Friday, November 30, 2007

Children's Museum

Although I moved to our town over two years ago, I didn't know until last month that we have two Attachment Parenting groups within a 30 mile radius. So I decided to deal with a (for me) long drive because I really need female friends who share similar values, and Zari loves to be around other children. Today we met at a Children's Museum, and it was so fun! It is an amazing place, full of activities, toys, play gyms, art/drawing materials, interactive educational displays, and more. There are entire areas designed especially for infants and toddlers. So much that I can't even start to describe everything.

Zari enjoyed herself, and I got to meet several cool mamas. Some of us went out to lunch afterwards. I chatted at length with a woman who'd had two cesareans, both for breech presentation. For her next baby, she really wants to have a vaginal birth and in this area--as in most--that means a home birth. So we talked about breeches, midwives, home births, and other good stuff like research on vaccinations. So, was it worth making the 35 minute drive? Most definitely!
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Journal of Perinatal Education

The new edition of the Journal of Perinatal Education (volume 16, no 4, fall 2007) has several very interesting articles, many based on the Listening to Mothers II survey. Articles marked with a blue "F" are free to the public. If you are affiliated with a university, you can probably access the other ones through your university library.
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Thursday, November 29, 2007

A simple breech birth criteria

Last spring, I had the pleasure of meeting Dr. Mayer Eisenstein, a physician who has attended home births in the Chicago area for several decades with HomeFirst. He worked with Dr. Gregory White, also with HomeFirst and author of the manual Emergency Childbirth used by police officers and EMTs.

While we were talking, Dr. Eisenstein told me of a simple criteria for predicting whether or not a vaginal breech birth will develop difficulties. He learned this when he was a young physician from Dr. Frank O’Connell, who was a senior obstetrician at St. Francis Hospital in Evanston, IL. Dr. O’Connell learned it from his father, also an obstetrician, who had worked as the Chair of Obstetrics starting in the late 1950s or early 1960s.

Rule #1: If the presenting part is at a positive station at 5 centimeters dilation, there is an overwhelming probability of an easy birth, irrespective of what part is presenting (foot, knee, butt) and irrespective of parity. In other words, it is just as true for primips as for multips, just as true for footling breeches as for frank (butt-first) breeches.

Rule #2: If the presenting part is at negative station at 5 centimeters dilation, there is a significantly higher probability of a difficult birth, irrespective of the presenting part or of parity.

These criteria are more accurate in predicting easy births than in predicting difficult ones. In other words, a women may still have a straightforward birth when the presenting part is at negative station, but it is just much more likely that difficulties will arise.

Dr. Eisenstein and some of his medical students reviewed over a decade of their records to see if this held up with the breeches they had attended. In over 100 breech births they had attended, the rule held true in all the cases.

Dr. Eisenstein added that it should be blatantly obvious at 5 centimeters that the presenting part is at positive station (this does not include zero station, only true positive station). No guessing.

Dr. O’Connell’s father also had another rule: “The sign of a good obstetrician is how few cesarean sections they do.” I like that one!
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Wednesday, November 28, 2007

Study about miscarriage

I am forwarding this information about a study on communication about miscarriage. If you are eligible, please participate!

Communication about Miscarriage

You are invited to participate in a study regarding communication about miscarriage. Through this study, I hope to provide insight into an understudied realm of family communication. To participate in this study, you must be at least 19 years old and have had a miscarriage within the last 2 years. Although you do not need to currently be in a romantic relationship you must have been married at the time of the miscarriage. If you are willing to participate, please visit the website (
to complete the questionnaire. If you should have any questions, please contact me at the e-mail addresses listed below. Please pass on this information to anyone you know that might be willing to participate.

Thank you for your consideration.

Cassandra LeClair-Underberg
439 Oldfather Hall
University of Nebraska-Lincoln
Lincoln, NE 68588
cunder @
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Tuesday, November 27, 2007

Blame the woman

Once again, women are simply too fat and too old, according to this recent article about rising maternal mortality rates in England. Oh, and they have the audacity to want a natural birth--which of course the article didn't bother to define--another alleged culprit behind rising mortality rates!

From the article:
But some medical staff and patient groups also fear the NHS’s policy to encourage “natural” birth without medical assistance is putting women at risk by denying them medical care in pregnancy and labour. Professor James Dornan, director of foetal medicine at the Royal Maternity hospital in Belfast, said: “Nature dictates that one in every 100 women will die while having a baby. The mortality rate in parts of Africa is now about 850 to 1,000 per 100,000. Left to nature that is what nature will do. I believe in women having choice but it has got to be informed choice.
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A family doctor's perspective on BOBB

Among members of the audience for The Business of Being Born was a family physician who attends births and her youngest daughter. She emailed me some of her thoughts about the documentary and gave me permission to repost them here. I highly admire her dedication; she works hard to give women hands-off, physiological births in a hospital setting.
Overall, I was impressed with the movie. I tried to look at it with two viewpoints in mind. One, my own sort of "birth junkie" self. Two, I tried to see it as my mostly mainstream clients and acquaintances would.

I was pleased overall with the births they showed, and I loved many of the commentators. I loved that the births were shown to unfold in their own time and that the mamas looked free to move on their own and birthed upright. I love that upright birth center birth where the mama is so joyous right after. I thought Michel Odent was absolutely great. I liked the juxtaposition of the "woman on the street" type comments in between, too--sadly, all those women ready to sign up for their epidural are what I deal with a lot of the time and are very realistic.

It was funny, because looking at the births, I actually thought some were a bit hands-on for my taste. (Why does the midwife have her hands around that woman in the water? What was she trying to do?) On the other hand, I think a mainstream viewer might think they were too "non-medical" especially since Cara can't seem to get gloves on in time ever.

I cried at every one of those births. Don't know what was up with that! My little dd even kept asking me if I was okay. (I cry a fair amount of the time at actual births, though, too--you'd think I'd get over it.) I think if people watched this movie and the only thing they took away was visions of women pushing their babies out standing, squatting, in the water, whatever, that would at least be a start. I find that I have to talk quite a bit during prenatal care about how women should try out different positions ahead of time and see what feels comfortable to them, and how we will be encouraging them to move any way they feel comfortable during labor and pushing. Sometimes family members especially are just shocked when the birthing woman ends up standing or squatting or kneeling. Sometimes I think they then think I'm a little nutty or not very professional, because I "let" this go on. Fortunately, usually the birthing woman herself can verbalize how being free to choose her position made her feel better, or that it was more effective for pushing, or whatever.

I was disappointed in the ending. I don't think they explained enough what was happening, and I was disappointed that the final interview blew off any benefits of homebirth and implied that it's all nice if you can have it, but thank God we had this cesarean and saved my baby. I actually think in her particular case transferring for a breech, growth-restricted baby was probably a good idea--but there had to have been a better way to wrap up that movie than Abby saying "Oh well, at least I got a healthy baby" you know?

I wish they'd wrapped up with some kind of activism information--like talking about CIMS, or ICAN. Here's where you can start to change the world kind of info.

The discussion after was really something. It was interesting to hear people's stories and encouraging to hear so many women who think this stuff matters. It was also discouraging, though, to hear how people struggle to get the birth they want. I am pretty disappointed in this whole VBAC thing, and disappointed especially that so many "low-risk" providers are just giving up VBACs and verbalizing that it's just too bad, so sad for the women involved, but nothing we can do. The midwife who talked expressed similar feelings to what I've been hearing from other family docs: "Oh well, we just can't because of these rules." I feel like so many birthing women basically can only have midwifery, or at least woman-centered physician care, if they are low risk, don't have any problems or inconvenient history, and do what the low-risk provider wants. Otherwise, you are stuck in the OB system and have to take the full court press. It's just not fair and I can't figure out how to fight it. Especially in this stupid state. I wish women like that woman who had an episiotomy against her will would make complaints--take it to the hospital administration, the chief of medical staff, and the medical board for failure to get informed consent. I know one complaint is not likely to do anything, but if there were more and more, I think hospitals and regulatory boards would have to listen. It is not okay that thousands of women are treated as if their wishes don't matter one bit routinely in the name of "standard of care."
I actually think all of medicine needs to be reworked. Something I was trying to say, and may not have got it out coherently at the panel discusson, is that having doctors in charge of medical care and responsible for the outcomes doesn't benefit anybody. If birthing women were in charge, in power, and responsible for decision making (not really so much the outcome, because there is so much that is up to chance), I think they would be more satisfied--AND doctors maybe could relax some. Because I think if we stopped this patriarchal, authoritarian way of practicing medicine there would be far fewer lawsuits. If every woman got actual informed consent AND had the opportunity to make her own decisions and then got supportive care when they needed/wanted it, they would be far less likely to sue. (I just went through a long involved discussion with a new client about VBAC and feel I gave her a good understanding of the risks either way, but she is really stuck in that no one in driving distance who takes her insurance does VBACs anymore--doesn't matter how informed you are if your options are so limited.) As a profession, though, we docs don't want to give up the power. We want to be in charge, want to be seen as demi-gods often, and don't want to present our selves as fallible humans doing the best we can with the knowledge we have and freely sharing that knowledge with our clients.
I'm not sure how to make a change in modern obstetrics, but I think one factor is that women have to refuse to accept paternalistic, condescending care. I don't care what kind of choices women make, but they need to insist on accurate information and fully informed decision making.

OBs need to get out of the business of normal maternity care. We have put normal care into the hands of folks trained in the abnormal. You know the saying, “if the only tool you have is a hammer, everything looks like a nail?” If you are looking for trouble, you generally find it one way or the other. Somehow, we have to get in through our heads that women's bodies have not changed that much in the last 30 years, so if the cesarean rate has sextuptled (and it has!), something must have changed in doctors. I'd like to see more consumer-driven organizations getting more and more active and making more of a mainstream presence. I mean, how many women even know there is something like ICAN or CIMS?
The problem, too, is that it seems that as a whole group, women may not care that much about birth. I wish this was more of a feminist issue--I don't understand why women are willing to be condescended to in this area and have choices taken from them. Have you ever read Barbara Katz Rothman? She is a feminist writer who has done a lot of work on birth politics and talks about how she talked an OB into attending her first home birth by basically appealing to the female OB on a feminist basis. (The book is In Labor: Women and Power in the Birthplace.) I just don't see that happening any more. I went into medicine out of a desire to provide woman-centered care from a background of feminist ethics. I feel more and more out of place in modern medicine every year--my colleagues think I'm sort of nuts, my family suffers from me not being there, and even many of my clients don't seem to care much about having the chance to direct their own care.
I wish I could have come to the rest of the discussion. Did you all come up with any way to change the world?
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Monday, November 26, 2007

November Carnival of Breastfeeding: Book Reviews

Join in this month's Carnival of Breastfeeding featuring book reviews! Last month, I reviewed Andi Silverman's Mama Knows Breast; read it here. You can also read other book reviews at the following sites:

Motherwear Breastfeeding Blog: A Book For Everyone On Your List
Breastfeeding Mums Blog: Book and Video Reviews
Tales of Life With a Girl on the Go: The Best Gifts
Breastfeeding 123: Review of Baby Matters
Crunchy Domestic Goddess: What Do Babies Want
Mama Knows Breast: Review of bOObs: A Guide to Your Girls
The International Breastfeeding Symbol Blog: The Baby Book and Unconditional Parenting.
Hobo Mama: Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent.
On School Street: Blindsided by a Diaper: Over 30 Men and Women Reveal How Parenthood Changes a Relationship.
James and The Giant Moose Blog: Having Faith: An Ecologist's Journey to Motherhood.
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Wednesday, November 21, 2007

Comments from Lynn Griesemer

Lynn wrote me these comments about her interview with To The Contrary and gave me permission to repost them here:

I visited your blog and just want to say a few things about your To The Contrary comments. These are shortened comments for lack of time

Background: I was asked to be interviewed for the show, not knowing the format. I was hesitant and reluctant to agree to an interview: The executive producer would interview me for 25-30 minutes on the topic and then edit it down. She did not say how much editing. I thought the show was 30 minutes devoted to one topic. I should have done my homework before agreeing. I also asked if there was a format where I could sit on the panel during the discussion. She said that's not how they do it. They interview me and then put the program together, with panelists selected ahead of time (usually women with political backgrounds). I recommended a few names to her thinking she would select one (such as Naomi Wolf, Robbie Davis-Floyd, Suzanne Arms and 1-2 others), but I later saw on the website that there is a list of about 16-20 panelists that they select.

My best experience of media exposure regarding unassisted birth was when I was interviewed for a live midday news program (1998 in South Carolina)--4 minutes of unedited comments.

What she put together did not make me shine, but yes, they were my words, spliced together to form what she thought would do justice to the topic or what would make for good television. The final product and panelists reveal the public's view of birth, so it was not surprising to me to see the end result. I can't be upset about it since I had no power over the final presentation, just like the Washington Post article at the end of July, which had misquotes--the number one being "Unassisted birth hammers home what it means to be a woman." Ouch! Those were not my words, but were condensed from something like, "Unassisted birth reveals a highlight of femininity" or something like that.

I have been criticized and my advice is: I am not the world's best speaker, nor am I photogenic. However, I am deeply passionate about birth and almost obsessed about the importance of birth and how it it is so crucial to our civilization. Those who criticize should step forward and try to get in the media. I respond to the media when called upon. (I'm not saying you are critical at all--I'm thinking of others who are quick to write emails.)

Feminist: If someone asked me, "Are you a feminist?" I would say yes, but the yes is qualified to include the concept that women can and should be able to make a full spectrum of choices--what is right for their lives. I would not join NOW or NARAL--their objectives and philosophies do not mesh with mine. (During the To The Contrary interview, I was asked a few questions twice, worded slightly differently probably to elicit certain comments from me. I am aware of these tactics and was ready for that.)

Daddy delivery: This phrase is the biggest insult to unassisted birthers--especially since it is sometimes used by unassisted birthers! I hate the phrase, which was referred to by many people in Charleston, SC several years ago. I don't know why these women who take the bold, countercultural action of having an unassisted birth refer to it as daddy delivery. It undermines what unassisted birth is all about. No one delivers a baby. Ultimately a woman gives birth, even in a hospital. However, I might say a C-section was a delivery. Generally, I refer to "delivery" as hospital birth and "birth" otherwise. And "daddy"--that is just too cutesy.

The woman is in charge of her birth. She selects who she wants at the birth and gently guides or directs--not really directs, but lets the ebb and flow go how she sees fit. She includes her partner how she sees fit and he takes her lead. Dads should not coach, nor should anyone. I suppose that's the feminist in me. It is the woman who is the queen of her birth.

Maybe unassisted birth is the ultimate feminist act. I'll have to think about that.

I saw somewhere an article that talked about unassisted birth as a militant movement. I think of militant involving some or all of the following: battle fatigues going to war / shield of armor / military / loud obnoxious megaphones shouting and picketing / angrily lobbying based on fear, ego, selfishness or power--everything that is not peaceful.

Unassisted birth is first and foremost peaceful for women, babies, families, communities, the world. Militant is contrary to what it is all about. Many of the unassisted birthers I personally know are humble, just going about the business of life, and many of their acquaintances do not know they birthed unassisted. It's important for a segment of society to work hard at making positive change and I commend people for spending the time and effort at lobbying for important causes.

The final thing I want to say is that almost every time you are on a TV show or interviewed for a newspaper article, there will be subtle or blatant misquotes, misrepresentations, or comments pieced together that lead to slight inaccuracies. It's also very difficult to capture the essence of unassisted birth in a short newspaper article or TV segment. There are so many deep facets to the whole issue. I'm still glad I decided to appear on To The Contrary. It was a good experience / practice.
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Tuesday, November 20, 2007

Class Presentation

I gave a presentation for my husband's freshman writing class about the unassisted childbirth movement. Zari came with me, of course, so I suppose you could say it was her first day of college!

The class is doing a project that involves reflexivity: getting to know a group that has different values and assumptions and examining your own preconceived notions and trying to see things through the group's viewpoint. The whole class is working on a presentation about unassisted birth. As part of it, several of his students came to the screening of The Business of Being Born to have a better idea about childbirth in contemporary America. They stayed for the whole discussion too!

All of this college must have worn Zari out. I nursed her during the Q&A after my presentation because she was really cranky. She conked out and didn't wake up for almost 3 1/2 hours!
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Monday, November 19, 2007

BBBB BOBB and other business

I had a fabulous weekend with women & their nurslings coming in from several different states for a Birth & Babies Bed & Breakfast get-together. We also watched a screening of The Business of Being Born. Now the house is so silent and empty with everyone gone.

Most of the audience stayed for the discussion after the film--we had lively conversations about VBAC bans, the disappearing art of vaginal breech birth, how to find midwives in midwife-unfriendly states, and how to bring about changes in our current maternity care system. The discussion carried on for several more hours at my house.

We also did made birth art with silk painting and learned how to make jewelry.

On Friday night, the dinner conversation must have been quite exciting because Zari fell asleep right in the middle of eating.

More pictures forthcoming, once other attendees send me theirs! Many thanks to everyone for coming from so far away. We had women from Iowa, Arizona, Missouri, Connecticut, and Michigan!
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Saturday, November 10, 2007

I did it!

I ran a half-marathon this morning. The weather was great: sunny, clear, very little wind, and a bit on the chilly side. Ignore the pink spots on my shirt--I spilled juice on myself during the run.

My deerskin finally arrived (4 pounds of scrap leather) so I made Zari some shoes since she didn't have any and it's been too cold to go barefoot. I used the Chloe Toes pattern. I first made a pair of red shoes in 12-18 month size, but they were too big. So I made 2 more pairs in the 6-12 month size, which fit perfectly: the brown and tan ones below, and a pair of black Mary Jane style shoes.

Zari had bed head this morning.
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Thursday, November 08, 2007

Request for animations of labor interventions

I received this request for information and thought I'd see if anyone can refer me to the proper source:

Do you know of any animations/simulations of labor (similar to those seen on National Geographic channel's "in the womb" series) of how amniotomy, lithotomy position and other managed labor practices affect the ease of the baby's navigation out of the uterus? I am looking for something based in science that shows how these managed childbirth practices make it harder on the baby.
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Wednesday, November 07, 2007

Lots of misc news

No particular rhyme or reason to what will be on this post, but here goes:

The Mother.Culture.Art breastfeeding photos are online again. They show the various ways breastfeeding is understood in our culture.

I have a plugged duct that is quite painful, enough that I didn't run this morning.

I made butter yesterday! I started buying fresh organic milk from a local farmer, and I thought I'd see if you could really make butter by shaking the cream. One mason jar and 15 minutes later, I had butter! I still have to knead the butter to get any pockets of buttermilk out.

Vanessa, the woman who had an unassisted birth in Le Premier Cri, just posted a comment on this blog. Bienvenue! I translated the information about her birth on the film's website. I invite any native French speakers out there to suggest revisions. There are several phrases that I couldn't find an exact English equivalent for, so I took some liberties. Here goes:


Vanessa, 32, and Mikael, 36, live in a collective with eight other people, a group of activists, artists, and organic farmers who met each other in the intersection of alternative ways of life. Their house in Maine reflects their values—it’s a retreat for city dwellers, surrounded by woods and fields, on the edge of a lake.

Vanessa fully embraces her pregnancy. It is her first baby, who is very much wanted and hoped for. Not only for her and Mikael as a couple, but also for each of their house mates.

Vanessa chose to give birth unassisted by the medical profession, deciding instead to take the responsibility of her son’s birth into her own hands. She is convinced that her body will know how to give birth and that if a problem arises during the birth, that she will be able to resolve it herself. She wants no outside interventions during the birth: “My reasoning is that if a problem presents itself, I will sense it. Women have always had that intuition. Giving birth unassisted is an affirmation of feminist and anarchist beliefs: nobody is better qualified to birth my baby than myself.”

Still, her decision worries some of the members of the group. Some would like a midwife there just in case...A legitimate concern, because it is also the first birth within the group, the first infant of the collective. A lot of their hesitations surfaced—primarily the worry that nobody in the group would know how to identify an emergency situation.

But Vanessa responds that it would be impossible to give birth the way she feels is best with a midwife waiting in the closet. “I would always be aware of her presence.” 

Vanessa is doing her own prenatal care. She does yoga and has regular massages. She drinks homemade herbal teas made from red raspberry leaves and nettles for her and her baby’s health. She is serene as she awaits the birth of her baby. 

She hasn’t decided yet where in the house she will give birth. Outside is probably out of the question because it will almost certainly be too cold. She will have a birth pool in the room. But she wants to leave everything open, to have complete liberty during the entire process to decide how and where the birth will unfold. The longer her pregnancy continues, the more Vanessa feels that her decision is right. 

“I want to be the only one deciding how I feel and how the birth should unfold.” Above all, she wants to ensure that she does nothing to hinder the process before it happens. She notes any desires or wishes that arise. Still, in order to have complete spontaneity during labor, everything needs to be well set up in advance.
Her final wish is to have a “lotus birth”—not cutting the umbilical cord and keeping the placenta and baby together until the cord falls off by itself a few days after the birth. “I really want this to be a rite of passage for me and my baby, and in order to for this journey to take place, you have to take risks and be willing to embrace the possibilities.” The knowledge of the risk she is taking is part of her journey, but she places her faith in nature, trusting that her baby will arrive safely into the world. She awaits as the full moon draws nearer.

Unassisted Birth
In the United States giving birth at home without medical assistance (called “unassisted birth” or “undisturbed birth”) is a growing trend. No doctor, no midwife, no nurse. The woman gives birth alone, with her family, or with close friends, whatever suits her best. Some women give birth outside, others in water, in the living room, or in a birthing room prepared especially for the event. 

A recurring theme in the unassisted birth movement is the right to have the freedom of choice and autonomy in making health care decisions. 

The unassisted birth movement is a militant protest against the over-medicalization of pregnancy and birth. Its supporters--including committed environmentalists, intellectuals, artists, and feminists—wish to overturn the established order and to bring childbirth back to its original meaning: bringing life into the world in a truly natural manner. Giving birth, according to women who choose unassisted birth, is a creative act that should unfold exclusively according to the mother’s desires, because they believe that what is good for the mother is also good for the baby. 

The unassisted birth movement proclaims that birth is a natural physiological process that does not need medical intervention. According to the movement, we are all in charge of our bodies, and the birthing mother is the best qualified person for bringing her baby into the world as long as she knows her body well. She knows what is best for her and for her baby. No one else has the right or the ability to tell her what is best for her. Medical procedures and technology are unwelcome intrusions, and women’s perceived dependence on medical experts leads them to accept treatment that in any other circumstance would be unacceptable. Women also reclaim their right to birth their babies into their own hands. 

Unassisted birth is also about facilitating mother-baby bonding. No one, except perhaps the baby’s father, should intervene in or interrupt the mother-baby pair after the birth. In France, the movement has no official representation. There are some reports of unassisted births, but no formal organizations exist that promote the practice. 1-2% of women in France give birth at home, but generally with a midwife in attendance—a practice quite common, for example, in the Netherlands

For more information:
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Saturday, November 03, 2007

Exercise update

Just ran 11 miles and I feel good. Last Saturday I tried to run, but I was super weak from the nasty illness I'd had and only made it about 2 miles. Next Saturday, weather permitting, will be my half-marathon! I figure it shouldn't be too hard to go from 11 to 13 miles. Plus the week after is a big get-together and the screening of "The Business of Being Born," so I wanted to finish my running before then.

Housefairy and Kelley: how is your exercising coming?
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