Attached at the Hip

The Baby and the Bathwater

This evening on Facebook, I came across a post that caught my attention.  It was a picture of a baby.  I have a thing for cute, sleeping babies, so I looked closer... And, to my horror, I discovered that the image was of a baby sleeping in a bed with - get this - a butcher knife. The title across the top of the image reads, "Your baby sleeping with you can be just as dangerous."  These shocking, ghastly images are put out by the City of Milkwaukee Health Department, part of a campaign from the Mayor's office to reduce the abominably high rates of infant mortality in their city.

It turns out that Milwaukee has had an unusual number of infant deaths that occurred while the child was bed-sharing.  Or so it would seem.  The City Health Department claims that 89 infants died in an "unsafe sleep environment" (which is not exclusive to bed-sharing) from 2006-2009.  (In the US in 2000, only 60 deaths are reported to have occurred in an adult bed, whether or not it was related to being in the bed.)  Even the Milwaukee Health Department acknowledges that there are multiple factors involved in these tragic deaths.  In fact, it doesn't appear that being in bed with a parent or caregiver is actually the most common factor!

Still, they have decided to vociferously work to undermine bed-sharing.  For the first time in my life, I was compelled to write to those in charge of making this abhorrent ad campaign.  Following is the letter I emailed to the Mayor of Milwaukee, Tom Barrett.  I encourage you to also write to the Mayor's office and the Department of Health and encourage them to withdraw these provocative, misleading ads.

Mayor Barrett,

I have recently been made aware of an upcoming publicity campaign directed by your office with the purported goal of reducing infant mortality.  The ghastly image of a child sleeping with a butcher's knife is certain to evoke emotion - but unfounded fear of bed-sharing with an infant will not, in fact, affect your city's infant mortality rates.

While you have had some notable deaths in your area related to bed-sharing, you have neglected to see the underlying and root cause of the problem.  It is not sharing the bed that is harmful; it is doing so when impaired (i.e., drunk) and, moreover, doing so when not breastfeeding.  

Dr. James McKenna of Notre Dame has done extensive research on mother-baby sleep patterns.  His summary of risk factors for infant death in bed-sharing are as follows:

"In sum, overwhelmingly, bedsharing deaths are associated with at least one independent risk factor associated with an infant dying. These include an infant being placed prone (on its stomach) and placed in an adult bed without supervision, or no breastfeeding, or other children in the bed, or infants being placed in an adult bed on top of a pillow, or who bedshare even though their mothers smoked during the pregnancy therein compromising potentially the infants ability to arouse (to terminate too little oxygen, or to terminate an apnea). 

Drug use and alcohol have historically been associated with poor outcomes for bedsharing babies so if drugs and/or alcohol are present, please don’t bedshare."

(Source:  http://cosleeping.nd.edu/frequently-asked-questions)

Bed-sharing with a sober, clean, non-smoking, breastfeeding mother in a suitable environment is not only safe but actually safer for the baby, as the mother is immediately available to any distress, illness, or need.  It is a normal, healthy human behavior that should not be discouraged by any government office.

(Sources:  http://www.askdrsears.com/topics/sleep-problems/sids-latest-research-how-sleeping-your-baby-safe

and http://cosleeping.nd.edu/ - video)

How much better would it be for your office to undertake education and support for your at-risk population to initiate and continue breastfeeding?  The benefits of breastfeeding are multifold and bed-sharing while breastfeeding is rarely harmful; indeed, the opposite.  Your bed-sharing concerns could be reduced or eliminated by educating mothers and supporting them in providing the most perfect, healthful feeding for their babies.  The rates of breastfeeding in African American mothers is significantly lower than other demographics.  The poorer and younger the mother, the less likely she is to breastfeed, as well.  Addressing these issues will have long-term benefits to your city and the generations to come.

(Source:  http://www.breastfeeding.com/all_about/all_about_more.html

and http://www.cdc.gov/nchs/data/databriefs/db05.htm)

Would it not also make sense to address the issues of drug and alcohol abuse, which present significant dangers to mothers, their children, and society?  There are, in fact, numerous factors that have led to the abysmal infant mortality rates in your city.  Addressing these issues is admirable and needed, but the attack on a normal, nutritive, safe practice is abhorrent.

Let's not "throw the baby out with the bathwater," shall we?

Sincerely,

H. B.

I dare say that providing accurate, research-based information on creating a safe sleeping environment would be far better, in the long run, for all of the children of Milwaukee.

Why use a Midwife?

Whether or not you've ever had a baby (or supported a woman who has), you've likely heard of the term "midwife."  What IS a midwife, you may have wondered, and WHY would someone choose to use one in lieu of an obstetrician?

While the latter question is multi-fold, the former is mostly straightforward.  "Midwife" means, literally, "with woman."  A midwife is a skilled, trained birth attendant (almost always a woman but I have known of male midwives), who supports a woman through pregnancy and childbirth.  Midwives may be nurse-midwives who work primarily in hospital settings; nurse-midwives who work in birth center or home settings; or certified midwives who work in birth centers or at home.  There is some overlap, depending on states and particular midwives.

The common thread behind all midwives is the adherence to the Midwives Model of Care, which includes support for ALL aspects of a woman's well-being (not just the physical aspects of the pregnancy), and a trust in the natural course of birth and the natural design of the woman's body to birth.  Therefore, midwives use far fewer interventions than obstetricians, and most midwife-attended births are "natural" births - vaginal, drug-free, non-interfered-with.  

Many midwives have expertise in alternative treatments and may employ herbal, homeopathic, and common remedies for various issues in pregnancy, birth, and postpartum.  Their varied "bag of tricks" often makes them far more successful in dealing with these issues than an obstetrician, who is not trained in handling many of these variances of normal.  Midwives will also carry oxygen for mother and baby, pitocin for handling heavy bleeding after the birth, and tools for suturing.  In some states, they may also carry IVs or other equipment.

So, now you know what a midwife is.  But why do people choose them?  There are many reasons, to be sure, but one of the primary reasons is SAFETY.  Many studies have shown that, for a woman with a low-risk pregnancy, birthing at home with a skilled midwife is as safe - or SAFER - than a hospital birth.  

This is a short film that covers this question thoroughly, "Why Choose a Midwife?"  In the film, a variety of doctors, including obstetricians, speak on why midwifery and home birth are good and safe options for many women, and why it is beneficial to states to support access to midwifery.

The Great Debate

Some time ago, a reader wrote and asked me to post about routine infant circumcision.  I was surprised to search the archives here and discover I hadn't posted anything about it in the past.  Today, I saw a post on the Peacful Parenting Facebook page that is so well done that it must be shared.  I know it's a very sensitive (ha!) topic, so first, let me share my own story.

My own journey with circumcision started 8.5 years ago, when I was pregnant with my first child.  There were many decisions to be made while pregnant: where to birth, what kind of diapers to use, whether or not to buy a crib, which dresser to get, whether to get an infant seat or a convertible seat, and, if it's a boy, whether or not to circumcise.  Most of those issues are not, in the long run, a big deal (even though I am now rather passionate about most of them!), but circumcision seemed like a much bigger one.  It was not something I had much exposure to or information on, so I began to dig up what there was.

My first thought was that we, as Christians, were supposed to circumcise, because, well, that's what all the Christians do - right?  It's clearly stated in the Old Testament as a command to the people of Israel, and by all appearances was prevalent in the Church.  But that seemed counter to the new covenant and New Testament statements such as in Galatians 5:6, "For in Christ Jesus neither circumcision nor uncircumcision has any value. The only thing that counts is faith expressing itself through love."  The New Testament is clear that we are saved by grace, not by any acts, including that of circumcision.  So why, then, did it seem like the norm in the church and the US as a whole?

Further research unveiled the origins of circumcision in the US, which was not for purposes of righteousness, but for an attempt to prevent masturbation in boys.  Whether that was for puritanical reasons or because they thought it created disease is unclear, but while the majority of the world was not practicing infant circumcision, it was introduced in the US for very suspect reasons.  (The US remains one of the only countries in the world to practice routine infant circumcision without religious reasons [it is a religious rite in both the Jewish and Muslim faiths].)

In fact, I discovered, there was no evidence of any real health benefit to circumcision.  The best I could find is that, maybe, intact males might experience more UTIs (which are far more common in girls than boys, to begin with).  But, still, we struggled with a decision.  It was the most trying of all, and it wasn't until we'd prayed long and hard that we finally felt a real peace with our decision to leave our child (if he was a boy) intact.  When he was finally born, I remember clearly the feeling that I couldn't possibly take my son home (he was born in a hospital) differently than how he was born, so perfect and beautiful.

Much later, after our second son was born (and also left intact), I came across this article on Biblical Circumcision.  I was awed by how much the conclusions they came to mirrored my own convictions following the research and prayer.  They had far more information than I did, but it all confirmed our decision once again.  I highly recommend that Christian parents read the article for an excellent lesson in the history of circumcision from a biblical perspective.

So, back to today.  The Peaceful Parenting blog posted an excellent, concise, and thorough article on cirucmcision that EVERY family should read.  The video at the end, while a bit long at 20 minutes, is also excellent.  Between the two, they answer all of the common questions about circumcision, including, what it is, why it's done, how it's done, what the short- and long-term effects are, and more.  I am a passionate believer in informed parenting, and hope that more and more parents will have access to this type of information in their decision making.  It certainly would have made our own struggle through decision much easier.

And, nearly 8 years later, I can testify that we have had absolutely NO regrets in our decision to leave our three sons intact.  With a combined 15 years of experience, we've had no UTIs, no complications, and have to do, well, nothing special.  It's so easy to clean and to teach them to clean, and they are very happy and comfortable with their natural bodies.  I am so grateful that there was at least some information out there when we were looking, and, moreover, that we were able to listen to the gentle nudges and assurances that this was the right thing to do.

.....

I know that many people have had to make these decisions without the benefit of resources like I found or am sharing.  And, I know many people who have learned more and regretted their decisions to circumcise.  I know there will be those who feel justified in their decisions, and that's fine.  Most of all, I do not want to condemn those who have made the decision to circumcise when they never had the resources to make an informed choice.  My goal is to share information to help everyone make the best decisions they can, from now into the future.  I trust we all make the best efforts we can to be the best parents we can be, today.

The Effects of Fear

I recently posted a link on Facebook to an article I found about the disturbing effects of cesareans on women's fertility.  The issues discussed in the article include secondary infertility as a result of a primary cesarean, as well as the emotional and psychological scarring that leads many women to refuse to have more children.  These women simply can't face the possibility of having another cesarean, even if they know that a VBAC is also an option.

One of the most concerning things to me about an article like this is that the vast majority of women do not go into birth knowing the true risks of cesarean.  They are not told about the risks to future fertility (something like 13% had issues, as described in the article), to their future children, and to themselves.  Most women who have cesareans believe it is in the best interest of their child and themselves, but statistically we know that most cesareans are not necessary.

As they say near the end of the article, necessary cesareans account for approximately 5% (WHO says up to 10% is acceptable) of all births. In the US, it's 36% nationwide! We are, without question, at a point when we are causing more harm than good. It's statistics, and the evidence is abounding. Rather than saving lives, we're taking them. Rather than preventing harm, we're causing it. We're past the point of diminishing returns, and the blasé attitude in this country about cesareans is only making it worse.

It is true that many people escape cesareans "relatively unharmed." And there are, certainly, those 5-10% of cesareans that truly save lives. But 26-31% of women in America are undergoing major surgery; being introduced to the risk of infections (which can be major), damage to internal organs, and fertility issues; and having their babies health and breastfeeding relationships jeopardized for no reason. They are completely avoidable, mostly iatrogenic (caused by a hospital/doctor), superfluous cesareans that do more harm than good.

Fear is a huge enemy to birth. Unfortunately, our society and our medical professionals create an atmosphere of fear around every.single.birth. This fear that "something could go wrong" (and I am very familiar with what can, truly, go wrong in pregnancy and birth) makes women dependent on doctors and medical technology. Instead of relying on their bodies and the Omniscient Creator of their bodies and this awesome thing called birth, they rely on the god of Technology.

Unfortunately, study after study and uncountable real life situations have proven that these technologies are NOT creating better outcomes. In fact, in the US, where we use a laundry list of technological interventions because of our inordinate fear of birth (such as ultrasound, pitocin, continuous fetal monitoring, epidural, vacuum, forceps, and cesarean), our neonatal and maternal morbidity and mortality rates are climbing. We are one of the worst countries in the world for mother/baby health.  And, yet, these Technologies are touted as saving lives and preventing problems. Do they? Sure, in some situations. But they're overused and are responsible for so many of these problems.

And it's all because of fear. 

Women need to be informed, and by being informed, empowered. I have studied birth extensively, and I am firmly convinced that it is, as one midwife said, "as safe as life gets." There are risks everywhere, and birth is no different, when it is allowed to progress as designed.

It is, ultimately, a God-designed and God-ordained process that has very specific goals for both mother and child. When allowed to follow these processes, it is an amazing, enlightening, empowering, and wholly transforming experience. For every interference, some of that is lost, and the risks are increased.

I do highly recommend Pushed: The Painful Truth About Childbirth and Modern Maternity Care, by Jennifer Block, as a very thorough look at our modern birth care system. I feel that every woman (and her spouse) should read it, specifically, the first few chapters. Those interested in cesarean, VBAC, and birth advocacy should read the entire book (and likely won't be able to put it down).

Save Handmade - CPSIA Blog-in Day

Some of the wonderful artisans of etsy have designated today as a blog-in day to raise awareness of the impending ramifications from the CPSIA legislation.  This is a major law that will affect everyone if not amended.  Read on to see just how it may affect YOU!

As parents and concerned citizens I’m sure most of us at one time or another have been confronted with the question of lead poisoning. But have you asked yourself what your government is doing to protect your children from lead contained in toys? The answer? They're banning toys, taking books from schools and libraries, hurting low income families, killing entrepreneurial spirit and risking putting the economy in an even greater depression than we've seen in decades. I'd like to introduce you to their solution: the CPSIA.

Do you know about the CPSIA? No? Then I ask you to take a few minutes to find out about it.

The CPSIA stands for Consumer Product Safety Improvement Act, a new set of laws that will come into effect on 10 February, 2009 and will impact many, many people in a negative way. Make no mistake, this is very real. View it for yourself. If Forbes, the American Library Association and numerous other media are paying attention, perhaps you should too. 

How will these new laws affect you? Well, here are a few examples: 

To the Parents of Young Students:
Due to the new law, expect to see the cost of school supplies sky rocket. While those paper clips weren't originally intended for your student to use, they will need to be tested now that your 11-year-old needs them for his school project. This law applies to any and all school supplies (textbooks, pencils, crayons, paper, etc.) being used by children under 12.

To the Avid Reader:
Due to the new law, all children's books will be pulled from library and school shelves, as there is no exemption for them. That’s okay though, there's always television. Our children don’t need to learn the love of reading after all.
Article from the American Library Associationhttp://www.wo.ala.org/districtdispatch/?p=1322

To the Lover of All Things Handmade:
Due to the new law, you will now be given a cotton ball and an instruction manual so you can make it yourself since that blanket you originally had your eye on for $50 will now cost you around $1,000 after it's passed testing. It won't even be the one-of-a-kind blanket you were hoping for. Items are destroyed in the testing process making one-of-a-kind items virtually impossible. So that gorgeous hand-knit hat you bought your child this past winter won’t be available next winter.

To the Environmentalist:
Due to the new law, all items in non-compliance will now be dumped into our already overflowing landfills. Imagine not just products from the small business owners, but the Big Box Stores as well. You can't sell it so you must toss it. Or be potentially sued for selling it. You can't even give them away. If you are caught, it is still a violation.

To the Second-Hand Shopper:
Due to the new law, you will now need to spend $20 for that brand new pair of jeans for your 2-year old, rather than shop at the Goodwill for second hand. Many resale shops are eliminating children's items all together to avoid future lawsuits.

To the Entrepreneur:
Due to this new law, you will be forced to adhere to strict testing of your unique products or discontinue to make and/or sell them. Small businesses will be likely to be unable to afford the cost of testing and be forced to close up shop. Due to the current economic state, you'll have to hope for the best when it comes to finding a new job in Corporate America. 

To the Antique Toy Collector:
Due to the new law, you'd better start buying now because it's all going to private collection and will no longer be available to purchase. “Because the new rules apply retroactively, toys and clothes already on the shelf will have to be thrown out if they aren't certified as safe.”http://online.wsj.com/article/SB123189645948879745.html

To the American Economy:
Already struggling under an economy that hasn’t been this weak in decades, the American economy will be hit harder with the inevitable loss of jobs and revenues from suppliers, small businesses and consumers. The required testing is far too costly and restrictive for small businesses or individuals to undertake. 

To the Worldwide Economy:
Due to this new law, many foreign manufacturers have already pulled out of the US market. You can imagine the impact of this on their businesses. 

If you think this is exaggerating, here is a recent article from Forbes
http://www.forbes.com/2009/01/16/cpsia-safety-toys-oped-cx_wo_0116olson.html

And for those of you prepared to be stupefied and boggled, The New Law
http://www.cpsc.gov/about/cpsia/cpsia.html

Did you know? If this upsets or alarms you, please react.  You can get a badge (and tons of other helpful info) in the Etsy CPSIA Action Kit:
Download the PDF file here.
http://www.etsy.com/storque/media/bunker/2009/01/CPSIA-Etsy-Resources.pdf

The Birth Survey

If you've ever been pregnant, you've most likely searched for a care provider and birth place that would be just right for you.  But how do you find out what care providers and birth locales are really like?  It's nearly impossible to get specific answers to questions from providers, and especially from hospitals.  Without this data, we're left to choose from the proverbial phone book, or insurance company lists. Even personal referrals leave a lot of unanswered questions.  But what if these choices could make a huge difference in your pregnancy and birth?

The reality is that the choice of care provider and birth setting makes a tremendous difference, both on the progress of pregnancy and the outcome of the birth.  The Coalition for Improving Maternity Services (CIMS) has undertaken the task of making information about care providers and birth locations available to mothers, so we can make informed decisions about our births.

The foundation of their project is The Birth Survey, which is open to all women who have birthed in the U.S. in the last three years.  The survey gives you the chance to submit feedback for your prenatal as well as delivery care, through a detailed series of questions.  The information is being compiled into reports for the benefit of both mothers and care providers and hospitals, who can use the feedback to improve their services.

If you've given birth in the last three years, I highly encourage you to take The Birth Survey (take it once for each birth), so that other mothers will benefit from your experiences.

Evidence for Birth

It is startling to realize that many doctors in this country are using unstudied, unproven techniques and interventions on a routine basis, on unsuspecting patients - women in childbirth!  A recent study has outlined a number of issues with the common high-tech practices employed in American hospitals, pointing out that low-intervention births are far safer for mom and baby.  They are also, of course, much cheaper.

Consumer Reports has an excellent, concise article regarding the study and the difference between high-tech and high-touch births.  The Consumer Reports Maternity Care Quiz is also eye-opening.  Another report, from USA Today, following this study illustrates just why doctors and hospitals are so eager to intervene:  profit.

There are so many reasons to follow an evidence-based protocol for birth, and so few motivations for the high-tech, low-touch style of birth common in this country today.  I hope that the publicity of studies such as this will empower mothers to demand the type of care they deserve, and encourage caregivers to step up to the mark and give the best, high-touch care possible.

"Baby" Foods

A few months ago I stumbled upon some really intriguing viewpoints on introducing babies to solids. While I've always gone somewhat against the grain when beginning solids with my babies (for instance, I don't start until past 6 months, skip the rice cereal, and see food as mostly for fun until over 1 year), these ideas were new to me.  The basic concept is that babies don't have to be, well, "babied" as much as standard American approaches suggest.  Rather than feeding them bland, pureed foods, babies can actually tolerate - and enjoy! - more flavorful and texture-rich foods.  Not only is this almost certainly healthier in giving them a more balanced diet (though breastmilk should always be the primary food source until one year of age), it also gives them a broader palate, so that in future years they'll be more open to more foods.  MSNBC has a great article on research done on the subject, indicating that most of our ideas on beginning solids are more myth than science.

With my older boys, we did try to introduce a lot of vegetables and keep a balance between fruits and veggies.  There's a prevailing notion that giving "too much" fruit will create a sweet tooth, and certainly it seems that more vegetables are not only healthier in the short term but may create more interest in them in the long run.  Unfortunately, this hasn't proven true for us.  In fact, my oldest son doesn't like many vegetables because of their texture, regardless of flavor.

So what if we introduce more textures, earlier?  How about letting infants chew on things (with supervision, of course!) like carrots and broccoli, either raw or lightly steamed?  We've been doing this now with our youngest son for a couple of months and it's gone over very well. He doesn't ingest a lot of food yet, which is fine - breastmilk is all he really needs.  But he does chew, taste, and explore a variety of foods and is clearly mastering the art of eating a bit more all the time.

For more information on Baby-Led Solids (as it's called in the U.S., or Baby-Lead Weaning in the U.K.), be sure to read the Rapley Guidelines, available in English on a German breastfeeding site, or in PDF format (updated June 2008) from Rapley's site.

What We're Made For

I just finished watching The Business of Being Born - and all of the extra footage.  When the movie ended, I still wanted more.  The "extras" are definitely worth watching, with many good and very valuable points made, as well as some closure that I felt was missing at the end of the film.

It was good.  It was very good.  I think every woman needs to watch this, ideally with her spouse, and ideally early in pregnancy or even before.  There is so much that women in this country don't know about how birth works, both from the physical perspective and from the medical perspective.  

Did you know that the U.S. ranks 2nd-to-last in the industrialized world in infant mortality?  And it is on the rise?  The only industrialized country with a worse record for infant mortality is Latvia.  We're tied with countries such as Poland and the Czech Republic.  If our medical system and medical advances are so great, why are so many babies dying?  And mothers are dying, too.  According to an OB/GYN on the film, we spend twice what countries like Japan and the Netherlands pay for each birth, yet have significantly lesser outcomes.  One big difference?  Those countries have a significantly higher proportion of midwife-attended births, and save obstetricians for when they're really needed - when there's a real problem.  When complication-free births are allowed to be intervention-free, you get fewer iatrogenic injuries and deaths.  There are also fewer pre-term babies when pregnancies are allowed to continue until the baby is ready to be born.  

I, personally, could've used a box of Kleenex (or, rather, Seventh Generation facial tissue) for the film.  There are so many highs and lows in the movie - the horror of unnecessary interventions leading downhill quickly; the rush of emotions and endorphins as a baby is born into the water at home.  I've seen both sides of birth, and so react very strongly both to the injustices and the triumphs.  

Birth is an absolutely amazing process, and one of the points that the movie makes very well is that it is a huge disservice to women that they are not being told that; that they don't know that birth is empowering, engaging, awe-inspiring, elating, overwhelming; that they don't have the chance to experience the hormonal bond between themselves and their newborn in the moments after birth; that they are not an active participant in the most incredible experience they'll ever have.  Women who birth at home don't do it because they're super-human.  They do it because they are human - and human women are designed for - and capable of - this most amazing thing we call birth.