Hot Momma finalist

I just learned that I was a Top 25 Finalist for the Hot Mommas Project whose mission is "to increase self-efficacy in women and girls by providing scalable, global, free access to role models online. "

My case is titled "Spreading the Word About Healthy Living" and can be found in the case library. The task was to present background and goals along with personal and professional challenges and then to create discussion questions based on the case study for other women to consider.

Writing my case study was a thought-provoking process that came at a time of transition that has begun and is still unfolding. I hope my experience and challenges can be of use to other folks on their journeys.

Reflecting on NIH VBAC conference

As I wrote shortly after attending the first day of the NIH conference on Vaginal Birth After Cesarean (VBAC) a few weeks ago, the experience was tiring. The panelists might have been trying to convey the message the uterine rupture is really rare -- less than 1% -- and that it does not deserve to be weighted more than a whole lot of other issues, including complications and risks of cesarean delivery. But honestly, it did not help this hopeful VBAC mom to see a bunch of photographs of uterine rupture!

I admired the birth activists who spoke out, women who have been working hard on this issue while I've been comparatively on the sidelines, not regularly attending ICAN meetings (in part because I didn't believe I would ever regain my fertility or get pregnant). But here I am, four and a half months along, and ignoring this issue is not an option. I've chosen to work with a midwife at home, and I hope that my baby's cord is long enough this time and that other factors go in my favor for a successful HBAC (homebirth after Cesarean).

No matter what kind of care I'd chosen, it's important that I understand the climate surrounding this issue as well as the facts. Indeed, the whole point is that the climate has dictated which facts get to "count," which in turn reinforces the tenor of the climate. Everything goes in a circle! But the way it spins has been heavily influenced by medical articles and the publicity surrounding them, and, most significnatly, by pronouncements by the American College of OB/Gyns (ACOG). Although the NIH statement is not perfect, it does call on ACOG to rethink its position about surgical facilities and anesthesia needing to be "immediately available" anywhere a VBAC is attempted.

It was powerful to follow the rest of the conference and the coverage by birth activists and then to write this news bulletin at Mothering.Com: "National Institutes of Health Conference Calls Vaginal Birth After Cesarean a "Reasonable Option."

Check it out for more background on the issue and responses to the conference.

How long until Daylight Savings Time ends?

Four-year-olds do not sleep when it's sunny. That's an exaggeration, but I cannot say that I am in love with this early switch to later sunsets. The hour shift has been tough enough when we've had three more weeks of gradual, natural lightening to get used to the idea. But now that it's mid-March... Ouch.

Last summer my non-napping three-year-old played hard enough that he was ready to hit the pillow by 7:00 most nights. This early spring, he's got more stamina -- physically, not emotionally! And, he has less chance to burn off calories if it's too chilly for his wimpy mom to want to run him around a ton, or if she's too busy working all day and making dinner after preschool to let him spend two hours at the park. But my son is so darn tired, I know he needs to get rest or I will be in for a big whine-fest the next day (to say nothing of what wrath the preschool friends will encounter). If only I'd taught the child how to rest by himself and he hadn't abruptly stopped napping at two and a half with no interest in quiet time...

In the winter, early bedtime was easy. It's dark outside during dinner. Now, three days into this new schedule, I'm well over the loss of the hour on Sunday, but with daylight streaming in well into bedtime snacktime, we struggle to wind the day down on schedule. Once you're used to quiet upstairs by 7:30 p.m., it's rough on the marriage and the psyche not to have it until 8:30 p.m.

Read the rest of "How long until Daylight Savings Time ends?" here at DC Metro Moms Blog.

Breathe on me, when you're not strong

I had a hunch my son was not in the greatest health when, on Wednesday morning, his breath didn't smell right. Whenever he gets a fever, his breath has a metallic or medicinal smell. I get the impression his body is heating up and detoxifying.

But it's hard to justify keeping a child home for funky breath when you've got a lot of work to do. So off he went for a full day of preschool. When we got home on a gorgeous afternoon, I was ready to walk him down to the library and finally get some exercise. He was whinier than usual (which is saying a lot these days), but we eventually made it out and back home in time for a quick dinner before I headed off to an ICAN meeting to watch Pregnant in America.

I didn't get home until 11 p.m. and had to find a source for a statistic for this piece on the NIH conference on vaginal birth after cesarean that was to be published by Mothering. I was exciting about the work and about having really gotten my head into this pregnancy at the meeting. My 20-week sonogram was scheduled for the following morning at 8 a.m. It seemed like perfect timing.

Except that it wasn't. I heard my four-year-old crying like a baby and wondered where the heck my husband was. Turns out he was right next to the boy in bed, as he had been for a few hours since the wakings and squirmings had started not long after he went to sleep. Something was up, and my husband, who had planned to work all evening while I was away at VBAC Central, was exhausted.

I told my son I was going to get him some water, dashed off the email I'd started, and went back up to more tears. I decided we were going to be together all night and that his wimpy IKEA bed was no match for my almost 20-pound-heavier-than-normal body. I suggested we move to the guest room, and he perked up at the idea and obligingly went to the bathroom before we headed downstairs. I didn't really know what his symptoms were, but I knew he'd be happy to take some "Curious George pellets," or Calms Forte, and I put some Rescue Remedy on his wrists and forehead.

He slept pretty well after that, until we plucked him out of bed Thursday morning to go to the appointment, which I did not want to reschedule or have my husband miss. E was clearly a little feverish and flushed, but that had faded within an hour or so. He was disappointed to have to cancel our playdate at the farm, but he acted pretty normal the rest of the day with, sadly, no desire to nap, even though I was dozing off on the couch right next to him.

I'm not sure when he crawled into our bed last night or this morning, but, right after my husband got out of bed and into the shower, I felt a little hand poking me and chirping, "It's morning time!"

I decided then the bug had passed.

NIH conference addresses vaginal birth after cesarean (VBAC)

More personal reflections will follow, but below is my official report from attending day one of the NIH conference on VBAC, a post I've also published in my column at the Washington Times Communities.

This week, the National Institutes of Health is holding a Consensus Development Conference entitled “Vaginal Birth After Cesarean: New Insights,” a three-day public meeting that, though focused on an obstetrical, biomedical model of hospital births, has drawn birth activists representing midwifery and homebirth interests.

The first day of the conference presented several short reviews of research on the topics of patterns regarding Vaginal Birth After Cesarean (VBAC), risks of VBAC versus cesarean section, and maternal and neonatal outcomes from VBACs, from “Trial of Labor” (TOL) and “Elective Repeat Cesarean Delivery” (ERCD).

In the United States today, some 31% of births are c-sections. Of the 1.3 million c-sections performed each year in the U.S., 40% are repeat c-sections. According to research presented by Dr. Kimberly D. Gregory, the rate of VBACs in the U.S. rose from 3% in 1981 -- when the NIH recommended a decrease in the overall national c-section rate, including a recommendation to increase the use of VBAC -- to a high of 23% in 1996. In that year, the rate began to decline after the publication of a a medical journal article about the risks of TOL.

In 1999, the American College of Obstetricians and Gynecologists (ACOG) required the “immediate” availability of emergency c-section facilities in any hospital that offered TOL and VBAC. Currently, the VBAC rate in the U.S. is around 7%*, even though VBACs, when attempted, are 60-80% successful.

The speakers at the NIH conference discussed the fact that risks associated with c-section need to be weighed against the potential risks of VBAC, which include a 1% or lower chance of uterine rupture. It was noted that much attention gets paid to this dramatic and catastrophic event, while less information is shared with mothers about the many risks associated with surgical delivery, including a higher likelihood of placental accreta in future pregnancies (a condition in which the placenta grows into the uterus).

Dr. Mona Lyndon-Rochelle explained that the risk of maternal death is highest with an elective repeat c-section without a trial of labor. Thus, then, how can we grapple ethically with the fact that more and more hospitals are banning VBAC procedures and forcing women who deliver there into mandatory repeat c-sections?

This question was raised in a Q&A session and was noted by the panel to be the very point of the conference. The NIH cannot force hospitals to change their policies, but the hope among birth activists is that the institute will make recommendations that will halt the trend toward denying women the birth they desire, forcing them into major abdominal surgery if they are unable or unwilling to find another institution at which to birth or a midwife with whom to work at home. According to the International Cesarean Awareness Network (ICAN), over 800 hospitals in the U.S. have banned VBACs.

When attendees asked questions about the safety of VBAC at home, or HBAC, they were met with the explanation that no research of acceptable quality was available on the subject, and even that it was not possible to obtain statistics on homebirth. Upon being questioned by attendees about non-medical effects of surgical delivery (including a question from Gina, an ICAN chapter leader for and the author of The Feminist Breeder blog), the panelists admitted to a dearth of information on issues like postpartum depression (PPD), post-traumatic stress disorder (PTSD), difficulty establishing or maintaining breastfeeding, and difficulty bonding with an infant.

In light of the fact that some hospitals not only ban VBACs but also require all c-section babies to spend time (one participant said four hours at the hospital where he practices) in the Neonatal Intensive Care Unit (NICU), it would seem that questions of mother-child bonding need to be investigated. A panelist noted that these were excellent questions that were discussed to some degree in the planning committee before it was determined that there was inadequate research to discuss them in this forum.

The conference will end Wednesday, March 10 with a presentation of the NIH’s draft statement at 9:00 a.m. followed by public discussion, after which the panel will meet in executive session before providing a summary of its findings to the press in a 2:00 telebriefing. The draft statement will be available after the proceedings at consensus.nih.gov with the final statement to follow four to six weeks later.

Further coverage of the conference from a VBACivist perspective can be found at the ICAN blog at http://blog.ican-online.org/, The Feminist Breeder Blog, which includes live radio coverage and interviews via podcast at http://thefeministbreeder.com/nihvbac/, and Momotics Blog at http://momotics.com/category/nih-vbac/.

*The most recent statistics used by the papers at the conference cite a VBAC rate of 8.5% in 2006.

The day after

It was nice to have such warm & fuzzy feelings about my son yesterday, but today I just feel guilty. He was so whiny and out of sorts this morning. It's great that he can adapt well to situations (like yesterday's marathon of being in others' care), but I feel like we always pay for it later.

Before we left for preschool, I gave him some drops of the Bach flower essences Gentian for feeling despondent due to setbacks and Red Chestnut for issues related to connection/separation to/from a loved one, and I think Elm for feelings of overwhelm/burden. I took them all, too!

I might search for some other remedies this evening or try to leave time for a foot massage with some essential oils. I think he and I both need to attend more to our body/mind/spirit in an intentional way. If he's going to learn that, he has to see me doing it for myself and, while he's young, for him.

Tired and missing my kid

It feels good to look forward to seeing your son. Lately I've felt so swamped -- and especially after all that snow with no break -- I haven't exactly loved all my many minutes with my boy.

Today I went to the National Institutes of Health for a conference on Vaginal Birth After Cesarean (VBAC), which I hope to write about in more depth later. But the experience of the day was something in and of itself. Getting dressed in real-people clothes, taking my boy to a friend's so she could drive him to school and pick him up, getting on a crowded Metro during rush hour, and then listening to a lot of doctors talk about best outcomes for moms and babies... Well, it was intense. Especially considering that I'm 4 months pregnant and hoping for a home VBAC (HBAC) with baby #2.

I knew E would probably be okay, but I also knew it was a long day for both of us. We were both exhausted when I picked him up from the park. I could not wait to trade my button-down and blazer for a sweatshirt and just sit on the couch hugging and talking to him. If we weren't both hungry with dinner nowhere in sight, I would have happily sat there for an hour. It felt good for that to feel so good.

For someone always looking at her watch and struggling to just be in the moment when I really want to be writing or researching or exercising, that uncomplicated couch time was a true delight.

Generosity of Peers

Tell people that you might need help, and they come through!

This has nothing to do with my last post about mood blues, which aimed to say that no one can help me but me. No, I'm talking about offers from other mamas to help out with my son this summer, when I'm expecting baby #2 in early August.

I wrote a post on DC Metro Moms blog the other day about missing out on sending my son to summer (day) camp with the two friends he went with last year. Since I wrote that piece, one mom has agreed to send her child to camp with mine for four weeks of the summer, and at least five moms have come forward to offer to have my son over for playdates while they or their babysitters watch him - before or after the baby. Truthfully, they admit, it would be good for their kids, too, because they are not going to have as much social time in the summer. Who can afford a nanny and camp when school is so expensive and there is a second child who can't go anywhere yet? But still, the generosity has been inspiring. This just might help me learn to take people up on their offers to help. What a concept!

Read "Dissed for Summer Camp," the original post on DC Metro Moms Blog.