"The words themselves have a soothing and centering quality due to their monosyllabic nature, similar to sounds made by babies."
27 February 2009
sat nam
if your're in IL
26 February 2009
science factoid
in a flash
That's how long it seems since my oldest, 11, was little and needed my help getting dressed. He needed my help again this morning.
Last night I got one of those calls moms hate to get. He was snowboarding and had a minor accident. Minor, but could have been major. A broken arm is all. He FELL, 10 feet, from the lift because he and his friend were horsing around, without the safety bar down. And he wasn't wearing his helmet. Good God - he could have had a traumatic brain injury, a broken neck...it sort of freaks me out to go there, so I mostly don't.
I count myself lucky that with three very active, risk-craving boys, this is the first broken limb among them...and sort of a rite of passage as well. I'm happy there was no concussion (he has had one of those). No blood. Just bad, bad judgment that he will be working off in equally bad karma by missing a few awesome activities and a screeching end to his ski season. I hope he learned his lesson about the safety bar and helmet and maybe got just a small hint that he's not indestructible. Please, please let that be true. Because there is so much about their lives, even at 11, that is out of our control.
He says he will hang the official X-Ray films in his room (the doctor suggested using them as window shades - crafty!) & is planning how to decorate his red cast.
On the way home from the ER he announced that he and the friend he was with on the lift had a plan for their shared 18th birthday: sky diving!
OY.
25 February 2009
new toy
This extravagant gift from my husband feels a bit like when my MIL gifted me with a Bugaboo stroller when they first came out...I sort of felt like I was driving a Hummer - conspicuous consumption. But I loved that stroller & think I will also love this - it's cool & I like gadgets.
And to sooth my consumption concerns, I will donate the new hard copies of some duplicate books (book club favs) to my local library.
24 February 2009
art overload
My 4yo is a prolific artist and is quite attached to keeping his masterpieces...including every last coloring page from story time at the library or the doodles he does while the others do homework. Any mom can do the math: 3 kids X all the pieces of paper, art included, that they bring home...unless there is some culling, pretty soon you are living a nutty hoarder lifestyle with toenail clippings in jars and stacks of newspapers lining the hall.
Said 4yo is on to me and has begun checking the recycle bin to make sure nothing of his has made its way there. I try to hide his stuff (not the cool stuff, just the junk) on the bottom or take it to the big bin outside...but one day last week I forgot & tossed it on top of the bin. Well, he found it and came to me in almost-tears and said, "Do you hate it or do you love it?! Because you said you loved it and then you threw it away! Why do you throw my art away? Which is it - hate or love?"
Ugh. Knife in my heart. I suppose I contribute to the issue by being overly enthusiastic about everything...so I'll try to work on that. I've also made a small pile of really great stuff to frame & display rather than just taping on the door.
Birth on film
23 February 2009
Parenting Magazine
Elizabeth writes:
The headline is "O,h Please!" and the pronouncement at the end is "Get real." How closed-minded! Can't wait to write a letter to the editor!
Here here! Thanks for the heads up.
22 February 2009
got milk?
21 February 2009
repeat cesareans
The Trouble With Repeat Cesareans
By PAMELA PAUL
Thursday, Feb. 19, 2009
For many pregnant women in America, it is easier today to walk into a hospital and request major abdominal surgery than it is to give birth as nature intended. Jessica Barton knows this all too well. At 33, the curriculum developer in Santa Barbara, Calif., is expecting her second child in June. But since her first child ended up being delivered by cesarean section, she can't find an obstetrician in her county who will let her even try to push this go-round. And she could locate only one doctor in nearby Ventura County who allows the option of vaginal birth after cesarean (VBAC). But what if he's not on call the day she goes into labor? That's why, in order to give birth the old-fashioned way, Barton is planning to go to UCLA Medical Center in Los Angeles. "One of my biggest worries is the 100-mile drive to the hospital," she says. "It can take from 2 to 3 1/2 hours. I know it will be uncomfortable, and I worry about waiting too long and giving birth in the car."
Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them. More than 9 out of 10 births following a C-section are now surgical deliveries, proving that "once a cesarean, always a cesarean"--an axiom thought to be outmoded in the 1990s--is alive and kicking. Indeed, the International Cesarean Awareness Network (ICAN), a grass-roots group, recently called 2,850 hospitals that have labor and delivery wards and found that 28% of them don't allow VBACs, up from 10% in its previous survey, in 2004. ICAN's latest findings note that another 21% of hospitals have what it calls "de facto bans," i.e., the hospitals have no official policies against VBAC, but no obstetricians will perform them. (Read "The Year in Medicine 2008: From A to Z.")
Why the VBAC-lash? Not so long ago, doctors were actually encouraging women to have VBACs, which cost less than cesareans and allow mothers to heal more quickly. The risk of uterine rupture during VBAC is real--and can be fatal to both mom and baby--but rupture occurs in just 0.7% of cases. That's not an insignificant statistic, but the number of catastrophic cases is low; only 1 in 2,000 babies die or suffer brain damage as a result of oxygen deprivation.
After 1980, when the National Institutes of Health (NIH) held a conference on skyrocketing cesarean rates, more women began having VBACs. By 1996, they accounted for 28% of births among C-section veterans, and in 2000, the Federal Government issued its Healthy People 2010 report proposing a target VBAC rate of 37%. Yet as of 2006, only about 8% of births were VBACs, and the numbers continue to fall--even though 73% of women who go this route successfully deliver without needing an emergency cesarean.
So what happened? In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be "readily available" during a VBAC to "immediately available." "Our goal wasn't to narrow the scope of patients who would be eligible, but to make it safe," says Dr. Carolyn Zelop, co-author of ACOG's most recent VBAC guidelines.
But many interpreted the revision to mean that surgical staff must be present the entire time a VBAC patient is in labor. While major medical centers and hospitals with residents are staffed to provide this level of round-the-clock care, smaller hospitals typically rely on anesthesiologists on call. Among obstetricians, many solo practitioners are unable to stay for what could end up being a 24-hour delivery; others calculate the loss of unseen patients during that time and instead opt to do hour-long cesareans, which are now the most commonly performed surgeries on women in the U.S.
Some doctors, however, argue that any facility ill equipped for VBACs shouldn't do labor and delivery at all. "How can a hospital say it can handle an emergency C-section due to fetal distress yet not be able to do a VBAC?" asks Dr. Mark Landon, a maternal-fetal-medicine specialist at the Ohio State University Medical Center and lead investigator of the NIH's largest prospective VBAC study. (See 9 kid foods to avoid.)
Part of the answer has to do with malpractice insurance. Following a few major lawsuits stemming from VBAC cases, many insurers started jacking up the price of malpractice coverage for ob-gyns who perform such births. In a 2006 ACOG survey of 10,659 ob-gyns nationwide, 26% said they had given up on VBACs because insurance was unaffordable or unavailable; 33% said they had dropped VBACs out of fear of litigation. "It's a numbers thing," says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. "You don't get sued for doing a C-section. You get sued for not doing a C-section."
Of course, the alternative to a VBAC isn't risk-free either. With each repeat cesarean, a mother's risk of heavy bleeding, infection and infertility, among other complications, goes up. Perhaps most alarming, repeat C-sections increase a woman's chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth. The rate of placenta accreta--in which the placenta attaches abnormally to the uterine wall--has increased thirtyfold in the past 30 years. "The problem is only beginning to mushroom," says ACOG's Zelop.
"The decline in VBACs is driven both by patient preference and by provider preference," says Dr. Hyagriv Simhan, medical director of the maternal-fetal-medicine department of Magee-Womens Hospital of the University of Pittsburgh Medical Center. But while many obstetricians say fewer patients are requesting VBACs, others counter that the medical profession has been too discouraging of them. Dr. Stuart Fischbein, an ob-gyn whose Camarillo, Calif., hospital won't allow the procedure, is concerned that women are getting "skewed" information about the risks of a VBAC "that leads them down the path that the doctor or hospital wants them to follow, as opposed to medical information that helps them make the best decision." According to a nationwide survey by Childbirth Connection, a 91-year-old maternal-care advocacy group based in New York City, 57% of C-section veterans who gave birth in 2005 were interested in a VBAC but were denied the option of having one.
Zelop is among those who worry that "the pendulum has swung too far the other way," but, she says, "I don't know whether we can get back to a higher number of VBACs, because doctors are afraid and hospitals are afraid." So how to reverse the trend? For one thing, patients and doctors need to be as aware of the risks of multiple cesareans as they are of those of VBACs. That is certain to be on the agenda when the NIH holds its first conference on VBACs next year. But Zelop fears that the obstetrical C-change may come too late: "When the problems with multiple C-sections start to mount, we're going to look back and say, 'Oh, does anyone still know how to do VBAC?'"
18 February 2009
missing ritual
Reading it, I couldn't help but think of friends who had lost a parent or a husband or a child. I especially thought of Molly and Stacey, whom I love...I hope this isn't too hard for them to read.
For others who see themselves in this, I am deeply sorry for your pain too.
The Long Goodbye
What grief is really like.
By Meghan O'Rourke
Updated Tuesday, Feb. 17, 2009, at 7:32 AM ET
--------------------------------------------------------------------------------
The other morning I looked at my BlackBerry and saw an e-mail from my mother. At last! I thought. I've missed her so much. Then I caught myself. The e-mail couldn't be from my mother. My mother died a month ago.
The e-mail was from a publicist with the same first name: Barbara. The name was all that had showed up on the screen.
My mother died of metastatic colorectal cancer sometime before 3 p.m. on Christmas Day. I can't say the exact time, because none of us thought to look at a clock for some time after she stopped breathing. She was in a hospital bed in the living room of my parents' house (now my father's house) in Connecticut with my father, my two younger brothers, and me. She had been unconscious for five days. She opened her eyes only when we moved her, which caused her extreme pain, and so we began to move her less and less, despite cautions from the hospice nurses about bedsores.
For several weeks before her death, my mother had been experiencing some confusion due to ammonia building up in her brain as her liver began to fail. And yet, irrationally, I am confident my mother knew what day it was when she died. I believe she knew we were around her. And I believe she chose to die when she did. Christmas was her favorite day of the year; she loved the morning ritual of walking the dogs, making coffee as we all waited impatiently for her to be ready, then slowly opening presents, drawing the gift-giving out for hours. This year, she couldn't walk the dogs or make coffee, but her bed was in the room where our tree was, and as we opened presents that morning, she made a madrigal of quiet sounds, as if to indicate that she was with us.
Since my mother's death, I have been in grief. I walk down the street; I answer my phone; I brush my hair; I manage, at times, to look like a normal person, but I don't feel normal. I am not surprised to find that it is a lonely life: After all, the person who brought me into the world is gone. But it is more than that. I feel not just that I am but that the world around me is deeply unprepared to deal with grief. Nearly every day I get e-mails from people who write: "I hope you're doing well." It's a kind sentiment, and yet sometimes it angers me. I am not OK. Nor do I find much relief in the well-meant refrain that at least my mother is "no longer suffering." Mainly, I feel one thing: My mother is dead, and I want her back. I really want her back—sometimes so intensely that I don't even want to heal. At least, not yet.
Nothing about the past losses I have experienced prepared me for the loss of my mother. Even knowing that she would die did not prepare me in the least. A mother, after all, is your entry into the world. She is the shell in which you divide and become a life. Waking up in a world without her is like waking up in a world without sky: unimaginable. What makes it worse is that my mother was young: 55. The loss I feel stems partly from feeling robbed of 20 more years with her I'd always imagined having.
I say this knowing it sounds melodramatic. This is part of the complexity of grief: A piece of you recognizes it is an extreme state, an altered state, yet a large part of you is entirely subject to its demands. I am aware that I am one of the lucky ones. I am an adult. My mother had a good life. We had insurance that allowed us to treat her cancer and to keep her as comfortable as possible before she died. And in the past year, I got to know my mother as never before. I went with her to the hospital and bought her lunch while she had chemotherapy, searching for juices that wouldn't sting the sores in her mouth. We went to a spiritual doctor who made her sing and passed crystals over her body. We shopped for new clothes together, standing frankly in our underwear in the changing room after years of being shyly polite with our bodies. I crawled into bed with her and stroked her hair when she cried in frustration that she couldn't go to work. I grew to love my mother in ways I never had. Some of the new intimacy came from finding myself in a caretaking role where, before, I had been the one taken care of. But much of it came from being forced into openness by our sense that time was passing. Every time we had a cup of coffee together (when she was well enough to drink coffee), I thought, against my will: This could be the last time I have coffee with my mother.
Grief is common, as Hamlet's mother Gertrude brusquely reminds him. We know it exists in our midst. But I am suddenly aware of how difficult it is for us to confront it. And to the degree that we do want to confront it, we do so in the form of self-help: We want to heal our grief. We want to achieve an emotional recovery. We want our grief to be teleological, and we've assigned it five tidy stages: denial, anger, bargaining, depression, and acceptance. Yet as we've come to frame grief as a psychological process, we've also made it more private. Many Americans don't mourn in public anymore—we don't wear black, we don't beat our chests and wail. We may—I have done it—weep and rail privately, in the middle of the night. But we don't have the rituals of public mourning around which the individual experience of grief were once constellated.
And in the weeks since my mother died, I have felt acutely the lack of these rituals. I was not prepared for how hard I would find it to re-enter the slipstream of contemporary life, our world of constant connectivity and immediacy, so ill-suited to reflection. I envy my Jewish friends the ritual of saying kaddish—a ritual that seems perfectly conceived, with its built-in support group and its ceremonious designation of time each day devoted to remembering the lost person. So I began wondering: What does it mean to grieve in a culture that—for many of us, at least—has few ceremonies for observing it? What is it actually like to grieve? In a series of pieces over the next few weeks, I'll delve into these questions and also look at the literature of grieving, from memoirs to medical texts. I'll be doing so from an intellectual perspective, but also from a personal one: I want to write about grief from the inside out. I will be writing about my grief, of course, and I don't pretend that it is universal. But I hope these pieces will reflect something about the paradox of loss, with its monumental sublimity and microscopic intimacy.
If you have a story or thought about grieving you'd like to share, please e-mail me at morourkexx@gmail.com.
Meghan O'Rourke is Slate's culture critic and the author of Halflife, a collection of poetry.
Article URL: http://www.slate.com/id/2211257/
Copyright 2008 Washingtonpost.Newsweek Interactive Co. LLC
16 February 2009
sharing the wealth
When I was born, there was another baby who needed milk & his mom was unable to feed him, so my mom did (at the hospital's request, as there were some sort of special circumstances)...I've never nursed someone else's baby, but I have donated my milk to a baby who's mom was undergoing chemo.
What about you - would you do this for another? If your baby were very hungry and you couldn't feed her, would you welcome someone else doing it? I know there are questions of health etc. (in the case of my donation, medical questions were asked of me), but I'm talking about how this feels to you, in your heart? I say yes & yes.
Thanks to Cooler Than The Cat for posting...
Another reason to get you Vit. D
Vitamin D deficiency linked to cesareans
Women deficient in vitamin D had a four times greater risk of having a cesarean says a multivariable analysis published in the Journal of Clinical Endocrinology and Metabolism. Theories are that skeletal and smooth muscle strength is compromised and it is possible that there might be an association to diagnoses of cephalopelvic disproportion and failure to progress as well as preeclampsia due to a link with immune status. The researchers conclude that a randomized controlled trial is warranted because vitamin D deficiency is on the rise. Read about it here.
15 February 2009
serindipity
happy sigh...
14 February 2009
Happy V Day
On this Valentine's Day, consider checking out the film, Until The Violence Stops, documenting the growth of Eve Ensler's The Vagina Monologues, which has grown into an international grassroots movement to stop violence against women and girls.
12 February 2009
a-ha
I know it's not rocket science & I'm a dope for taking so long to figure this out, but seriously, I'm feeling like such a better version of myself.
11 February 2009
Welcome baby Aoife Jean!
What luck to have a nurse who used to work in a birth center (the same one where I, myself, gave birth to my second son), as well as such a wonderful doctor - a true gaurdian of the sanctity of birth.
Welcome to the world, Aoife!
My 4yo was right - you were born on 2/10!
10 February 2009
where's the moxie?
09 February 2009
now the work begins
"The woman who starts the race is not the same woman who finishes the race"...
She SwimsShe RidesShe RunsSheROX!
08 February 2009
T minus
07 February 2009
happiness - more inauguration
A friend just sent me a link to a NY Times visual editorial - really cool! Check out the whole thing here
06 February 2009
pee standing up?
Ladies - if this has ever seemed like a good idea to you...then check out the Freshette! Though sort of amusing (goodness knows my oldest son thought so when he saw my computer screen!), it could also be a good idea if you are someplace (like a triathlon with reportedly few porta potties) without access to the loo!
It's no stadium pal, but it's pretty close! ;-)
05 February 2009
Tri - do!
My friend & I went and bought a couple of books today on training, as well as some new bras. We did this after swimming laps (and doing a sort of lame aqua circuit class), both agreeing that the swim will be the hardest part for us. We will train in the ocean over the summer.
Overall I'm feeling great about this!
Anyway, I've come up with my own little catch phrase for all this...contrary to the common mom-anthem about not having time:
I don't have time not to exercise!
04 February 2009
doula anthology
Dear Doulas,
Please help submit stories for an anthology about doulas.
Editor seeks true, first-person accounts from moms, dads, midwives, docs, nurses,
and others present at doula-supported birth. What did you experience,
observe, feel, learn, reflect upon? How were you moved, changed by the
experience? What can you share with prospective parents, reluctant
practitioners, passionate advocates? Send double-spaced
MSWord attachment (2,000 w. max) + 50 w. bio by Aug. 31.
eclift@vermontel.net
Thanks for your help and please share this request
03 February 2009
(economic) woe is we
Tomorrow, Wednesday 2/4, Public Radio/WNYC's Brian Lehrer show will have on Maplewood head librarian to discuss how hard times are impacting libraries...specifically, ours - the one that serves moms with no other way to gather and meet, the one that gives refuge to kids when school lets out...take a listen tomorrow.
Here's the comment that planted the seed for the show, which states,
The library here in Maplewood, NJ has 8% more traffic in the last year. People are gathering there and using the internet access and computers to look for work. They are also checking out a lot more books instead of automatically visiting Amazon or big box stores. They are also taking advantage of the free children's story times and crafts and other programming. It's pretty amazing to see people actually utilizing the library for all the things it has provided all along. (This would be filed under "Bright Spot" except that the funding for the library will probably be slashed soon.)
co-sleeping
02 February 2009
Erykah Badu tweets home birth
...here's the story on MTV.com Congrats to the family!
Erykah Badu, Jay Electronica Blog Child's Birth In Real Time On Twitter
'Morning, I'm in labor,' soul singer tweets on Sunday.
By Jayson Rodriguez
Artists have always done strange things to win our attention, right? And lately, we've seen how musicians are using micro-blog site Twitter as an über-marketing tool. This weekend, one pair of artists took things further than we expected, as Erykah Badu and her beau, upstart rapper Jay Electronica, sent tweets of their daughter's birth in real time.
The ever enigmatic Badu kick-started the experience, telling the more than 4,500 followers of her Twitter blog, "Fatbellybella": "Morning, I'm in labor."
The Grammy-winning singer gave updates on the time between her contractions before going AWOL. Presumably Badu was, you know, giving birth when she disappeared. But Electronica kept sending updates throughout the birth on his page, "JayElectronica."
Badu and Electronica chose to forgo delivery in a hospital and instead opted for a home birth with a midwife. According to updates, it looked like the midwife may have been running a bit late.
"Labor has begun," Electronica wrote. "Everybody stand back. No hospitals. No doctors. No medicine. We're waiting for the midwife to show."
While waiting for the midwife, Electronica described the vibe and sent messages to rapper Talib Kweli ("I'm build for this sh--") and producer Just Blaze ("You should be here").
Electronica also compared the atmosphere to a scene from "The Color Purple." He wrote that only a few family members were present in Badu's Brooklyn home, including her daughter Puma. The rapper told followers he was sending the tweets between watching contractions and rubbing Badu's feet. He even blogged about Badu's water breaking, how far along she was dilated and when she started pushing.
"I see the head, full of hair," he wrote. Just over 20 minutes later, Badu gave birth.
"Feb. 1 2009 my first child, my daughter born at 130 PM exactly," the new father wrote. "It's the happiest day of my life."
Later, Badu, who has two children from previous relationships with rappers Andre 3000 and the D.O.C., popped back online with a message to fans.
"I can't believe it's over," she wrote. "Home birth, no painkillers, about five hours, she was a little past due date, but I didn't mind waiting. Breath."
01 February 2009
on the cusp?
Check out an Associated Press article on birth, health care reform and The Big Push For Midwives.
By DAVID CRARY – 3 days ago
NEW YORK (AP) — With health care costs high on the national agenda, advocates of home births are challenging the medical and political establishments to give midwives a larger role in maternity care and to ease the state laws that limit their out-of-hospital practice.
Pending bills to further this goal have significant backing in several states, which home-birth supporters want to add to the 25 states that already have taken such steps.
Nationally, a group called the Big Push for Midwives marked President Barack Obama's inauguration with an e-mail campaign urging him to ensure that midwives who specialize in home births are included in deliberations on federal health care reform.
"We're at a tipping point now," said Katherine Prown, the Big Push campaign manager. "Home births are still only a small part of the total, but it's poised for growth."
The campaign seeks to emphasize that in this time of economic crisis, home births can be a safe, satisfying and moneysaving option for many women. But it runs into adamant opposition from the American Medical Association and the American College of Obstetricians and Gynecologists.
"Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause celebre," the obstetricians' policy statement says. "Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby."
According to the latest federal data, there were only about 25,000 home births nationally in 2006 — most of them assisted by midwives — out of nearly 4.3 million total births.
Midwife-attended home births increased by 27 percent between 1996 and 2006. Home-birth advocates believe the numbers will rise as more states amend their laws to accommodate the practice, which they contend is at least as safe as hospital births for healthy women with low-risk pregnancies.
One of the strengths of the state-by-state campaign is its diversity, Prown said.
"We're one of the few movements that's succeeded in bringing together pro-life and pro-choice activists, liberal feminists and Christian conservatives,
" she said. "In every state we manage to recruit Republican and Democratic co-sponsors who normally would never be on the same bill together." The states are now evenly split on legal recognition of certified professional midwives (CPMs) — those who lack nursing degrees and who account for most midwife-assisted home births.
Half the states have procedures allowing CPMs to practice legally — including five which have taken such steps since 2005. The other 25 states lack such procedures and CPMs are subject to prosecution for practicing medicine without a license.
Depending on legislative decisions, the balance could shift this year. Among the battlegrounds:
_In North Carolina, a House study committee recommended in December that the legislature develop licensing standards for CPMs. The committee said the current system doesn't meet the needs of women who chose non-hospital births because of the "extremely limited supply" of obstetricians and nurse-midwives offering to handle such births.
_In Idaho, advocates who failed previously to get a voluntary licensing bill through the legislature are back with a mandatory licensing bill. State Rep. Janice McGeachin, R-Idaho Falls, says the changes helped persuade the state boards of nursing and pharmacy to drop their opposition. The Idaho Medical Association, which fought the earlier version, has expressed respect for the changes in the bill and is deliberating on whether further changes might produce a version it could accept.
_In Illinois, advocates also are back with a new version of a licensing bill that failed in 2007. Rep. Julie Hamos, D-Evanston, says it toughens qualification standards for CPMs — changes that prompted the Illinois Nurses Association to drop its opposition. The Illinois State Medical Society remains opposed.
"There are many in the legislature who feel a need to have this option — they need to be educated," said Dr. Shastri Swaminathan, the society's president. "We're in strong opposition to licensing midwives who don't have the medical training to provide safe home births."
Cost is a major element in the debate. A routine hospital birth often can cost $8,000 to $10,000, with higher bills for cesarean section deliveries that now account for 31 percent of U.S. births.
Midwives' fees for home births are often less than a third of the hospital cost, in part because the mothers generally don't receive epidural anesthesia or various other medical interventions at home.
For pregnant women, insurance coverage can be a decisive factor in their choice. Many insurers cover care by nurse-midwives in hospitals; coverage is less common for midwives who aren't nurses or who assist with home births.
Many obstetricians acknowledge that the spiraling cost of maternity care and high rate of C-sections are problems.
"But the answer is not to have births at home," said Dr. Erin Tracy, an obstetrician at Massachusetts General Hospital in Boston. "We obviously support women's empowerment, but the No. 1 guiding principle has to be the health and safety of the mother and baby."
The national physicians' groups do support births assisted in hospitals and birthing centers by midwives who've completed nursing school or an equivalent postgraduate program.
The American College of Nurse-Midwives, which represents these midwives, says it differs from the AMA in considering home births a legitimate option for pregnant women. But the college says only nurse-midwives or others with comparable training should be allowed to assist.
"We don't believe it's safe without being integrated into the full health care system," said Melissa Avery, the college's president.
The education standards endorsed by the college would exclude many of the estimated 1,400 certified professional midwives, who often acquire training through apprenticeships.
Jane Peterson of Iola, Wis., is an example. She began a midwife apprenticeship in 1980 and has attended more than 1,330 births since then, many of them before she and her counterparts were legally authorized to practice under a 2005 state law.
Peterson, 56, said she strives to develop collaborative relations with local doctors so that transfers to hospitals go smoothly if risk factors develop. She believes such cooperation should be encouraged nationwide, so more women can feel comfortable about choosing home births.
"People will tell you that you changed their lives," said Peterson, reflecting on the rewards of her job.
"It's hard work — getting up on a cold winter night, going out one more time through the snow. What keeps you going is the recognition women feel — as though they are a different kind of mother when they've been able to give birth their way."
On the Net:
- American College of Obstetricians and Gynecologists: http://www.acog.
org/ - Big Push for Midwives: http://www.thebigpu
shformidwives. org/