30 August 2008
As we head into this Labor Day weekend and prepare to say goodbye to summer, make plans to be BOLD (Birth on Labor Day): see BIRTH, the play by Karen Brody.
NJ's BOLD performance of BIRTH will be next weekend, details here.
I saw the performance last year in NYC and was blown away - powerful, visceral, wonderful. Don't miss it!
Sounds pretty great, huh? Don't be a hater.
29 August 2008
Well, the tooth fairy lamely came anyway. He thought she had forgotten him, but apparently she had come on time, just not to his room because she got confused and thought he might have been sleeping elsewhere (a reasonable assumption in our house)...yeah - that's the ticket. whew.
28 August 2008
Under the law, women will be tested early in their pregnancies and again in their third trimesters unless they refuse. If a woman refuses, it will be noted, and an H.I.V. test will be performed on the newborn unless the mother has religious objections.
This mom had recently switched from an OB to midwives and had maybe not been retested (maybe - the nurse, let's call her Nurse Ratched, took the mom's recollection rather than asking the midwife or checking the records) in her third trimester. So she was given the option of donating some of her own blood to be tested now or waiting for her baby to be stuck. Of course she submitted. She was not told that she could decline. (we had talked about it in class & this mom was OK with being tested)
Why do I care? Not too long ago, I wouldn't have thought a thing about it...until I was asked to do an interview for a feature piece in The MotherHood (for which we took some heat and got lots of appreciation) and learned about the possibility of false positives on HIV tests during pregnancy or in newborns.
In a nutshell, here are my concerns (& the concerns of The MotherHood publisher, Lisa Duggan), published in an editorial in The Times of Trenton and relayed to our legislators in the state senate, where I spoke at hearings along with members of NOW, ACLU et al:
Today, bill S-2704, which proposes mandatory HIV testing for all pregnant women and newborns in New Jersey, is up for a vote. If the bill is approved, New Jersey would become the first state to require pregnant women to be screened for HIV twice -- once in the first trimester and again in the third trimester of pregnancy. The bill does include a provision allowing mothers to opt out of the screening, but this supposed freedom of choice is false, given that the bill also requires testing of newborn babies if the HIV status of the mother is unknown. This amounts to de facto testing of the mother's HIV status without her consent, as newborns carry their mothers' antibodies for the first 18 months of life.
Screening for HIV is currently an "opt in" choice for New Jersey women. The sufficiency of this method is borne out by a recent study conducted at the Johns Hopkins Bloomberg School of Public Health, which states in part: "A targeted campaign of testing and counseling aimed at those who are at high risk for HIV would be more effective than the mass patient screening proposed by the Centers for Disease Control and Prevention."If the legislative body of New Jersey is convinced that mass HIV testing is warranted, let its members begin with their own families: We challenge all members of the Senate, Assembly, the governor's office and each member of their respective households to submit to an HIV test before mandating mass testing for their constituents.
When Senate President Richard Codey proposed the bill most recently, he referred to it as a "no-brainer," despite the fact that HIV screening tests are known to cross-react with some 70 factors or conditions, including pregnancy and flu or other vaccinations, generating false positive test results. And in spite of the well-known fact that 60 percent of infants who test positive at birth will test negative at 18 months without anti-retroviral treatments.
An HIV positive test result, false or not, implies a prognosis of death in seven to 10 years and a lifetime prescription of toxic anti-retroviral medication to commence during pregnancy. It requires that a woman have a surgical birth. A woman testing positive will be prohibited from breastfeeding her child. Having a surgical birth and not being able to breastfeed are two factors known to contribute to postpartum depression, a serious public-health issue.
If readers are thinking that some false positive test results are a small price to pay for identifying true positives, we ask that they consider what testing positive actually means. If a woman's first HIV screening test is positive, she will have to carry this psychological burden for about two weeks, until confirmatory tests prove it to be negative. However, many wrongly diagnosed women will have to wait much longer than that before learning that they are truly not infected. More than half of all persons with primary false positive screening tests in low-risk populations (e.g., blood donors or pregnant women) can be expected to test indeterminate on their rapid confirmatory test. Test results can only be resolved as truly negative by repeat testing on samples taken one to three months into the future, and as the manufacturer of one confirmatory test states, "The psychosocial and medical implications of a [false] positive antibody test may be devastating."
When examining the fiscal realities of mass testing, we can look at the national analysis shown in the recent Johns Hopkins study. It determined that the CDC's mass testing strategy, on which the New Jersey bill is based, is likely to cost $864 million for one year: "For the same price, a targeted testing and counseling approach would identify more than three times as many people with HIV and could prevent four times as many new HIV infections compared to the CDC's testing strategy."
We're concerned that the bill is silent on many critical issues. No language in the current bill indicates, for instance, where funding for mass testing and requisite treatment will come. The bill does not address how state-mandated testing would compromise New Jersey's current medical privacy laws (HIPAA) or potentially result in the loss of insurance coverage for individuals and families.
Further, child custody or public assistance to families could be unfairly tied to compliance with this testing and advised treatment protocol. With the specter of child custody hanging over their heads, mothers and babies who test positive will be forced to take the currently recommended anti-retroviral drugs. These drugs are associated with serious potential side effects and are known to cause cancer and birth defects in animal studies. This is especially troubling for those mothers and children who are later proven through confirmatory testing to have been HIV negative all along.
Mandatory mass testing is neither dependable, nor cost-effective nor legally sensible for New Jersey. It violates a woman's right to make her own childbearing and medical decisions and can potentially lead to unwarranted and drastic medical treatment in the case of false positive results.
It is most certainly not a "no-brainer."
We urge each member with the power to vote on this legislation to study carefully all the available information on HIV testing and consider the fiscal and legal implications for the state before making testing and treatment mandatory for the women and children they serve.
I am NOT against testing when it is done out of informed choice. Especially when it is targeted. What I am against is yet another taking of women's ever-eroding dominion over their own bodies and the bodies of their babies.
Oh - and now apparently NJ has now made Vitamin K injections mandatory at birth for infants too...even the midwife didn't know about this one yet.
If you're still reading, thanks for hangin' in - I know this was a long one. But I should stop writing now - I need to make an appointment to take my kid in for that extra shot he now needs in order to be legal for middle school in NJ.
*at the hearings, I believe experts said there were some 6 cases of HIV positive infants last year in NJ - I'm going from memory of the specialist's testimony though
27 August 2008
In the blink of an eye. That's how fast it goes.
My oldest baby...still in my belly eleven years ago. Now his once tiny baby feet are bigger than mine, officially...we bought shoes yesterday, skateboard sneakers, of course. Soon he'll be taller than I am.
I am off to middle school with him to get the lay of the land before school starts next week.
26 August 2008
My take away from Michelle Obama's speech was this,
And one day, they — and your sons and daughters — will tell their own children about what we did together in this election. They'll tell them how this time, we listened to our hopes, instead of our fears. How this time, we decided to stop doubting and to start dreaming.Of course that's what I want for this country, but it's also what I want for birthing women. That we might set our sights a little higher than just making it out alive. Of course that's the point, but it doesn't mean we have to plan our births, or our lives, only to avoid disaster. Birth, like life, can be full and beautiful and powerful if we make room for that possibility. Of course there are some births that will need to be about survival. But most births do not come down to that and do not need to come down to that, especially if we choose our birth team well. That means finding care providers who trust that birth works most of the time, if we let it.
Let's listen to our hopes, instead of our fears. Stop doubting and start dreaming. And then do whatever we can to make those dreams happen.
25 August 2008
24 August 2008
"Sometimes moving on requires understanding what happened, mastering the story and the experience, and even breaking the silence about what occurred. At times, a woman is ready to take these steps toward healing immediately after her delivery. For some individuals, this process can come years after the experience. Challenging childbirth can have a sense of “freezing in time” until the silence can at last be broken."I am thrilled to see this available, not only for my clients who might be working through a past birth, but for the many women who call just seeking some support and guidance...they have so many stories to tell and wounds to heal - this seems like a place where that can happen. I am also thrilled that they will provide consultations and education to those of us who work in birth so that we can be better prepared to listen and serve.
Brava to the creators!
And brava to Nicole, another birth blogger, for her wonderful & comprehensive post on this topic.
23 August 2008
Good to see all the ladies who came out to the birth open house today at Shakti. It was cool to meet these (obviously self-selecting) women where are open to change or doing what it might take to have the births they want.
And the chocolate truffles by a local chocolatier, (Nadine Kerstan/Chocolate Polka Dot) on which Gayle Lemke (director of Shakti Ma) and I collaborated were fantastic! Remember, chocolate helps get the oxytocin flowing!
For more of those truffles and more empowering information on birth, don't forget to save the date & register for the October 12th event we are doing at SOPAC: "Conception, Pregnancy & Birth ...the journey that shapes our lives", with screenings of Orgasmic Birth & The Business of Being Born, and what promises to be a mind-blowing seminar with Anna Verwaal.
Scroll down to the bottom of this blog page to see all the details.
22 August 2008
A dear family friend, Buddy Harman, died last night...my dad will be a pallbearer for his old friend. The heartbreak in my dad's voice was hard to hear.
Buddy was a legendary drummer ("the most recorded drummer ever"), someone you have heard play a 1000 times without knowing it. Take a listen to Crazy (Patsy Cline), Bye Bye Love (Everly Brothers), Ring of Fire (Johnny Cash), Stand By Your Man (Tammy Wynette), Viva Las Vegas (Elvis Presley) or Pretty Woman (Roy Orbison), to name just a few. He played regularly on the Grand Ole Opry & was recognized by The Country Music Hall of Fame for creating the "Nashville Sound".
I knew none of this as a kid, spending nights with his family every week - he was just our friend. My best to Marsha, Summer, Autumn, Mark & the rest of his family.
At my last eye check up the doctor told me that since I'd turned 40 I would likely need them. I told her that I was seeing just fine, thank you very much. Then almost immediately I started to notice that the lights needed to be a little brighter or I was squinting. Today I just decided to embrace it & actually be able to enjoy the book I'm reading (with its ridiculously small print). Embrace my future crone!
21 August 2008
It's paved with mangos. Or maybe it's mangoes. I know - how about just spelling it c-r-a-c-k? Because that's about how addictive they are, in spite of being tree ripened, fat fee and high in vitamin C. The fact is that they are coated in the most delicate dusting of sugary goodness and I have actually induced stomachaches in myself from eating too many at once. Must I give up my Costco membership & remove temptation?
20 August 2008
I should be grocery shopping instead of sitting at my computer. I have no idea what to make for dinner. Procrastinating for a few more minutes, I read this, linked to here.
If it seems unimaginable that a working, insured mom would need to take her kids to a soup kitchen, not to volunteer but to eat, then read it and contemplate what "working poor" really looks like. wow.
19 August 2008
18 August 2008
Does this make me as bad as some L&D nurses who just call birthing couples "mom" & "dad" instead of their names? Guess I'm in no position to judge.
17 August 2008
Me: "hold on - I'm in the bathroom"
DB3: "I just need you to put my socks on me" (barges in, ignoring my requests for privacy/respect of personal space)
Me: "I'll be out in a second"
DB3: "ughhh - I hate you mom!"
Me: ( willing self not to respond dramatically), "sorry to hear that"
DB3: "actually, mom, I don't hate you"
It's not that I'm wishing the birth were over at all. It's just that I start to get itchy when I have not attended a birth for a couple of weeks. And I know that I am entering the phase of extra high-alert where I will double check that my cell ringer is on even more than I already do and start thinking about childcare contingency plans (also more than I already do).
Oh well, patience, grasshopper.
How about you - what wacky things do you do when waiting for births?
16 August 2008
Many times when I speak with women about their past birth experiences, there is a recurring theme of feeling they were really not heard, that their concerns were minimized or brushed off. One step in the right direction is to try to help women be philosophically aligned with their care providers going forward. Hopefully care providers are offering evidence-based, mother-friendly care - to know all of this is called transparency. It can also be incredibly healing to be able to be heard now, even if it is after the fact.
"The Birth Survey is structured around the Coalition for Improving Maternity Services (CIMS) evidence-based 10 Steps to Mother-Friendly Care and other quality of care indicators. The creation of The Birth Survey has been inspired by Childbirth Connection's Listening to Mothers Survey (Harris Interactive, October 2002)...
...We hope that the Transparency in Maternity Care Project will provide information that will help women make fully informed maternity care decisions.
We also believe that maternity care practitioners and institutions must have access to feedback from their patients..."
15 August 2008
What's in your fridge?
Bet you don't have a duck head!
(I've taken out the original picture of the duck head in question - seems too lurid in retrospect)
yech...I was cleaning out the refrigerator & came across the remnants of a wonderful family meal in Chinatown two+ weeks ago - Peking Duck. When the chef guy presented the duck to the table before carving, my 7.5 yo asked if he could have the head. I mentally tried to recall if this was on the list of telltale signs of a future serial killer but since the duck was already dead & chef guy seemed to nod with new respect at my son, I tried not to worry. So we brought it home, of course, and I silently congratulated myself for being a cool mom (holy hubris!). I can imagine what someone might think when reading this: yes - it was disturbing to see the disembodied head while I ate the flesh; yes, as a meat eater I really should feel comfortable seeing where my food comes from or not eat it at all; yes, I thought this might be a sign I should be a vegetarian; yes, we did do a mock Aflac ad while dining (come on - I'm just being real).
We also have some left over goat meat that our wonderful Trinidadian babysitter dropped by, along with roti & chana - the kids love her cooking.
We have some ground flax seed - not ground enough, I say - I was chewing bits of something in my breakfast smoothie this morning.
And we have some octopus ceviche, left over from dinner at a Mexican place the other night. The kids thought it tasted just like chicken. I think (know) that we eat out too much.
So what's in your fridge?
14 August 2008
Here's what I did when I was in that situation (but I body surfed too, so you you may not want to listen to me)
- go to the beach
- dig a hole
- lay towel on sand, over hole
- lie down & dig your toes in the sand
- that's it - enjoy. nice, huh?
13 August 2008
We spent a few days at the beach...
We even went on a rainy day on purpose, in hopes of better waves and had a blast. We made it back to the car just as the first claps of thunder started (don't judge, people - I know I'm a mom & need to be safe - we were & it was fun!)
For some reason, the jellyfish were thick - I've never seen it like that before. The clear ones are harmless; the ones with reddish-brown tentacles can sting, but there were, thankfully, only a few of them.
We think a lot of them were dead already, so we didn't feel too bad about discovering that you can skip them like stones - at least they were getting a chance to get back in the water (she says somewhat sheepishly, trying to feel better about letting her kids skip jellyfish)...
(BTW, DoulaBoy3 was playing on the beach w/DoulaDad - he's just not wave-ready yet)
12 August 2008
People are such asshats sometimes - they want women to be all better & not need anything so that they can feel comfortable. When they ask "how are you", you feel like you are supposed to say "fine" to let them off the hook. And then offer them a cup of coffee, maybe a sandwich and some witty conversation. (It goes without saying that in this sort of scenario, one should be freshly showered, made up and fitting into one's skinny jeans already, with the laundry done and house gleaming). Oy.
Having babies can be wonderful & it can be hard - it's usually both at the same time, even without having to recover from major surgery...too bad that many folks have internalized the Hallmark version of birth & babies & life - that it should all be a glossy lens view of sweet bliss. If it were that way though, it would probably be pretty grim, without any texture in the long run. But in the moment, in the short run, it can kind of suck sometimes. Especially if you are told not to feel the way you do and it seems like you're letting people down, killing the fantasy.
Speaking of tough cesarean stories...I have a would-be client - she has had two prior cesareans and thought she had a doctor/midwife team supporting a VBA2C. She is a nurse and is incredibly well-informed. They have just told her they changed their minds. Game over. Thanks for playing. She is crushed & I wish I could make this different for her. I will offer her information on making it about the birth & not the surgery, but she has every right to her feelings...
Of course a healthy mom & baby is what ultimately matters, but it's not the only point...let's set our sights higher when possible.
The US is the top of the heap for many things, but safety in giving birth isn't one of them. We rank number 41st in the world for maternal mortality, with 13.1 maternal deaths per 100,000 live births. That means there are 40 countries where it is safer to give birth:
It is safer to give birth in the following countries: Australia, Austria,Belgium,Bosnia and Herzegovina, Bulgaria, Canada, Chile, Croatia, Cyprus, Czech Republic, Denmark, Finland, France,Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Latvia, Lithuania, Luxemborg, Malta, Netherlands,New Zealand, Norway, Poland, Portugal, Quatar, Slovakia, Slovenia, Spain, Sweden, Switzerland, The former Yugoslav Republic of Macedonia, and the United Kingdom
But here's the kicker...because of NJ's status as highest in the nation for cesarean rates, if we were our own country, NJ would be 51st (down from the already deplorable 41st that is the US ranking), with 21 deaths per 100,000 live births! (and this is based on old 2004 stats - the numbers have gotten worse)
In addition the the 40 countries the US (as a whole) ranks behind, NJ would also be behind: Bahamas, Barbados, Balaras, Brunei Darussalam, Republic of Korea, Saudi Arabia, Serbia and Montenegro, Singapore, Ukraine, Uruguay.
Props to ICAN (International Cesarean Awareness Network) of Somerset County, NJ for pulling together this information. According to their calculations based on CDC statistics,
The NJ maternal death rate is 60% higher than the US average.
So this isn't a simple debate of birthing preferences - this is life & death, if not for us then for our neighbors right here in NJ.
The sky's the limit for cesarean surgery rates, apparently. I was reading Radical Doula & saw that like just about everywhere, NYC cesarean rates are on the rise, averaging about 31% (with many hospitals or care providers being much higher). A recent story on NY-1 highlights the research compiled by the New Space For Women's Health & Choices in Childbirth. They found a 24 percent jump in c-section rates throughout the city in just six years (2000-2006).
“We're concerned because we believe that there isn't enough information about the risks of cesarean section,” said New Space for Women's Health executive director Rebecca Benghiat.
Her group claims the higher rates could be linked to malpractice fears, lack of informed choices, and increasingly casual attitudes about surgery.
At least NJ doesn't have to feel bested by NYC on this issue - our rates are, sadly, even higher. NJ's preliminary 2006 rate, according to the CDC , is 37.4% of all births or 38.9% according to 2007 NJ health statistics (and you can bet the 2008 rates will be higher still). That makes NJ number one in the US again, unless you count Puerto Rico (a whopping 48%, which is still lower than St. Barnabas right down the road from me: 49.4%!). Certainly more that the 10-15% suggested by the World Health Organization...hell, I'd take Utah's 21.5%!
03 August 2008
You know how some people keep a tally of what they spend or eat? I think I should look into writing down my on-line time...that whole idea of, "well - I don't want to have to write it down & see in black & white that I do it too much, so maybe I won't do it at all right now"
Nah - never mind. But maybe I will go out & play.
02 August 2008
Yesterday we were in the car & were about to drive by the house where we used to live.
As I often do, I said, "say Hi Old House" to the boys.
As we passed, E shouted,
"Hi house where I was born! Mommy - remember when I was born in that house?!" ...Yes I do!