And some are very, very bad.

One Fish, Two Fish, Red Fish, Blue Fish...

"Who is the bad fish in this picture?"

...I asked my husband, with a pit in my stomach, as I read to our 13-month old son.

He raised an eyebrow and said, "Uh, the red one, obviously."

I always thought it was the yellow one.

My whole childhood, in the thousands of times I've read Dr. Suess's wonderful book "One Fish Two Fish", I thought the bad fish on this page were the little yellow and blue fish.  The red fish, in my child's eyes, was their father.  The yellow fish was in trouble and had been "very very bad."  The little blue fish was smug because he'd gotten away with it and his sibling was taking the blame. The red father fish was spanking the little yellow fish.

I saw this page last night through adult eyes and decided, beyond any shadow of a doubt, that our home will never be a spanking home.

I was not raised in an abusive house, by any definition.  My parents are wonderful, kind, and supportive people who I am honored to have in my life.  As I have said before, they made the best decisions they could with the information they had, and always did what they believed to be right.  So, in keeping with the times, our home was a spanking home.  We weren't spanked for minor infractions; it was rare and reserved for only the worst offenses - things that could cause us real harm, like playing with fire or messing with dangerous tools, running away from our parents in an amusement park, darting out into traffic.  Offenses that, by conventional logic, were "deserving" of a spanking. We were only spanked if we were "very, very bad."

Spankings were never doled out in anger; they were measured, explained, and followed up by a hug.  Once the spanking was over, it was over and the world continued to turn.   My parents never left marks or bruises, and, presumably, the harm of the spank was less than the potential harm of the offense.  A spank certainly hurt less than an abduction or 3rd degree burn could have.

Spanking has an interesting history in the United States, but not as far back as you'd think.  While there are ancient historical examples of young adults being physically punished by their parents, the concept of disciplining small children "by the rod" is a relatively recent phenomenon.  Ancient Jewish law in particular is very clear in its opposition to causing harm to children.  The New Testament is even more definitive. Throughout history, spanking has been reserved for adults only, as a method for removing sin and allowing penance.

Spanking as a form of discipline for little ones seems to have come into fashion during the Victorian era (1837-1901), first in Europe and spreading to the USA, along with the notion that children should seen and not heard.  It began first with spanking young men and women to punish for sexual deviance (aka, masturbation), and slowly moved backward in age.  Spanking on the rear end was preferred because it could not accidentally cause harm to the internal organs, and on the naked bum because it would help the child associate pain with sexuality (sound familiar, intactivists?).

Books were published about the right way to spank, and the oft-used and always misinterpreted bible verse "Spare the rod and spoil the child" was used to support spanking small children for any offense.  This verse has many, many different translations depending on the version of the Bible.  While revisiting the earliest versions, the word discipline is a more accurate translation, and the rod is more like "Thy rod and thy staff, they comfort me" than "thy rod beats me when I mess up."

Notice that He is not swinging the rod at the wayward sheep....
The rod is hooked so the Shepherd can gently pull his flock into safety.

Spanking is seeing a gradual decline in popularity, but a majority of Americans still believe it is an appropriate and effective form of discipline.  In a 2000 poll, 61% of parents believed that regular spanking is acceptable, even beneficial to children.  An astonishing 37% believed that spanking a child younger than 2 is acceptable.  Not surprisingly, 56% thought that a 6-month old baby can be "spoiled" by too much attention.  More than 90% of parents report that they have spanked their children.

Frankly, these parents either haven't kept up with research or are ignoring it.  The American Academy of Pediatrics not only states that spanking can cause damage, they further illustrate that it doesn't work, long-term.  They are especially vocal about spanking children under 18 months of age, citing an increased of physical injury.  Children who are spanked occasionally as small children need to be spanked more and more often to "behave" as they age, and parents are left with very few disciplinary options with teens,

Another recent study by Pediatrics reported that children spanked at a young age were much more likely to be aggressive in the years following: ""The odds of a child being more aggressive at age 5 increased by 50% if he had been spanked more than twice in the month before the study began." 

Additional research has shown that children who are spanked are more likely to have social and emotional problems, are more likely to commit violent crimes, and are more likely to be involved in abusive relationships as adults.

For an in-depth review of corporal punishment studies, click here

Spanking emotionally harms the child and the parent, and can damage an otherwise trusting relationship.  Children who are spanked are less likely to confide their troubles to a parent, for fear of reprisal.  Instead, spanked children learn to be better liars to avoid consequence.  They learn to avoid being caught, not to make good choices.

9 Alternatives to Spanking

So, here is my question for you.... which fish is the bad fish?  Which fish will you be? 

More importantly, when your child reads the book, which fish will they think is "very, very bad"?

For more information about preventing child abuse, visit www.preventchildabuse.org.
To learn more about positive (non-hitting) discipline techniques, click here.

Vaccines and Decisions

I have never been so torn on an issue, perhaps in my life, as I am on the subject of vaccines.  Right now, I have the luxury of indecision.  Because of one of my meds (the immune suppressant), my doctors have decided it's best for my son to be unvaccinated for the time being, and I have the medical seal of approval to postpone the decision of vaccination.  My son did get DTaP before I went on these meds, and technically he could have inactivated vaccines, but we're holding off until I'm 100% sure.  You can't "un-vaccinate"; once it's done, it's done.

For those who do not vaccinate, a medical exemption is the holy grail of paperwork.  For those who believe in the importance of complete vaccination, my situation is a terrifying limbo of irresponsibility.  I see both sides of the issue, and I'm stuck.

Most parenting issues have become clear to me with research.  Breastfeeding, circumcision, spanking, co-sleeping, babywearing.  They're pretty clear-cut, and most research sits on one side or the other.  Vaccinations... eek.  Not so clear.  I have done hundreds of hours of research on vaccines, and I'm still incredibly torn.

Borrowed from Peaceful Parenting, in case you want to say "I'm vaccinated and I'm fine"
Our children are being vaccinated against many more things than we were.

I have reached 2 conclusions, both of which are controversial.  Isn't this whole topic?

1 - Vaccines are not useless.  They do work.  Maybe not as well as advertised, but they have value.  The rabies vaccine prevents the spread of rabies among dogs.  The influenza vaccine does actually reduce the incidence of flu it purports to prevent.  Since the widespread vaccination of the American public, the diseases for which we vaccinate have decreased precipitously.  I am still immune to measles, mumps and rubella, 25 years after my last booster, diseases I did not have naturally.  Vaccines generally do protect against the diseases they claim to, a majority of the time.

2 - Vaccines are not 100% safe.  They have risk.  Vaccine-related injury is real, adverse reactions are real, and to the rare number who experience them, the injury is often worse than the disease the vaccine is intended to prevent.  It is possible that vaccines damage the overall health of a person's immune system.  Unvaccinated children are, overall, healthier than their vaccinated counterparts, experiencing less chronic and acute illness during childhood and early adulthood (these studies are imperfect in design but still compelling).  Parents who consciously choose not to vaccinate are not morons; they are generally better informed and educated about the issue than those who vaccinate. 

Ethically, I am opposed to the concept of forcing a child to endure pain and sickness, against their will, to prevent potential future harm.   The child is not in immediate medical need or danger, like a child who needs stitches. I am opposed to sacrificing one child for the benefit of many; the herd immunity argument doesn't sway me.  One child should not die so that millions can live; that argument holds no water to the mother of the dead child, nor should it.  I believe in the inherent ability of the natural immune system to handle routine illness, and I believe that a bored immune system is a dangerous thing to have, increasing risks of allergies and auto-immune responses. 

Logically, I am opposed to the reintroduction of measles and polio into the general population, and I do believe that vaccines have something to do with the decrease of diseases (but not all - Polio in particular has a really interesting link to pesticides).  I don't want to see a Rubella outbreak.  I have heard the cries of a baby with pertussis, and they are heartbreaking.  If my son were to experience harm as a result of a vaccine-preventable illness, or worse, were to pass that illness on to another child, I would be devastated.

Emotionally, vaccinating feels wrong - no mother "looks forward" to a visit for shots.  On every other parenting decision, I have trusted my "gut" or "mommy instinct" and it's always been right.  Here, in this one circumstance and no other, I am expected to restrain my baby, cause him pain and potentially cause him harm, to avoid the potential of harm.  This isn't about fighting a diaper change or being annoyed about being in a carseat; the pain is real, the immediate harm is real (even if it's only a mild fever and a sore leg).  If you physically restrain an adult against his will and stab him with a pen or a thumbtack, it is called assault.  I spent a lifetime terrified of doctors and needles.  Babies today are mandated to have triple the number of vaccines that I had; every child I know is petrified of going to the doctor; their parents have to lie to them and bribe them to get them in the door. 

Intellectually, I realize that people used to die of vaccine-preventable diseases in great number, and that my ancestors would likely think I'm crazy for even debating this topic.  Vaccines are considered among the world's greatest medical discoveries, one of the greatest discoveries of human history, by minds greater than mine.  My pediatrician is in favor of most (but not all) vaccines; I respect her opinion as a medical professional.  I respect her years of experience and expertise.  I also know that the entire American pediatric business model revolves around vaccines, and without a visit every 2-6 months for a shot, pediatricians offices would be a lot emptier than they are now.  Money talks.  Vaccines make literally billions of dollars a year for doctors and pharmaceutical companies, both via direct and indirect sources.

Polio kills.  Mumps is bad.  Tetanus, Diphtheria, Hepatitis, pertussis, HiB, meningitis, all of them - this is bad stuff, and I don't want my baby to get any of them, if I can help it.  Hell, my double exposure of chickenpox (at 13 and 32, thanks immune suppressants) was miserable enough that I'd happily have taken a shot in the arm instead of 6 cumulative weeks of misery!  Regardless, I am too informed to respond to the "less mercury than a can of tuna" line. 

I am asking for feedback tonight, on what ultimately made your decision, one way or the other.  I don't have to make a decision right now (in fact, I can't) but I could use some guidance. 

Why did you decide to vaccinate your child, or choose to skip or alter the standard schedule?

Necesareans

Note: if you are planning a natural birth, especially with hypnosis, don't read this without your "Bubble of Peace" on Mega-Force-Field-Strength.  If you are planning a peaceful, wonderful, pleasant and awesome birth and you want to visualize only wonderful happy things, click here for my favorite water birth video.

If you'd like to learn about real medical reasons for c-sections so you can potentially help avoid an unnecessary one, please proceed.

You've been warned.  Bubble up?

Necesareans

The current US c-section rate is somewhere between 33 and 38% of all deliveries.  The World Health Organization states that no region in the world should have a rate greater than 10-15%.  If the WHO is correct, that means that 54%-73% of all American cesarean deliveries are unnecessary.  Average the numbers out, and that means that 2 out of every 3 c-sections performed in the USA may be unnecessary.    Let’s play with some pretend, averaged and hypothetical numbers.

The 2010 rate is estimated at 33.9%.

100 laboring women.  33 have c-sections.  22 women had surgery they may have been able to avoid.

Now here’s the twist.  11 of them did need c-sections.  There are valid medical reasons for c-sections.  Women used to die in labor, far more often than they do today.  Babies used to die in horrific numbers during childbirth, and the c-section is an amazing medical advance, a relatively “safe-ish” surgery that can and does save lives.  Before the advent of the c-section, labor and delivery were leading causes of death for young women and babies. Since 1980 (and not on this chart), the number of maternal deaths is rising again, and many say it is because of the overuse of the cesarean section.

Maternal deaths per 100,000, 1880-1980

How do you know which one you are?  Is your birth a real emergency, one of the 11, or one of the 22 that might have been avoided and could be putting you and your baby at needless risk?  Your doctor will always tell you that you’re one of the 11, unless you have an elective surgery (very rare – despite the hype, less than 0.5% of c-sections are truly elective, with zero “medical” reasoning provided).  Your doctor will always say that you had a c-section because it was necessary.

So, you’re in labor, or close to it.  Things aren’t going according to plan.  Your doctor wants to do a c-section, and they’ve been to medical school.  You haven’t.   How do you keep from being part of the 22?  How do you know if you’re one of the 11?  Ultimately, you have to trust your care provider, which is why selecting one is so very important.  You also have to do everything you can to reduce your risk of running into a real medical reason (avoiding interventions unless they are medically necessary).

Below is a list of medical indications for cesarean section, with details. Knowledge is power, right?

As always, please note: I am not a doctor.  I have not gone to medical school.  I have never performed a c-section.  I am not an expert.  I am a mommy who likes to write stuff and post it on the internet.  Please do not take anything I write as medical advice, but as information and opinion.  Inform yourself, do your own research, and talk to your medical experts before you make a serious decision that could seriously impact you and your baby.

Necessary C-Sections

Placenta Previa

Placenta Previa means that your placenta is located above your cervix.  Both partial and complete placenta previa (placenta blocks the cervix completely at the time of delivery) is absolutely an indication for c-section.  If your placenta blocks your baby’s exit, you are at risk for extreme bleeding, and there is no way for the baby to get out.

What you should know: Placentas can move.  Suspected placenta previa can be often be confirmed via ultrasound or even via vaginal exam.   Just because you have a low-lying placenta early in your pregnancy does not mean it won’t shift out of the way by the time of delivery. “Marginal” placenta previa, where the placenta is just very close to the cervix, is not generally an indication for c-section.  You should know which one you have before you consent; information is power.

Cord Prolapse

If your water breaks, and the cord comes out before the baby, this is Umbilical Cord Prolapse.  Cord prolapse is an immediate emergency – either you must immediately deliver vaginally, or proceed directly to the OR.  Time is of the essence to save the baby’s life – whichever method gets the baby out fastest should be used.

What you should know:  Cord prolapse is much more likely to happen if your baby is premature, and especially if your waters are broken artificially.  So, if your care provider offers to "get things moving" by breaking your water with a hook, remember that this is a (small) possibility.

“True” Knot in Umbilical Cord

These are very difficult to diagnose prenatally, but it has happened with 3D ultrasound (which carries risk).  A true knot is exactly what it sounds like - it can prevent oxygen from getting to the baby.  If one is seen on ultrasound (again, rare – usually they are discovered after delivery), you will likely be sent to the OR.

Placental Abruption

If your placenta detaches from the wall of your uterus while the baby is still inside you, this is a placental abruption.  Symptoms are severe abdominal pain, heavy bleeding and back pain.  Partial abruption prior to labor is usually treated by bed rest and transfusions, but a complete abruption at any point or any kind of abruption during labor is an emergency situation.  Like a cord prolapse, immediate steps need to be taken to get the baby out – immediate vaginal delivery or emergency cesarean.

Click here to read a very sad story about a baby lost due to an abruption - recognizing the symptoms of an abruption and seeking immediate, emergency help is vital to avoiding this tragic result.

Uterine Rupture

If the uterus tears, an immediate, emergency c-section must be performed to save the life of the mother and baby.  This is rare (1/1500 births).

What you should know: Risk of uterine rupture is often given as a reason not to allow VBACs (vaginal birth after cesarean).  New research shows that the risk of c-sections may be higher than the risk of rupture, which is very rare.

Toxemia, Severe Pre-Eclampsia, HELLP syndrome, pregnancy-induced hypertension

Pregnancy-induced hypertension is high blood pressure that just keeps rising.  Eclampsia, toxemia and HELLP are all potential complications of uncontrolled high blood pressure in a pregnant woman.   If PiH isn’t controlled, high blood pressure can cause strokes, cerebral hemorrhage, respiratory distress and even death for the mother, as well as endanger the baby.  Toxemia, HELLP and Eclampsia are all potentially deadly complications of uncontrolled PiH.

During pregnancy, there are a number of treatments that can slow disease progression.  The only “cure” is delivery.  If your blood pressure rises severely enough and quickly enough, it is imperative to get the baby out ASAP.   BP over 160/110 is considered severe.  Because prolonged labor can be stressful on your body (not that c-sections aren’t!) many doctors prefer to perform a c-section to avoid the possibility of your blood pressure rising further.  If the situation becomes unmanageable, immediate action to deliver the baby is required.

You should know: You can reduce the risk of pre-eclampsia with diet and exercise, among other things.  Click here for more information about pre-e (to start).

Transverse Lie (baby is lying sideways)

While it is possible to deliver a breech baby vaginally, it is not possible to deliver a baby who is sideways in the womb.  That being said, babies move.  Just because your baby is sideways NOW doesn’t mean they’ll be sideways when you actually go into labor.  80% of babies who are transverse at 37 weeks have moved when you go into labor!  So, don’t just schedule the c-section.  Wait to see if baby flips.  Check out http://www.spinningbabies.com/ if you want to get your baby on the move.

You should know:  While transverse lie is an indication for surgery, breech often isn't.  See below.

Acute Fetal Distress

Fetal distress is often used as a reason for c-section delivery, but the definition is nebulous.  “We’re worried about the baby” is a sure-fire way to get a laboring woman into the OR without argument.  There is a difference between “fetal distress” and “acute fetal distress.”  There is a clear definition of acute fetal distress. 

Most babies become mildly distressed during labor – so do many moms!  Being born is hard work, and it can be stressful.  Your baby is often working as hard as you are in this team effort.  There’s a BIG difference between being stressed and being in danger.  Below are the textbook definitions of “Acute Fetal Distress”.  #1, 2 and 5 alone are enough to indicate acute distress.  #3 and 4 are used in conjunction with other factors.

1 – Fetal heart rate greater than180 bpm or less than 100 bpm for longer than 4 minutes.  Note – an occasional rise or fall to these numbers does not automatically indicate distress.  An average over one minute is used.   

2- Repeated or variable deceleration.  It is normal for the baby’s heart rate to increase and decrease during and after contractions.  If the dips become too severe, it can indicate fetal distress.  If they don’t happen in time with the contractions (variable), they could be related to something else, such as trouble with the cord or placenta.

3 – Meconium staining of the amniotic fluid.  This alone is not necessarily an indication of distress, but it is a symptom.  Distressed babies release meconium (poop in the womb).  Not all babies who produce meconium in utero are distressed.  (Irish girls have pale skin.  Not all girls with pale skin are Irish.)

 4 – Fetal Movement: frequent decrease and weakening.  Again, this is not an indicator by itself; many babies get “quiet” during labor, often just to sleep.  If decreased movement happens along with another factor, it’s cause for concern.

5 – Acidosis: If you want to be sure if your baby is in distress and there is time, this is a definitive test.  A blood sample is taken from your baby’s head (a tiny scratch).    They can immediately test the blood’s PH, oxygen and carbon dioxide levels to see if your baby isn’t getting enough oxygen.  This is only possible if the baby’s head is engaged and your water had broken.

                pH below 7.20 (Additional information about acidocis here)

                pO2 (oxygen level) below 10mmHg

                CO2 (carbon dioxide) above 60mmHg

If the baby is in acute distress, it’s time to get the baby out, by the swiftest method possible.  Please, if your doctor says the baby is in danger, don't spend time printing out this post and checking the lab work...

More information about fetal distress here

You should know: If the baby is in mild distress, the first course of action should be to attempt to remove whatever is causing distress.  Sometimes, your position can be compressing the cord – occasionally, if you change position (lie on your side, your stomach, or even get in a tub), this can alleviate pressure and allow the cord blood to flow properly.  If you’re on pitocin, they should turn it off.  Overly strong contractions can stress the baby.

Previous Abdominal Surgery

This is not absolute, but depends on the type of incision and the type of scarring.  Certain abdominal surgeries can cause complications during vaginal childbirth.  One example is a iliostomy/j-pouch surgery, removal of intestines, vertical previous c-section, or c-section that is not yet healed (less than 1 year).  Necessity is dependent on the location of scarring and weaker tissue.

Active Herpes Lesions

If you have genital herpes and have active lesions, you can pass the disease on to your baby at birth.  Herpes can be deadly to a newborn, and there is no cure, so they’ve got it for life.  Between 10 and 14% of women with genital herpes have a lesion at delivery.  The chance of passing the virus to your baby decreases based on the amount of time Mom has had the disease.  If you have had herpes for years, the theory goes that you have developed antibodies and will pass these to your baby – even if you have a current lesion.  If you acquire herpes during your pregnancy, especially during the 2nd and 3rd trimester, your risk is highest, and you may consider a c-section even if no lesions are present.      See this site.

Multiples greater than twins

Triplet and higher deliveries are almost always delivered by c-section.  First, these deliveries are rarely full-term, and premature babies may not handle the stress of labor as well as full-term babies.  Second, 3+ cords and 3+ placentas can be complicated.

You should know: Twins are regularly delivered vaginally without complication.  Even triplets can and have been delivered vaginally (see here for a recent study), but this is rare because triplets and greater so often arrive ahead of schedule.

Known Health Emergency for Baby

If your baby has certain known health issues or birth defects (I hate that phrase, no baby is “defective”) that need to be addressed immediately, a cesarean section may be your best choice. Work with your neonatologist.

Health of the Mother

If a mother is physically incapable of labor because of her own health conditions, c-section is the alternative.    Some examples include physical abnormality (certain kinds of dwarfism or pelvic abnormalities), some kinds of paralyzation, out-of-control diabetes, and a few other extreme conditions.

Generally speaking, most women are capable of at least attempting a vaginal birth (there is stress involved in a c-section as well; delivering a baby isn't a walk in the park no matter what your health).  You and your doctor need to weigh the benefits and risks.

DEBATED REASONS

These are reasons often given for cesarean sections.  There is debate about them.  Some people say they’re necessary to mitigate risk, others say that vaginal birth should first be attempted.  Do your research, work with your care providers and reach your own conclusions.

If you do decide to have a c-section, armed with the facts, more power to you.  My goal is informed consent.  If you personally decide that the risks of a c-section are less than the risks of vaginal birth, awesome.  I just hate to see women pressured into something they "had" to do when they didn't want it.

Abnormal Fetal Position (breech): 

Most midwives and doctors will not deliver a breech baby vaginally – but some will.   Many babies are born happily and peacefully in the “frank breech” position, that is, butt first, feet by head.  This position is most favorable to vaginal birth, if you can find an experienced provider who is willing to assist.  Breech babies have all been delivered successfully vaginally.  Breech births do carry higher risks of cord prolapse, increasing with the type of breech delivery.  Not included here is Footling breech, which carries the highest risk.  In this presentation, baby comes out feet first. 

If you attempt vaginal delivery of a breech baby, it is of vital importance that your midwife/OB be well-versed in the intricacies of breech birth.  If you can’t find one (providers are much more rare than breech presentations), you may have a c-section.  It is important to note that vaginal breech birth should not be attempted without an experienced medical professional who is on board with delivering breech.  There are risks to delivering breech vaginally; neonatal death has happened as a result of breach deliveries being handled improperly.  Work with your provider to assess your individual situation.

HIV Infection

Some research has shown that HIV transmission from mother to baby can be reduced by surgical delivery.  Other research has contradicted this, and found that there is no increased risk with vaginal delivery.  For more information, start here and keep on going: http://www.wdxcyber.com/npreg13.htm

Failure to Progress

I would personally argue with this reason.  If failure to progress exists but is not accompanied by any health issues for mom or baby (see Acute Fetal Distress above), what most mothers need is patience, not surgery.   Mom may need more support.  She may need help feeling safe.  She may need (eek, omg, yes I’m saying it), help with pain so she can sleep, or other medical assistance.  Surgery should be the last option, not the first.  Get in a tub.  Close the doors and kick the world outside.  Listen to soft music, turn down the lights.  Magic can happen!

Long ago in caveman days, you wouldn't want to deliver a baby in "unsafe" conditions.  Say, there's a warring tribe attacking your cave, or a tiger on the loose - real, physical danger.  You wouldn't want to deliver a helpless baby.  We're programmed so that labor slows down in periods of stress and fear.  Many women who aren't progressing need to feel extra safe and protected before their bodies will allow them to birth their children.  Threatening most women with unwanted surgery is not a way to make them feel safe!   

Healthy labors can last for days, especially the first time around.  This is not necessarily pathogenic.  It is annoying to hospital administrations who may want the room for the next woman.... So, personally, unless fetal or maternal health shows signs of deterioration, I'd argue against the knife.

True “failure to progress” is defined as 4 or more hours with no dilation progress, when mom is dilated at least 5cm.  Early labor (less than 5cm dilated) can last for a really long time under totally normal circumstances.  

Twins (or sometimes even triplets)

Twins are, like breech, a variation on normal.  Like breech delivery, you will need to find an experienced caregiver to work with you, but it's absolutely possible.  Baby position is also key here - ideal presentation is below, but babies have been successfully delivered in all sorts of presentations. 

This is a great site to see videos of twins born vaginally: http://www.givingbirthnaturally.com/natural-childbirth-video.html

This is also a great discussion of mothers who've done it.

An additional complication to the births of multiples is prematurity or babies who are small for their gestational age.  Please work closely with a trusted professional to determine your best 

Twins, both head down, an ideal position for vaginal birth.

  What you should know: Delivering one twin vaginally and then the next by c-section is not unheard of.  Some providers (but not all) prefer that you have an OR on "standby" or at least nearby when delivering twins or triplets the old-fashioned way. 

Previous Cesarean Delivery

VBACs are not permitted in many hospitals.  Why?  Well, there have been some studies done that showed an increased risk of uterine rupture in mothers who had previously had a c-section.  It scared hospital administrations, and nowadays a lot of hospitals won't let you try vaginally.

The evidence does not support this fear.  The risks of a second c-section are usually higher than the risks of attempting vaginal birth.  You may have to fight hard for a VBAC, but the evidence is with you.

I am oversimplifying the situations surrounding VBAC - but if you'd like to consider it, please do some research.  Not all cesareans are alike, and not everyone is a good candidate for VBAC.  If you are a candidate, you may want to consider it.  See the bottom of this page for additional information.

Macrosomia (baby's too big)

This one's tossed around a lot as a reason for surgery.  Again, most evidence does not support it.

I don't remember where I found this picture.

1 - It is very difficult to truly assess the size of a baby before he's born.  Ultrasounds and belly measurements are notorious for being way off.

2 - Most mothers' bodies won't make a baby too big to come out.

3 - Big babies are delivered vaginally all the time.  11-12 pounders!

4 - Baby fat squishes.

If a baby is truly too big to come out the old-fashioned way, that will prove out in labor.

Cephalopelvic disproportion  (CPD)

A variation on the "baby's too big" theme, true CPD is also rare, and virtually impossible to diagnose prenatally.  CPD means the baby is too large to fit.  Sometimes smaller-statured mothers are given this as a reason for c-section. 

Tiny mommies have big babies naturally all the time. CPD is real, but it varies widely.  Mothers who have had c-sections for CPD have gone on to have successful VBACs. 

You should know:  If a baby does get "stuck" (shoulder dystocia), changing positions can enlarge the pelvic opening.  The Gaskin Manuver is a potentially life-saving technique that can be used in the event of shoulder distocia.  The lithotomy position (on your back with your legs up in stirrups) is the one of the *smallest* positions for a woman's pelvis.  Flip to all fours or squat, and you can get up to another 3cm in diameter!  Shoulder dystocia is a true emergency for the baby, and a competent provider is absolutely essential to saving the baby's life.

Plus-Sized Mama

I am a plus sized mama.  I gave birth (vaginally) to a 7 pound baby, who ultrasound "estimated" at 9 pounds 3 days before his birth.  Whoops.  So much for that "big baby" worry.  Some doctors offices will label you "high risk" by the size of clothes you're wearing, and automatically steer your chubby self to the operating table.  I call bullsh!t on this one, with some exception.

Generally speaking, if you are healthy enough to vigorously engage in the activity that got you pregnant in the first place, there's no reason that you shouldn't at least attempt a vaginal birth.  If, however, you have a hard time getting around, you might have a tough time managing labor.  You never know though - you may be surprised with the amazing things your body can do.

In fact, the risks of c-sections are often higher in obese women then the risks of vaginal delivery.  Check this out if you're a plus-sized mama-to-be.  Personally, I don't see harm in attempting a vaginal birth, no matter what your size - but, again, not a doctor.

You should know: Taking care of yourself during pregnancy and having a supportive care provider are the best ways to ensure a healthy labor and delivery, regardless of your size.  If you are plus sized and suspect that your provider is not "size-friendly", switch.

There are undoubtedly many reasons I missed that are either real or dubious reasons for c-section.  If you know of any, please comment with them and I will happily edit this article.  I will also happily correct any (verifiable) mistakes; I'm not a doctor and I don't play one on the internet.

Ultimately, many c-sections are necessary, but not all of them.  Women who have c-sections are no less strong and awesome than those who deliver vaginally, with or without medical assistance.  C-sections are not a failure, often they are a massive and amazing miracle that could have resulted in the death of mother or baby not long ago in our history.

What's important through the whole process is informed consent; if you have a c-section, that you understand why it is necessary and agree with your doctors about the choice.  Choice, and understanding.   C-sections are a blessing and a curse; if used when necessary, c-sections save lives.  If unnecessary, they put the health of the mother and baby at increased risk for infection, bleeding, and even death.

Women are people worthy of respect throughout all of labor and delivery.  Contrary to media portrayals, we are capable, intelligent and rational people, even after our water breaks.  :)  We want what is best for our babies, and we want to be treated as adults and active participants in our own healthcare.


Additional Resources:

For more information about the unnecessary c-section epidemic and how it's affecting maternal and neonatal health, check out: http://www.theunnecesarean.com/ and http://www.ican-online.org/

For information about VBACs, click here: http://www.vbac.com/ and http://vbacfacts.com/

For support dealing with birth trauma, including PTSD, visit these sites: http://www.solaceformothers.org/ and http://www.birthtraumaassociation.org.uk/

To learn more about recovering from a c-section, see here: http://www.csectionrecovery.com/ and http://www.csectionguide.com/

My new bumper sticker

I have a new-for-me car.  It has a virgin bumper.  I've been in search of the perfect bumper sticker for about 2 months.  Not an earth-shattering decision, obviously, but something I've been on the look-out for.  I don't want to have 20 stickers on my nice, shiny car, but I would like one...just one.

I considered something silly (Do not meddle in the affairs of dragons, for you are crunchy and good with ketchup),  but I really wanted to say something important and thought-provoking.

I strongly considered an anti-circumcision bumper, but frankly, that's a really good way to start a nasty argument with most people, and I'm not sure a bumper-sticker slogan is really going to change most minds.  I drive clients around in my car, and that's not the conversation I should be having with prospective customers, as a rule of thumb.  Besides, there are so many other things that are important to me.

Breastfeeding...ok, maybe....religious tolerance, music in schools, peace, the importance of treating others with respect - how the heck do you boil all of that down to a 2" x 6" piece of plastic?  I thought about having one made that said "Babies are People Too", but I care about people of all ages, and frankly, most folks don't treat adults all that well.

Then, yesterday morning, I saw it on my neighbor's car.

I have spent my $2 and it will be coming in shortly.  There's the crux of my parenting and societal philosophy.  Thank you, Mr. Douglass, for this small piece of your wisdom.


It is easier to support breastfeeding than pay for the health consequences of formula-feeding for the masses.  You can help a mom breastfeed her baby - so much easier than treating asthma, auto-immune conditions, obesity and the rest.

It is easier to get up multiple times in a night with a newborn than treat an adult with anxiety and depression, whose earliest memories were of being left alone when they were crying for help.

It is easier to leave a penis alone, rather than repair a penile adhesion, restore a foreskin, or treat erectile dysfunction.  It is easier to tell a child that you left the decision up to him, rather than apologize if he is not happy with your choice.

It is easier to use gentle discipline than deal with violence in an adult.



It is easier to teach tolerance to a child than reform a teenage bully.


It is easier to invest in education than in prison systems.



"Easier" does not mean easy.  None of those things are easy at the time - they're so hard that you might not be able to do them all, every time.  That's ok - we're human.  I've only been at it for 9 months, and I've already messed up on quite a few...that doesn't mean I'm going to give up trying.  Ultimately, over a lifetime and in a society, it's easier than the alternative.

I'm trying to keep my long-term glasses on.  I'm not trying to raise a "good baby" or an "obedient child."  I am trying to raise a strong, courageous, compassionate man...who just happens to be 29 inches tall right now.

Nurse-Ins are for EVERYONE

Often, the only outspoken lactivists are mothers who are currently nursing their children, or have nursed them in the past.  The lactivist community is strong, but insular - demonstrations are often nurse-ins, and understandably, conversation in lactivist groups tends toward the ins-and-outs of being a nursing mother.

Breastfeeding is more than a mom's issue.  It's an everybody issue.

Right now, there's a controversy spreading on Facebook, across the internet, in cafes, stores and churches.  Facebook has recently banned a number of users for posting photos of themselves breastfeeding.  They have deleted an event for a national "Nurse-In", which calls for mothers to post breastfeeding pictures.  Why?

"It's obscene."

I cannot breastfeed my son.  I'd love to post a picture of our brief nursing time, but alas, I didn't capture one at the time.  My husband can't breastfeed, my mom is way past that, and I don't have any friends who are currently breastfeeding their kids.  Nonetheless, I support nursing moms, and their right to feed their babies wherever and whenever the baby needs food.

So, why would I care?

"OMG, I DON'T WANT TO SEE YOUR BOOBS!"

Nursing in public prevents angry, screaming babies.  I hate listening to babies cry hysterically.  It's the worst sound in the world - give me fingernails on chalkboard any day.  Every instinct in my body drives me to find the sound of the screaming child and fix it.   Evolution or God made people that way - we react strongly to the sound of a distressed child, our hormone levels changing, anxiety activated.  When I hear a truly upset baby, all I want to do is help.  If the child is hungry, the solution is simple - feed the baby.   I'd so much rather round the aisle in Target and see a nursing mom than have to hear her child screaming across the store.

Once upon a time, I traveled a lot for business.  When you board a packed plane, there are a few things you dread having in the seat next to you.... a smelly person, an exceptionally large person, and above all else....please.... not a baby!

Well, on one trip, I approached my seat and found a mother with her 18 month old son in her lap.  It was a 4 hour flight, and I was dreading every minute.  We took off, and he started to holler - ear pressure is no fun.  His mom made eye contact with me, popped out her boob, latched him on, and smiled.  I smiled back nervously...did she just do what I think she did?   Her son looked up at me past his mom's nipple and grinned.  I was a little shocked, but there was no screaming.  We chatted on and off during the plane ride, and every time the little one got fussy, she nursed him and he relaxed.  What a pleasure!

That was my first real experience with nursing.  At 23 years old.  What, you say?  It's not a typo.  I understood that, theoretically, women could breastfeed their children, but I had never actually seen it.  For realz.

"OMG, MY KID CAN SEE YOUR BOOBS!!"

I was 23 years old the first time I saw a mother nurse her child.  My mother breastfed me for a few weeks until her doctor told her that she didn't produce enough milk and I was going to starve.  She believed him, and formula-fed me and my younger brothers from then on.  Some of my earliest memories were of bottle-feeding my youngest brother.

I have dozens of cousins, and a large, close family.  During my childhood in the 80s and 90s, either none of them breastfed their children - or if they did, they did so in secret, hidden away in the spare room with the coats.  I never saw it, not once.  My baby dolls came with bottles.  Cartoons showed babies being fed with bottles.  I was raised to believe that's how babies are fed.  With a latex nipple on a tube.

So, when it came time for me to have children, I did research - and found out that breastfeeding is not just best, it's normal - it's how babies are supposed to eat.  All the time.  Babies were made to breastfeed.  Breasts were made for making milk.  Not filling out a bikini top.  I knew it was the right thing to do....but I didn't know how to do it.

I took a class. I read books.  Then it struck me - this is a normal thing to do.  Why did I have to take a class to learn how to do the "football hold"?  Why did I have to take a class to show me how to latch a baby on my breast?  The answer is simple - I had never seen it, up close and personal.  Is it any wonder how difficult breastfeeding was for me?

If you want to know why so many women attempt to breastfeed and fail, I would say to look there.  They didn't learn how, when they were 10 and first learning how to care for infants.  Why can't fathers support breastfeeding moms and give advice?  They never saw it, in real life or on TV. 

I later found out that 2 of my aunts did breastfeed my cousins.  They did it in spare bedrooms or the bathroom, because they were told or led to believe that nursing was "indecent" and "obscene." So, at the multitude of gatherings, all I ever saw, and all that millions of American children have ever seen, was a mother either bottle-feeding or sneaking off quietly to some dark room, away from the action, to perform this "disgusting bodily function."


Here's the truth.  Babies don't come with bottles in real life.  They come with boobs.  We are mammals, and mammals breastfeed their young.  Duh.

"OMG, CAN'T YOU COVER UP??"

You don't ask the mother cat with kittens to "cover up" - right?

So, here I was, an expectant mommy, and I bought a nursing cover.  I'm sorry, these things are stupid.  If you're a breastfeeding dummy like me, nursing isn't "instinctual."  It's hard!  Getting the right latch is hard.  Getting the kid on the boob is a challenge at first.  Doing it blind is damn near impossible.  Yeah, yeah, some nursing covers have a hole at the top you can look down through - but their purpose is to reduce sight of breastfeeding.  Right?

Ok, let's see how a new mom, who has never actually witnessed a nursing mom do her thing (because it's gross and indecent and should be done in private only), attempt to get a proper latch with a cover.


Instructions for ensuring a proper latch:

1- The first step to a proper latch on is getting baby to open WIDE!  Brush baby's lips with your nipple to encourage him to open wide, as if yawning.
  (Oh yeah, sure.  I'll see his wide-open mouth with my x-ray vision.  With a cover on, I'm going to brush her nose with my nipple, not her lips!)

2 - Once baby's mouth is open wide, quickly pull him onto the breast by pulling the baby toward you with the arm that is holding him.  Make sure you move the baby towards you, and not move yourself towards the baby.
(Sure, no problem.  I'll just hope I'm pulling him in the right direction, and try to accomplish it one-handed, so I can keep this blanket in place....)

3 - The baby's gums should completely bypass the nipple and cover approximately one inch of the areola behind the nipple.  Make sure the baby's lips are everted.  Some baby's will tighten or purse their lips, especially the lower one.  If the lower lip is inverted (turned in), try simply pressing down on baby's chin to evert the inwardly turned lip.
(Forget x-ray vision.... now I need x-ray vision and a friggin MIRROR!)

 4 - Note how the baby's lips are correctly everted, and the mouth is open wide.  Also notice how much breast tissue has been taken in, almost the entire areola is in the baby's mouth. 
(Hmmm... can't see that areola through the blanket, can I?)

 That is mostly a "beginning" problem... what about later on?


I absolutely love this YouTube Video of an older baby's reaction to being covered...



See?  Not always easy.


Plus, returning to my point above, if nursing moms always cover up, little boys and girls have to learn about breastfeeding from a BOOK. 

Babies are people too.  They deserve to eat when they're hungry. and they deserve to enjoy their meals without a blanket over their heads.  Pretty simple stuff.

"OMG, CAN'T YOU JUST FEED IT PUMPED MILK IN A BOTTLE??"

Sigh.  Again, a dumb idea from someone who's either never breastfed, or someone who never had problems.

First, when babies are super-little, bottle-feeding can cause "nipple confusion".  Just like it takes a mom some time to figure out how to breastfeed correctly, it takes babies some time.  Artificial nipples work differently than boobs.  They have one hole, boobs have multiple holes.  Breastmilk flows at different rates during a feeding, bottles flow at only one speed - fast!  Babies have to work at the boob.  They just have to open their mouths with a bottle.  If you introduce a bottle before a baby is fully established with breastfeeding, you can actually sabotage the breastfeeding relationship.  

Not all babies will take a bottle, either.  Choice #1 - food from the source, at the right temperature, starting out light and progressing to a thick, sweet dessert as the meal progresses.  Great company, skin-to-skin contact, and just the right fit.  Choice #2, your meal all mixed up, shooting out fast, either too hot or too cold.  Sure, it's still a steak dinner with cheesecake, but you're getting it through the drive-through.

Not all moms have a strong enough supply to pump and feed their baby the old-fashioned way.  To pull this off, she has to make enough food for breakfast and lunch at the same time, but still have enough in the "fridge" for lunch later on.  Pumping's not easy, either - you don't get the same amount from a machine as you do from a baby.

Even if Mom does become a pumping pro, it can change her supply to the other side of things, with engorgement and overproduction.  If you think nursing in public is gross, just wait till she whips out the pump!

NEWS FLASH: Breast milk is not shelf-stable.  It's milk.  Hello.  It has to be refrigerated once it's been pumped out.  So, if Mom's away from a fridge for longer than a couple hours, it's the boob or nothing.   And we're back to the screaming baby.

"CAN'T YOU JUST GO IN THE BATHROOM??"

Right.
'Cause that's a nice, safe, clean and comfortable place to enjoy a meal.  

Did we forget?  Babies are people, too.

So, nursing moms, keep it up. Whip it out.   
Feed your babies.

Nurse in public.  In church.  At the store, in an airplane, in the playground, at the mall, at Christmas parties and birthday celebrations, in line for Santa, at a restaurant.  You're doing what's best for your baby, absolutely.

Just as important, you're showing that little girl at the next table over how to do it right.  You're teaching your nephew how to become a supportive father.  You're reducing noise pollution.  You're improving the public health.

You're saving the world, and I'm more than happy to hold your cape.