn containing a toxic mold may have caused the high prevalence of neural tube defects (NTDs) seen on the Mexican-American border in the early 1990s, research suggests.

Scientists have for decades been trying to determine why the incidence of NTDs among Mexican-American women doubled in 1990-1991. No chemical links to the affected infants have been confirmed. But the researchers note that the period began the same crop year as an outbreak in corn mold and that Mexican Americans in Texas consume a lot of corn, largely in the form of tortillas.

To investigate whether a toxin produced by corn mold, fumonisin, may have been responsible for the outbreak, Stacey Missmer (Harvard School of Public Health, Boston, Massachusetts, USA) and colleagues conducted a population-based case-control study.

They found that, after adjusting for confounding factors, a moderate (301-400) compared with a low (100 or less) intake of tortillas during the first trimester of pregnancy was associated with an increased likelihood of having a NTD-affected pregnancy (odds ratio = 2.4). No increased risks were observed, however, with higher intakes.

"Our findings suggest that fumonisin exposure increases the risk of NTD, proportionate to dose, up to a threshold level, at which point fetal death may be more likely," the researchers conclude.

Posted: 16 February 2006

Sick, sick, and sicker

Sorry I have been so quiet, quite unlike me I know. Well between preparing for the inaugural ICAN/AIIC Canada board meeting and being so sick that to pry me off the couch was a feet neither birth child nor husband could do, I haven't spent much time on the computer. With both of these now mere history (with the noted exception of severely cramped upper back muscles from the coughing and sneezing which nearly loosed my head from its moorings on many an occasion), I am making a brief appearance. Now I am off to get the 2005 finances in order for ICAN/AIIC Canada to give to our ICAN Int'l finance officer... catch you soon at a blog near you!

Prenatal Depression

It grieves me greatly that newborns are facing withdrawal due to the medications their mothers take. I truly understand the need that some mothers have for treatment of depression, though there are alternatives to SSRI's which many feel are way over prescribed.

Mom's antidepressants hit third of newborns: study
Feb. 6, 2006

CHICAGO (Reuters) - Nearly one in three infants born to women taking anti-depressant drugs exhibit signs of withdrawal and expectant mothers may want to limit the drugs they take, researchers said on Monday.

Symptoms such as high-pitched crying, tremors, gastrointestinal problems and disturbed sleep may show up in the first 48 hours after birth and were more pronounced in infants whose mothers had been taking higher doses.

A closer look at the 37 infants exposed in the womb to paroxetine hydrochloride, sold as Paxil by GlaxoSmithKline, showed the risk of symptoms disappeared if the mother's dosage was less than 20 milligrams daily while the risk was highest among those exposed to 27 milligrams or more.

Thirty percent of the 60 newborns exposed to one of the popular class of drugs known as selective serotonin reuptake inhibitors (SSRIs) in the womb were found to have withdrawal symptoms and the symptoms were classified as severe in 13 percent, said the study by Dr. Rachel Levinson-Castiel of the Children's Medical Center of Israel, in Petah Tiqwa.

Symptoms usually did not peak until after the first day of life but the long-term effects are not known, the study said.

Two of the exposed infants suffered seizures but they did not persist.

Previous studies into the effects of SSRIs on newborns have identified other symptoms such as rapid breathing, bluish skin color from lack of oxygen, feeding difficulties, low blood sugar and jitteriness.

Yet a study published last week by researchers at Massachusetts General Hospital in Boston said women who need an antidepressant cannot depend on hormonal changes in pregnancy to relieve their symptoms so may choose to continue taking the drug.

"Because maternal depression during pregnancy also entails a risk to the newborn, the risk-benefit ratio of continuing SSRI treatment should be assessed," Levinson-Castiel wrote in the journal Archives of Pediatrics and Adolescent Medicine.

Unfortunately, "the long-term effects of in utero exposure to SSRIs have not been demonstrated clearly," not even for those whose symptoms were severe early on, she wrote.

Both studies recommended pregnant women simplify their drug regimen to a single drug at the lowest effective dose.

Pre-eclampsia Concerns

Having seen the devistating effects of pre-eclampsia and it's much more dangerous cousin HELLP syndrome in my own clientelle, I echo Red State Moron's quest for the holy grail. Yet, outside of mainstream obstetrics, we have seen the dramatic reduction in pre-eclampsia, toxemia and HELLP (not to mention preterm birth, low birth weight and IUGR) in the late Dr. Tom Brewer's practice. Nay, not reduction, elimination of the above.

How on earth did he do this? Simply, it was nutritional counselling and adherance to his guidelines. The stunning results are found here. Ironically, nutrition is virtually ignored in allopathic medicine as having any impact on health. The reason? The easy answer is because nutrition is not taught in medical school beyond a basic level, and certainly not in the depth needed to effect pregnancy outcomes. Physicians cannot provide information on what they don't know. Why are they not taught? Because it isn't ethical to do RTC's based on nutrition because you may be compromising patient health.

Just like it isn't ethical to do RTC's on elective caesarean vs. vaginal birth... either primary or post-caesarean because it knowingly compromises patient health to subject a woman to unnecessary major abdominal surgery for a normal physiological process in the absence of indications. But I digress.

Dr. Brewer's nutritional basics stand up both in his studies and when compared to the newest nutritional studies, guidelines and information available. Midwives have long supported the critical aspect of nutrition, but in North America most women seek obstetricians or family practic physicans (if they can find any who are still catching babies). Interestingly, some obstetricians are now following suit by having nutritional guidelines for patients with excellent results. Notably, Dr. Motha does this in her Gentle Birth Method: The Jeryarani Way. But not nearly enough are doing this or providing any nutritional counselling at all.

I pray that each mother finds either guideline and follows it towards superior outcomes in spite of the lack of obstetrical training and knowledge in the field of nutrition.

We are not moving today!

God has been gracious today. Allan's evaluation was superb and though his store manager is looking for slight improvements in three fairly minor areas, he is in line for being promoted to a co-manager position soon. That was a no-brainer as Allan has superb management skills and I didn't doubt for a minute that he would not have anything but an excellent eval.

His store manager also asked specifically that he stay in the store because he needs his strong leadership right now. Even though, his district manager did ask if he would transfer to Grande Prairie, which he declined again... mostly because there is no way in heck that we could afford to move there on his wage (even with a raise). It was really a moot point though, given his store managers request, but is a future option for sure.

Ironically his other boss (our builder, who we have been working for part-time) called to ask how the eval went and offered Allan a full-time job until he was able to open a sales position for him this fall. I of course told him when he called to tell me of his eval outcomes.

Wow, the options we have been praying for suddenly all fall in our laps in the same hour. We were asking for a sign as to which path we should travel, following Allan's management career in Wal-Mart or moving to the very lucrative construction/sales career offered by our builder. It seems that the latter is where we may be heading... but at a more leisurely pace which is OK with me.

I have never participated in a Meme before, so here it goes...

Four jobs I've had:
1. Real Estate Agent
2. Art Gallery Framer
3. Photo store manager
4. Doula

Four movies I'd watch over and over again:
1. Mulan ('cause I have kids. I know every word by heart and it is still good)
2. Sweet Home Alabama (I have no clue why, but I do)
3. Anything with Tom Hanks (what a gifted actor)
4. Anything with Angelina Jolie (again with the gifted thing)

Four places I've lived:
1. Camrose, AB
2. Lloydminster, AB
3. Spruce Grove, AB
4. Kingman, AB (well on a farm just outside of Kingman... where I grew up)

Four websites I visit daily:
1. orgyn.com
2. Focus on the Family
3. Keel the Pot blog
4. Christianity Today (an article called The Baby I'll Never Forget)

Four of my favourite foods:
1. Anything chocolate
2. Mashed new red potatoes with butter and dill
3. Fried chicken, especially KFC
4. A crisp apple pear

Four places I'd rather be right now:
1. Somewhere warm
2. Cleo's with an unlimited budget
3. At a spa, with my sisters and mom
4. In the new house we are designing, I can't wait!

Secondary Infertility Post-Cesarean

Well it looks like the experts have finally weighed in on secondary infertility after a cesarean delivery.

Subfertility link to cesarean 'may not be causal'
Source: Fertility and Sterility 2006; 85: 90-5

Investigating whether cesarean delivery is independently associated with later subfertility.

The observation that women who undergo a cesarean are less likely to have further pregnancies than other women probably does not reflect a cause-and-effect relationship, research findings suggest.

While it is biologically plausible that the surgery involved in a cesarean section may affect future conception, women who undergo this mode of delivery also differ in many respects from those who do not, including their history of primary infertility, which could confound the association.

For their study, Gordon Smith (Cambridge University, UK) and co-workers studied the relationship of cesarean delivery with later subfertility, with adjustment for potential confounders. They used retrospective data from a cohort study of more than 100,000 women who had their first baby between 1980 and 1984.

Compared with women who had a spontaneous vertex delivery, those who had a planned cesarean section were significantly more likely to not have a second birth during follow-up, with a relative risk of 1.21. Adjustment for maternal and obstetric characteristics, however, attenuated this association to a relative risk of just 1.07, which was no longer significant.

"These data suggest that the association between cesarean birth and subsequent subfertility is more likely to be caused by confounding than by a causal relationship," the researchers conclude.

Well duh. Though some of us certainly do know that despite normal ovulation pre-cesarean and infrequent or no ovulation post-cesarean (though for me it took two cesareans to truly obliterate my ovulation), there are many many women who choose to not have more children because of the negative emotional impact of the surgery. I could list many women whom I have talked to personally who are terrified of another cesarean. Being post cesarean in today's obstetrical quagmire that ACOG has put birthing women in allows only two options, elective repeat cesarean section or homebirth - with or without midwifery care.

Finally, let us never forget the women who cannot become pregnant without it being life-threatening (for instance, a friend of mine experienced embolic thrombosis as a result of cesarean surgery - she risks her life to even fly).

Giving Birth in a Hospital? Think Hard.

It has long been known by physicians, nurses and mothers alike that obstetrics is practiced a far stretch away from an evidence-based standpoint.

Starting way back in North America when midwives attended most births in the home while physicians pined away in their offices, trying to think up new ways to attract customers, er, patients, physicians thought they had a clue about birth. Or rather, how they could improve birth. It isn't obstetrics that improved birth, to be honest it would be hard stretched to say that the office of obstetrics has caused a great deal of problems. General knowledge of anatomy and physiology, the advancements of hygene, and understanding of infection are what have really increased safety. Let's look at what obstetrics has done...

• As much as 100% episiotomy rates at certain times during the last century, and even when it was proven to cause harm or at least not improved outcomes in almost every situation, the rates are shockingly high, as much as 50% or more in some practices.
• EFM (electric fetal monitoring) has not only became common in all hospital L&Ds, it is still used today as standard of care despite it's causing highly interventive outcomes (like cesarean section). Even more frustrating, continuous EFM is known to cause complications in labouring mothers because of lack of maternal mobility which is a key aspect in a well-progressing labour.
• Anyone who knows me knows I am appauled by the skyrocketing caesarean rate. Over 8% places unnecessary risks to the mother specifically and the baby inadvertently (prematurity and cuts from the scalpel to name only two). Just ask the WHO counsel who recommended a rate of no higher than 10-15%. They know the numbers should be lower but US supporters knew they could not sell such a low number to obstetricians "back home" so they settled on the higher average. Incomprehensible that physicians would knowingly risk patients lives to protect their own liability insurance and their personal time (heaven forbid they lower their patient load and reduce their income!). Equally incomprehensible is the number of hospitals and insurance companies who have contributed to this outrage.
• Breech babies born by cesarean instead of vaginally based on one flawed study... knowingly so the minute it was published. Last week a new study refutes the Hannah breech trials and stands behind the safety of vaginal breech birth, yet we have scores of delivering physicians who don't know the basics of leopold maneuvers (relying instead on ultrasound results) nevermind how to catch a frank or footling breech.
  
• Speaking of ultrasound, how can so many things be tested on our unborn without adequate testing like this all-too-common screening tool? No long-term and precious few short-term studies have ever been done on the effacity of ultrasound screening.
• Which then brings me to the sheer number of drugs that are "safe" for mothers until proven otherwise. I will not even start counting the number of drugs resulting in birth defects, stillbirth and more that have been used on pregnant women without adequate testing. Just recently we have the new "stop smoking patch" that has been found to cause birth defects and metronidazole causing the very preterm risks it was preported to fix.
• Oh, and let us not forget the biggest one, the safety of birth in hospitals. The huge homebirth study published last year in the not only shows the safety of homebirth, it shows the huge risks of hospital birth by contrast. Heck, just last week a young healthy mother gave birth and lost all four of her limbs because of the bacteria she recieved from the hospital she chose to give birth in. Terrifying to me.
  

Infant Bonding

In my research for the new online Postpartum Doula workshop I will be teaching, I have been reading a lot about infant bonding. At Birth Psychology I was reading this and was struck by one woman's response:

I had herpes, and they whisked the baby away to intensive care for observation and wouldn't even let me touch him for three whole days. I grieved. I felt that he had died. Finally on the third day I went to the nursery and demanded him. But I felt very little when I got him. I know it's nonsensical, but my emotional feeling was that he had died, and this was someone else. I wanted desperately to love him, and I knew that nursing would be the fastest way to make up for the bonding I had missed, so I made myself nurse him and I hated it for a long time. When I would sit down to nurse him I would feel so impatient I could scream. It took months for me to feel that I was really his mother, and he was really my baby. Finally it did happen, but it was awful for a long time.

Wow. Deja Vu. Here is my story with its parallels:

I had an emergency cesarean section under general anesthesia and while going under I prayed that God would be kind and save my baby as I believed I would not survive. I did survive yet the experience left me detached as a result of the emotional trauma I had experienced. Four hours after I went under the knife, a screaming infant was placed in my arms in my postpartum room. I searched the face of this strange little thing, almost frantically looking for something, anything, that would identify him as my own. It was only when I saw the stork bite on his forehead, the same mark of both my sister and my beloved Grandfather, that I relaxed and a warm flood of love flowed over me. Bonding came quickly as I fell in love with this tiny baby, yet it was a fine thread that could have been easily broken with a far different bonding outcome had I not been able to identify with him.

Theological Breakthrough

Eric, my eldest, has been struggling with confirmation classes for three reasons. First being that he is older than his classmates (which include his brother), second because he is a kinisthetic learner and third, well he is a firstborn/leader type. Being homeschooled, his leadership has not been supressed to conform to a classroom setting and as such, he doesn't conform well to dry old testament history that he covered extensively in grade school.

After a couple of meetings with our pastor who teaches his class, she suggested we switch gears. Instead of sitting listening to lecture for an hour and a half, having just covered the same material as prep homework, he is instead to only pre-read the biblical text to be covered that day and will be the teachers assistant, doing the board writing, showing journeys on the maps (they are currently covering the exodus) and so forth.

For the first time, he came home so excited yesterday loving confirmation classes! In addition, he talked all the way home about something new. He learned that what we had believed to be the exodus route of the Isrealites through the Sinai Peninsula was indeed wrong.

The Red Sea Crossing shows us that they traveled straight through this area, already occupied by the Egyptians, to the Gulf of Agaba where the read red sea crossing occured (see link for archeological and theological proof).

They then travelled on to Mt. Sinai (Jabal el Lawz) with it's blackened peak.

Mount Sinai was completely in smoke, because the Lord descended upon it in
fire. Exodus 19:18

It has been quite a day of learning and triumph.

Grand Rounds

Grand Rounds up today at Grunt Doc.

MedBlogs Grand Rounds features the best writing about medical topics in the blogosphere, brought to you weekly with rotating hosts.

Medical Journals and Politics

Since talking to Henci Goer way back in 2000 about the concerted effort to misalign natural childbirth for the benefit of "daylight obstetrics" in busy obstetrical practices and hospitals, I have been very wary of the press and even trusted medical journals like the New England Journal of Medicine. In 2002 Henci documented her observations in an article printed in Midwifery Today called The Assault on Normal Birth: The OB Disinformation Campaign.

Today, Red State Moron blogs about a very similar concern reported in the Wall Street Journal, but this time we see the NEJM dipping their toes in the Vioxx scandal. The article explains (emphasis mine),

"Accusations aren't the usual fare of august medical journals, so it's worth trying to understand the publication's self-insertion into the Merck litigation. Its extraordinary decision to publish a critical statement about a Vioxx study it ran years ago is being hailed by trial lawyers as the best evidence yet that Merck played fast and loose with its data. Another way to say this is that the New England Journal is joining the ranks of academic publications risking their reputations as non-partisan arbiters of good science in order to rumble in the political tarpits.

The worry here is that the health community and broader public will soon have one less place to find legitimate "science." These publications have viewed themselves as the gold standard in research, using their peer review processes to build reputations for careful and unbiased science on the leading issues of the day. Any suggestion that these publications have an axe to grind -- whether against corporate America, private markets, or specific drugs -- undermines their standing as neutral arbiters. That in turn makes it that much harder to separate good science from the "junk" version. And that truly warrants an "expression of concern."

As Red State Moron suggests (and I agree), "And this is exactly where I think the medical and science blogs will gain an audience, and perhaps respect. As another way of providing "peer review", and as a means of disseminating the information to the public. Because really, how many of you read the NEJM, The Lancet, or JAMA (to name a few)?" Indeed, how many physicians read their own journals, nevermind the patients they serve?