Rising up

I got married in the summer of 2001. When I was a newlywed, I had only known one woman who had given birth outside of a hospital by choice.  (And I never could have imagined I'd eventually do the same!) 

Nine years later, I can't believe how much has changed.  I can't even count the number of people I know who have given birth at home (or would be open to the possibility).  So many women! That is partly because I have sought friendships and attracted friendships with like-minded people.  But I don't think that's the only explanation.  I think giving birth at home is becoming more and more common.  In fact, I know it is.

Did you see that report back in March from the CDC?  Amy Newman from RH Reality Check summarizes it's findings:

Over the last five years, out-of-hospital births (which includes home birth and birthing at a free-standing birth center) rose 3 percent and home births rose 5 percent after having sharply declined between 1940 and 1969 and then remaining static over the last few decades.

Clearly women aren't abandoning hospitals in droves.  We're talking about a tiny percentage of the total births in the U.S.  But I expect that trend to continue.  Not because hospitals are BAD.  They're not bad.  They serve an essential purpose for women who experience birth complications.  But I expect home births to continue to rise because more and more women are realizing that, being low risk, they can have an equally safe but likely more satisfying birth experience staying home.  And the more women choose that path, the easier it becomes for their friends and family members to choose it... and on and on.

I often wonder what maternity care will be like in the U.S. when my daughters reach their childbearing years. 

Will the cesarean rate have decreased?  Will home birth midwives be able to practice legally in every state?  Will hospitals be more mother-friendly? 

I know my daughters may not choose the same path I have chosen.  I will support them in whatever they choose.  But watching them both scramble to get on my lap whenever they hear the unmistakable sounds of a YouTube birth video, seeing their complete and utter fascination with every detail, their comfort level and curiosity as a baby head emerges from its mother... all of that makes me hopeful that they will at least not enter their childbearing years fearful and uneducated. 

When my oldest daughter does tell me, on occasion, that she doesn't want to have babies because "It will hurt,"  I always smile and respond, "But it's SO COOL!  I love doing it!"  I hope that hearing my love of birth will, with time, ease her fears. I plan to school them all their lives in the beauty of birth and teach them how to help each other and other women through that process.  It makes me so happy to think of them doula-ing each other some day... and their friends... and their daughters... and grand-daughters. 

When I got married in 2001, no one in my family or circle of friends would have ever dreamed of giving birth at home.  Ever.  And now I'm surrounded by home birthing mommas... and looking at the possibility of generations of my own daughters joining those ranks.  What a beautiful sight.

Change is good.

Food, Inc.(redible)

Ax and I watched the documentary Food, inc. on PBS last week.  Heather's post reminded me that I've been wanting to blog about it. And she reminded me that the film is still available for online viewing until midnight tonight.  I'm sort of out of the loop when it comes to media and movies and academy award nominations, etc.  So I didn't really know much of anything about the film until another friend posted about PBS showing it on facebook last week. 

After watching the film, I posted my reaction on facebook:  "Wow. Wow. Wow. Scary indeed. It has prompted us to take our health-consciousness to a whole new level. Wow."  And a little while later, I elaborated more on my feelings, "Let's just say there are certain things I will NEVER purchase ever again, if I can help it. The film made me want to vomit, scream, cry (from sadness AND joy), and cheer. So many emotions packed into one 120 minute stretch."

So, while I can say without hesitation that I believe Food, Inc. is a film everyone should watch, I can also say without hesitation that it's not a fun or easy film to watch.  It's painful to watch, for many reasons,  and incredible in every aspect of the word...  astonishing, unbelievable, disgusting, and heart-warming too.  As we watched, I felt, with deep intensity, both the spirit of evil prompting much of what happens to bring food to our supermarkets and the beautiful, inspiring, wonderful spirit of love that motivates farmers like Joel Huesby.  I strongly believe that God aches to see how modern industrialized agriculture is depleting the earth, disrespecting His creations, and making all of us weaker and weaker over time.  And I strongly believe that God is eager to help us repent and choose a better way for ourselves, our children, and the rest of our posterity.  The film motivated Ax and me to make some major changes that will improve our lives, and we feel confident that God is pleased with those changes and will help us find the best, most affordable ways to move forward with those plans.

Which brings me to something I wanted to address from the film.  I was frustrated with the way the film represented the financial costs of healthy eating.  There is a portion of the film where they follow around a low-income family of four as they order their dinner from a fast food chain dollar menu ($11.48 for five hamburgers, two chicken sandwiches, and three soft drinks to feed a family of four), and then they go to a grocery store and lament how expensive the pears and broccoli are.  The sentiment is... if fruits and vegetables weren't so expensive, we'd eat healthier... what a shame that we can only afford fast food!  Then it finishes with the family discussing the outrageously expensive prescription medications the father has to take for his health problems... diabetes, etc.  And the mother sort of laughs and says something like, "I guess you either pay on the front end for healthy food, or you pay on the back end for medical bills."

I've thought a lot about this part of the film since last week.  I'm so frustrated by it.  I think the filmmakers wanted us to see the way low-income families struggle to make healthy food choices, but I think they also misrepresent some things.  It's so sad that there is such a disconnect when it comes to food prices... People grow up buying food like this family does and never learn that there is a much easier, cheaper, better way to feed themselves.  Healthy isn't more expensive!  It's usually cheaper!  Personally, I can't afford junk food!  (Though we do eat it on occasion.)

Thoughts rolling around my head in reaction to this part of the film:

• $11.48 is NOT a cheap dinner for a family of four.  Even if you just brought your own reusable water bottles instead of ordering sodas, you'd save yourself enough money to go buy some of those "expensive" pears or broccoli to eat with your dollar menu burgers.  They could EACH have an entire 16 oz package of strawberries this time of year (88 cents last week at Fry's) for less than what they spent on their sodas! 
• The way to buy groceries is NOT to buy the broccoli (or anything else) when it's "expensive."  When you're struggling to make ends meet, you have to buy things when they're on sale.  Only buy produce in season when it's cheapest (or join a co-op like Bountiful Baskets where you can get enough produce to feed your family for two weeks for just over $1 a day).  And stock up on staple items when they're on sale.  Don't pay regular price for anything (unless you have to).
• The mother in the film says, "We don't have time to cook."  I understand that people are busy, especially hard-working families like theirs.  But I think people also over-estimate the amount of time (and money) it takes to make an inexpensive, fairly healthy meal.  For example... taco salad is a piece of cake.  You could even cook a bunch of taco meat on the weekend and freeze it to use a bit at a time during the week.  All you'd have to do on the weeknight is warm up the meat in the microwave, tear up some lettuce, cut up whatever veggies you want on top, and throw some pre-grated cheese on there.  Really fast and easy and probably a fraction of the cost of their fast food dollar menu meal if the meat and veggies were purchased on sale.  I'd say a little effort is beyond worth it to cut costs and improve health.  
• Sometimes even the organic stuff is a better deal.  If you watch carefully, you can eat organic for less than what you'd spend to eat non-organic.  Watch for sales and specials.  And even if you have to pay a bit more for the organic grass-fed beef, it's worth every extra penny... which really isn't "more" than what you'd spend eating fast food hamburgers anyway if you look at how many people can be fed with just one pound of $4.99/lb grass-fed beef.  When we use one pound of beef to make a meal, it usually translates into dinner (more than one helping each) for two adults and two small children and lunch for two adults the next day.  That's more than six servings.  That $4.99 went a long way.  And the more we "eat meat sparingly," the less we'll have to spend. Why is grass-fed beef worth the price tag?  Watch the film. :-) But, in short... it's safer for human consumption, better for the cows' stomachs, better for the land, and nutritionally superior in so many ways. 

Alright... enough rambling.  Here's a trailer for the film:

I know I'm starting to sound like a broken record

I'm amazed that magnesium is the real answer to so many problems, but even many scientists and researchers seem unaware of its importance.  This Reuters article talks about the rise in kidney stones among children in South Carolina and points to excessive antibiotic use as a possible cause.  Antibiotics deplete magnesium!  And the "stone belt" (from Virginia down to Florida and over to Texas) mentioned in the article is an area of the country with primarily very soft water--low mineral content.  Hard water and healthy gut bacteria help raise our bodies' magnesium levels.  They don't mention it in the article, but low magnesium can lead to kidney stones. Magnesium is the missing puzzle piece no one (well, almost no one) is talking about.

Get yer magnesium, my friends!

Magnesium Manifesto

"There is no life without magnesium." -Mark A. Sircus

I feel so overwhelmed. There is simply so much to say, and I have no idea how to say it all coherently because my mind has been spinning with all this new, amazing information for almost a week. I'll do my best. (And I'll pepper as many of my research sources as I can fit in throughout the post, so I'd recommend clicking around and checking them out.)

Magnesium is incredibly important.  (Especially for pregnant women, but I'll get to that later.) Magnesium is probably most well-known for its partnership with calcium in muscle function--calcium contracts muscles, magnesium relaxes them.  But magnesium is actually involved in far more than that.  From what I gather, every time a nerve cell fires, magnesium is required to control the entry of calcium into the body's cells.

Dr. Christianne Northrup sums it up nicely when she says, "Magnesium is essential for the functioning of more than 300 different enzymes in the body, particularly those that produce, transport, store, and utilize energy. . . . In short, living without adequate levels of magnesium is like trying to operate a machine with the power off" (source).  And Mark A. Sircus, a magnesium proponent, describes magnesium as "the source of life" and "the lamp of life" because of its essential role in plant photosynthesis and human bodily functions (source).

As I've immersed myself in studying this amazing mineral over the past week, I have come more and more to see it with deep awe and reverence. Magnesium is at the core of all life and life-giving.  I'm in love with magnesium.

And, unfortunately, most of us are low on magnesium. Magnesium and calcium must be maintained in their proper balance in order to function correctly, but the average modern American consumes far more calcium than necessary and not nearly enough magnesium. That excess calcium can disrupt many important functions. Instead we should take in more magnesium than calcium or at least a 1:1 ratio.

There are myriad ways that magnesium deficiency can manifest itself in your body. Some of those are:

• Anxiety and panic attacks
• Asthma
• Nausea and vomiting
• Headaches and migraines
• Abnormal bowel function, constipation, etc.
• Heart disease
• High blood pressure 
• Muscle pain, cramps, and spasms
• Depression
• Hypoglycemia
• Kidney disease and kidney stones

And low magnesium can lead to several problems of particular interest to women, both pregnant and not pregnant:

• Recurrent miscarriages and premature labor
• Premenstrual syndrome
• Menstrual cramping and bloating
• Infertility caused by spasms in fallopian tubes
• Pregnancy leg cramps
• Pre-ecplampsia
(Source)  

So how do we ensure that we get enough magnesium?

Our ancient ancestors would have obtained more than enough magnesium through plants, nuts, and seeds from the earth's rich non-depleted soil and through soaking in the pristine ocean's limitless supply of magnesium chloride. With soils depleted of nutrients and oceans often too far away and/or full of toxins and pollutants, we aren't quite so lucky. But we can do our best with what we've got.

What are the best food sources of magnesium?

You pretty much can't go wrong with dark leafy greens, nuts, seeds, legumes, salmon, and whole grains.  Some of the best among those sources, according to The World's Healthiest Foods:

• Pumpkin seeds
• Spinach 
• Swiss chard
• Sunflower seeds
• Sesame seeds

Magnesium is also found in hard water.  One site I visited explained:

In a survey of 25 cities in the US, the lowest death rates from heart disease were found in areas where the drinking water supplied above average levels of magnesium. Part of Texas has the highest levels of magnesium in drinking water, and also the lowest cardiovascular mortality rates in the US Australia has some of the lowest drinking water magnesium levels, and also the highest cardiovascular death rate in the world.

How can we improve the body's ability to absorb dietary magnesium?

Avoiding or limiting certain magnesium-depleting foods and beverages will protect your body's magnesium stores, including:

• Soft drinks
• Sugar and refined carbs
• Excess unhealthy fats
• Alcohol 
• Caffeine
• Excess animal protein
• Certain medications, such as diuretics and steroids/corticoids

Increasing consumption of probiotics and prebiotics has also been shown to increase the absorption of essential minerals, in part because of their ability to break down the mineral-binding phytic acid in foods, releasing those formerly bound minerals for absorption. (See here)

Getting vitamin d through regular sunlight exposure will also improve your body's ability to retain magnesium and calcium.  Sunlight seems to do this more efficiently than vitamin d supplements. (See here) 

How else can we get magnesium?

Ocean water is a limitless source of magnesium chloride.  And, based on my internet research, magnesium is better absorbed through the skin than the gut.  If you live near a beach with clean water, regular soaks should benefit your magnesium levels.  For the rest of us, taking baths with epsom salts (magnesium sulfate) or magnesium chloride flakes will raise levels of magnesium in the body.

Magnesium is also available, of course, in oral supplements, but these can cause diarrhea in some people.

Pregnant Women, Listen up!

Clearly magnesium is essential for all of us, but I'm becoming convinced that maintaining adequate magnesium levels could reduce or eliminate a large portion of the pregnancy complications women encounter.  And, as I listed earlier, magnesium can also remedy many of the other complaints associated with our womanly cycles.

Dr. Christianne Northrup shared a story that illustrates what I'm talking about:

I was first introduced to magnesium during my obstetrical training, where I saw how effective magnesium sulfate was in preventing seizures and restoring normal blood pressure in pregnant women suffering from toxemia. Magnesium is also frequently given to women having preterm labor to stop contractions. It works! 

A good friend of mine, Alexa, had her third baby in 1994. About seven weeks before the baby was due, she started to have contractions that would only stop when she lay down. Because she was 2.5 centimeters dilated and almost fully effaced (conditions often present when a woman goes into labor with a full-term third child), she was put on bed rest. Luckily this helped, and she was able to avoid a lengthy stay at the hospital. After having her baby, Alexa was extremely run down, had frequent migraines, and severe muscle cramps. She decided to go to a Naturopath for help. He immediately diagnosed severe magnesium deficiency, and she was given weekly magnesium IVs to correct the imbalance. . . .
 
Alexa's OB/GYN was insistent that she get 1500 mgs of calcium every day to protect her baby's and her bones. He told her to take a couple of Tums, an antacid, any day she didn't get enough calcium from the food she ate. Tums contains calcium, and it was the calcium "supplement" he recommended to all his patients. (This was his strategy for keeping her calories from dairy fat down, too.) He never recommended that she increase her magnesium, just her calcium. It's not surprising that she had a magnesium deficiency after following his advice during three pregnancies.  (Source)

This story is frustrating for so many reasons.  But I want to focus on what Dr. Northrup says in the first paragraph.  Doctors know that magnesium helps women with toxemia and preterm labor.  So my question is... if they know it, why do they wait until a woman comes to the E.R. to pump her full of magnesium?  Why are they putting women on bed rest when they have preterm labor instead of teaching them about optimizing their magnesium levels?  Why aren't women with recurrent miscarriages or infertility or PMS or excruciating menstrual cramps being tested for low magnesium?!

Why aren't we all being told how crucial it is to keep our magnesium levels optimal?


I couldn't know this information and not share it.  So here I am.

Magnesium is crucial. 

Please spread the word.

For them I could

Sometimes I feel like it's inevitable. I'll probably end up a midwife, in the end. But most of the time I don't really look forward to it. It terrifies me to imagine holding the lives of women and babies in my fallible human hands. I don't really want to be a midwife. But I've been thinking lately of some facts and figures that just might be enough to propel me forward on the path toward midwifery.

First, my cousin-in-law, Liz, wrote a blogpost discussing the book Half the Sky. She shared a couple of excerpts that have been reverberating through my skull ever since:

In much of the world, women die because they aren't thought to matter. There's a strong correlation between countries where women are marginalized and countries with high maternal mortality. Indeed, in the United States, maternal mortality remained very high throughout the nineteenth century and beginning of the twentieth century, even as incomes rose and access to doctors increased. During World War I, more American women died in childbirth than American men died in war.... 'Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving.' (p. 115-116)

"More women die in childbirth in a few days than terrorism kills people in a year." (Jane Roberts, letter to San Bernadino Sun, qtd. on p. 146)

Then, last night, my brother-in-law watched a PBS segment on maternity care in rural Peru. He thought I'd be interested, so he passed along the link to me. Last year, CNN reported that Peru's pregnant women were "dying at scandalous rates"(source). Yesterday, PBS shared some of the solutions that are being implemented to reduce the mortality rates in Peru's remote areas. The segment starts with this intro:

High in the Andean Mountains of Peru, far from the modern conveniences of a city, generations of indigenous women have given birth at home, their only help from family or a village midwife.

The longstanding tradition of childbirth at home wasn't a problem for most women. But, in that small percentage of cases where complications developed at the end of a pregnancy, in a remote rural area, you could be days away from the nearest medical facility on foot, even multiple-hours' drive.

(Screenshot from the PBS segment)

I've been studying childbirth for the past seven years, but most of my reading and research has revolved around maternity care in the U.S. Although we still have a long way to go here in the U.S., our risk of dying in childbirth is far lower than the risk most women of the world face. I think I could feel content remaining a doula/birth activist if the rest of the world didn't exist. But it does exist.

The World Health Organization puts things into persective:

Every minute, at least one woman dies from complications related to pregnancy or childbirth – that means 529 000 women a year. In addition, for every woman who dies in childbirth, around 20 more suffer injury, infection or disease – approximately 10 million women each year.(Source)

Far too many women die simply because they lack "skilled care during pregnancy, childbirth and the first month after delivery," according to WHO.

While I don't feel compelled to become a midwife for my fellow American sisters, I do think I'd be willing to shoulder the risks inherent in midwifery in order to help save the lives of women in places where maternal deaths are excessively common. For them I could do it.

Unfortunately, those who are able to help these women often lack the ability to communicate in indigenous languages. I have a deep love for languages and have always wanted to learn to speak more of them. I've also always wanted to travel to Africa, South America, and other far-off places. I couldn't think of a better reason to fulfill those dreams. Someday down the road... I hope.

Ask Busca: Iron and Vitamin D suppplementation for infants?

Ali, a nursing student, asked:

[The teacher of my nutrition class said] that babies who are breast fed will likely need an iron and vitamin d supplement. This makes absolutely no sense to me, because breast is supposed to be best, so why would anything need to be supplemented. The teacher said because the baby stops living off of it mothers iron stores at four months, and so that is why, but do they not get enough from the breast milk. I would just think that if the mother was eating healthy that the baby would not need to be supplemented on anything.

Busca's (excessive) babble:

Thanks for your question, Ali. So sorry it has taken me nearly 6 months to finally give you a response! I'm not a doctor, nurse, dietician, or nutrition expert, but I do love to dig around and see what I can find to help my readers out. So here's what I dug up in regard to iron and vitamin D supplementation...

Iron Supplementation

I knew kellymom.com would probably have something to say about it. And, indeed, she does. In fact, she has so much great info over there, that I'm just going to direct you to her site where you will find just about everything you could possibly want to know on the subject of iron supplementation. Here's a brief excerpt:

Healthy, full-term infants who are breastfed exclusively for periods of 6-9 months have been shown to maintain normal hemoglobin values and normal iron stores. In one of these studies, done by Pisacane in 1995, the researchers concluded that babies who were exclusively breastfed for 7 months (and were not give iron supplements or iron-fortified cereals) had significantly higher hemoglobin levels at one year than breastfed babies who received solid foods earlier than seven months. The researchers found no cases of anemia within the first year in babies breastfed exclusively for seven months and concluded that breastfeeding exclusively for seven months reduces the risk of anemia.

The original recommendations for iron-fortified foods were based on a formula-fed baby's need for them and the fact that breastmilk contains less iron than formula (doctors didn't know then that the iron in breastmilk is absorbed much better). Also, a few babies do have lower iron stores and will need extra iron at some point. . . .

La Leche League recommends that babies be offered foods that are naturally rich in iron, rather than iron-fortified foods. . . .

Note: Additional iron intake by the mother will not increase iron levels in breastmilk, even if the mother is anemic. Iron supplements taken by mom may produce constipation in baby. Anemia in the nursing mother has been associated with poor milk supply, however.

Learning about baby-led weaning really changed the way I saw iron supplementation. My first two daughters had iron-fortified rice cereal before 6 months of age, but my son was exclusively breastfed without any supplementation for 6 months. Afterward, he simply ate whatever offered foods he managed to get into his mouth. But I never worried about his iron levels.

Vitamin D Supplementation

As for Vitamin D, there was a recent news article on the subject that caught my eye and prompted me to finally tackle your question. USA Today reported on a couple of studies published in the journal Pediatrics related to infants and vitamin D. Nicolas Stettler, a pediatrician interviewed in the article, acknowledges, "Because humans originated in equatorial areas with year-round sunshine, babies in the distant past wouldn't have needed to get vitamin D from breast milk," but, according to the second study from Pediatrics, 58% of infants today have deficient vitamin D blood levels. It also reported that "Getting lots of sunlight helped raise vitamin D levels in moms, but not in their newborns." (It was unclear to me whether they meant that the mother and baby were both exposed to sunlight or whether they meant that sunlight didn't improve the vitamin d levels of breast milk.)

I have to wonder when I hear that breast milk is "low in Vitamin D," whether that really just means that mothers themselves have been low in Vitamin D for decades leading researchers to conclude that breast milk is always low. I've read elsewhere that Vitamin D supplementation will increase the Vitamin D content of breastmilk, so I think that's worth exploring. Maybe breast milk isn't inherently low after all?

I am partial to Vitamin D expert, Michael F. Holick, who has been researching Vitamin D for more than three decades. The home page of his website has some great info on Vitamin D:

Vitamin D is not a vitamin but a hormone. It is unique in that it is made in the skin as a result of exposure to sunlight. Photosynthesis of vitamin D has been occurring on earth for more than 750 million years. Some of the earliest life forms that were exposed to sunlight for their energy requirement were also photosynthesizing vitamin D. Both children and adults have in the past depended on adequate sun exposure to satisfy their vitamin D requirement. It is well documented that at the turn of the last century upwards of 80% of children in the industrialized, polluted cities of northern Europe and northeastern United States suffered from the devastating consequences of vitamin D deficiency rickets. The skin has a large capacity to make vitamin D. Exposure of a person in a bathing suit to a minimal erythemal dose of sunlight, which is typically no more than 15-20 minutes on Cape Cod in June or July at noon time, is the equivalent to taking 20,000 IU of vitamin D orally. It is now well documented that in the absence of any sun exposure 1,000 IU of vitamin D3 a day is necessary to maintain healthy levels of 25-hydroxyvitamin D in the circulation. An analysis of the NHANES III data has demonstrated that neither children nor adults are receiving an adequate amount of vitamin D from their diet or from supplements.

Holick is a strong proponent of sensible sun exposure. And so am I. I feel fortunate that I live in the Valley of the Sun where my children and I can go outdoors at any time of year most days and receive more than enough Vitamin D in ten minutes to keep our levels adequate. Even so, during times of the year when the weather keeps us indoors more often, I have mixed safe amounts of liquid vitamin D into my kids' yogurt or juice to keep their immune systems functioning and prevent illness.

(Getting a few minutes of backyard Vitamin D at lunchtime in February)

The American Academy of Pediatrics is opposed to exposing infants to direct sunlight. Personally, I think their recommendation is counter-intuitive. Human beings have been living with the sun for thousands of years (and without chemical sunscreens). We even took my newborn son outside for a few minutes every day (at my midwives' recommendation) because of his slight jaundice. Even after his slight yellow tinge had disappeared, I still took him with me outside in the early April morning sunshine while I watered my vegetable garden. He absolutely loved it. As soon as the sun's warm rays would fall on his face, his facial muscles would relax and take on a look of total peace and serenity. He always turned to face the sun no matter where I put him. And my instincts told me it was good for him. My gut tells me newborns need a few minutes of sunlight every day, just like the rest of us.I love the sun. I really think that human beings need regular sunlight exposure to survive. I don't generally use much sunblock on myself or my children unless we are in the sun for an extended period of time. I remember asking our pediatrician about the safety of sunscreens for infants when my first daughter was about 6 months old. He encouraged us to use hats, clothing, and shade rather than chemical suscreens. At the time, I was slow to take his advice and continued to use sunscreen. As I learned more about Vitamin D and safe sun exposure, my sunscreen use has decreased dramatically. Now we rely on hats, clothing, and shade to prevent sunburn (as our pediatrician recommended all those years ago). We all try to wear shirt-style swimming suits to keep our backs and shoulders protected. When we do use sunscreen, I focus on the areas most likely to sunburn--the nose, cheeks, ears, tops of feet, etc.While I wouldn't advocate spending large stretches of time in direct sunlight, I do advocate spending a few minutes every day (sunscreen-free) with some of your skin exposed to the sun, even babies. In places where sunlight is minimal in winter months, I also advocate taking Vitamin D supplements. I'm convinced that widespread Vitamin D deficiency is largely responsible for the "cold and flu season" phenomenon.

So what am I trying to say with all this Vitamin D babble? Yes, babies need vitamin D. How they get it is a personal decision mothers should discuss with their pediatricians. Personally, I'll echo what the Vitamin D council has to say:

Infants and children under the age of one should obtain a total of 1,000 IU (25 mcg) per day from their formula, sun exposure, or supplements. As most breast milk contains little or no vitamin D, breast-fed babies should take 1,000 IU per day as a supplement unless they are exposed to sunlight. The only exception to this are lactating mothers who either get enough sun exposure or take enough vitamin D (usually 4,000–6,000 IU per day) to produce breast milk that is rich in vitamin D. Formula fed babies should take an extra 600 IU per day until they are weaned and then take 1,000 IU a day, as advised below.

Children over the age of 1 year should take 1,000 IU per every 25 pounds of body weight per day, depending on latitude of residence, skin pigmentation, and sun exposure. On the days they are outside in the summer sun, they do not need to take any; in the winter they will need to supplement accordingly.

I hope that helps!

Speaking of loving the sun, this is one of my new favorite songs. I was introduced to it over our Spring break trip to CA when I attended a prenatal yoga class taught by my book collaborator, Felice. Love it! It's definitely going on my next birthing c.d.

Re-post: Defining Female Empowerment

The feminism chatter on CJane's blog has got my head spinning. Now I'm all befuddled and not really sure where I stand, but it brought my mind back to this post from last August, so here it is again in case you missed it...

The whole battle between the two camps is due to the faiure [sic] of women in the country to fight for real empowerment. They take up an 'easy' cause, child birth and child raising, to fight for with the enemy that does not exist, other women. Rather than fight men for equal pay (the ERA is STILL not ratified in this country!), equal opportunity, fight sexism, fight discrimination, they pick easy 'battles' with no true winners. My partner calls the breast-home birth-epidural-vaccination battles 'Hen Chatter'. No real substance or results. These arguments do nothing to better the lives and livelihoods of women or our daughters. Filled with hystrionics [sic] and personal anecdotes they are just busy work, like darning once was, for women. Keeps the little women busy and from tackling the real fights. Keep it up ladies and we will remain in the 1960's for another half century. Empowering women is not about how you have a baby!

-Ali (excerpt from her comment in response to "Pushing Back: Has the natural childbirth movement gone too far?" by Lisa Selin Davis)

I linked over to Lisa Selin Davis' essay from the Citizens for Midwifery blog. Initially I expected the article itself to get me riled up. But it turned out to be fairly balanced. Just a few painful jabs. Then I started reading the comments. Why do I let myself read the comments? The essay's title is quite fitting, in fact. Except Jennifer Block's title was making reference to the way women as a whole are "pushed" into less than ideal maternity care. This essay refers to the way women "push" each other. And, after reading the comment by "Ali" above, I certainly did feel as though I had been violently shoved to the ground.

My immediate reaction was... I have to write a blogpost! So I opened-up this window, poised to spill my reaction on the blank screen with gusto. But I stopped myself. I knew I needed to take a breather so I could express myself with a level head.

So I folded our (massive) piles of laundry while my husband and kids scrubbed the toilets and cleaned the bathrooms. Then we all put our piles of clothes away. And we put more loads of laundry in the washer. Now, with my sweet babe napping, and my husband getting lunch ready, I think I'm ready to say what's on my mind. I do my best thinking while completing seemingly brainless tasks, I think--showering, housework, etc. Multi-tasking is fun, no?

Here's what I've been thinking about today...

4.3 million births were registered in the United States in 2006 (source). And the vast majority of women worldwide will give birth at some point in their lifetimes. That translates to a mind-boggling number of births. So, in my view, what happens to women in childbirth is an issue that should matter to all women everywhere.

But, of course, we are all in different stages of life. The issues that matter to each of us are usually those most pertinent to our circumstances. I happen to be in my childbearing years. I have spent the past six+ years totally immersed in childbirth and childrearing. That is where my head is. So I am well-versed in the abuses toward women (and babies) occurring within that sphere. On the flip side, most of my female age-mates have spent the last six years in graduate school and the workforce, building their careers. They would be well-versed in the abuses toward women within their spheres.

Doesn't it make sense for all women to work within their own spheres of influence? What good would I do championing the cause of females in the corporate world if I have absolutely no idea what it's like to be in their shoes? What good does it do for any woman to say, in essence, "What matters to you is meaningless! My crusade is so much better than yours!" It reminds me of the similar sentiment that my work as a "stay-at-home" mother is menial or pointless, or that my career choice is somehow harming the progress of womankind. It is attitudes such as these that have led me to eschew the "feminist" label.

"Ali" accuses me and other birth advocates of fighting with "the enemy that does not exist, other women." But what has she just done? Is she not attacking me and women like me? I have always tried to make it clear that I do what I do to educate, inspire, and empower other women. Not ever to attack them. And, yes, I said empower.

Let's talk about empowerment. I can't tell you how many times I've heard women say, following the birth of their child, "That was the most empowering experience of my life!" I would love to see the day that childbirth is empowering for every woman, and never disempowering, as it is for too many. "Ali" may not be aware just yet, but women across the country are abused daily by their maternity care providers (many of them males). Can't we agree that needs to change?

Women can be empowered in a multitude of ways. Having a salary equivalent to a male executive is only one of them. Shouldn't "feminism" be about what matters to all women, not just about what matters to one small niche of them? Who is Ali to decide what ought to be empowering to other women? Aren't we all entitled to decide that for ourselves?

The fact of the matter is that the childbirth experience is a huge, often life-changing rite of passage for women. And what happens during that special experience matters deeply to many women, and rightly so. How does it harm the progress of womankind for us childbirth advocates to focus our efforts on maximizing the empowerment of that pivotal, life-changing experience? Can "Ali" and her partner really believe these issues are "hen chatter" or "histrionics"? Or that our efforts "do nothing to better the lives and livelihoods of women or our daughters." It is, in large part, because of my love for my daughters that I continue my crusade.

Furthermore, I happen to believe that darning is a valuable lost art--one I very much wish I had. Oh how many hole-filled socks I could have made wearable again!

So, "Ali" wants to get women away from their "needlework" and out fighting the "real fights" in the feminist agenda. I'm glad there are women like her fighting for equality in their realm of experience. But if you imagine all of womankind as a whole, perched on a tabletop, doesn't it make sense that we can't just raise one corner? Shouldn't we all "stand close together and lift where we stand" and improve every aspect of women's lives simultaneously, each exerting our efforts in the areas most suited to us? You work over there, I'll work over here, and together we'll all make a difference? Isn't that how it should be?

Thank you, ABC News

For raising awareness about the many problems with our maternity care system in this country and the rising maternal death rate.

Now let's change things.

For those of us who yell at the t.v. (and everyone else too)

For more info, see here and here and here.

Speaking of the rising cesarean rate...

Rixa shared this article from right here in AZ. Joy, a mother of three, pregnant with her fourth, has only one hospital in her vicinity, and they will court order a cesarean delivery if they must... even though Joy delivered her third child via VBAC at the very same hospital two years ago. The hospital says they are no longer equipped to handle VBACs because of reduced staffing. Joy says their logic doesn't hold up:

"They don’t want to allow VBACs because she said they aren’t equipped for emergency c-sections, but if they can’t do emergency c-sections, they shouldn’t be having labor and delivery at all. That’s why women go to the hospital to have their babies – in case there is an emergency."

Can you really argue with that? If there's one place in our culture where women are told they should feel "safe" giving birth, it's the hospital. The hospital is supposed to be the place you can count on in an emergency. Have they informed the women of Page that they're no longer that equipped safety-net women think they are? I somehow doubt it.

Joy has her feelings painted in protest on the back of her minivan: "Page Hospital enter my body without my permission... sounds like rape to me." (Read the article here.)

"Pit bull with a smile"

This lady is my new hero. :-)

(Thanks for the link, Sweetpea!)

More information on the Canada Home Birth Study

Per Amy Romano's exellent explanatory post:

The researchers compared outcomes in the planned home birth group with those of two groups of women who met eligibility requirements for home birth but planned to give birth in hospitals instead. One of the two comparison cohorts had planned hospital births with midwives (n=4752); the other with physicians (n=5331).

Now that changes things! I was wrong in my last post. Apparently they did weed out the high risk women!

So... go read the rest of Amy Romano's post. Great info in there. Thanks, Amy!

More evidence on home birth safety

A friend shared a link to a news article reporting a new study out of Canada. The headline: "Home Birth With Midwife As Safe As Hospital Birth: Study." Here's an excerpt with a summary of the study's findings:

The authors of the new study compared three different groups of planned births in British Columbia from the beginning of 2000 to the end of 2004: home births attended by registered midwives (midwives are registered in Canada), hospital births attended by the same group of registered midwives, and hospital births attended by physicians. In all, the study included almost 13,000 births.

The mortality rate per 1,000 births was 0.35 in the home birth group, 0.57 in hospital births attended by midwives, and 0.64 among those attended by physicians, according to the study.

Women who gave birth at home were less likely to need interventions or to have problems such as vaginal tearing or hemorrhaging. These babies were also less likely to need oxygen therapy or resuscitation, the study found.

The authors acknowledge that "self-selection" could have skewed the study results, in that women who prefer home deliveries tend to be healthier and otherwise more fit to have a home birth. (Source)

The study doesn't appear to distinguish between low-risk and high-risk births--something most doctors would raise a red flag about. Doctors attend more high-risk births, so it's not surprising to see a higher mortality rate under their care. It's a tricky thing trying to compare different types of births because so many factors are involved in birth outcomes. But I still find this news encouraging.

As for the "self-selection" factor, I can definitely attest that I took a far more proactive role in my health during my home birth pregnancy than I ever had before. I exercised, I ate much more healthy food, and was more educated than ever about how to make my pregnancy and birth smooth and healthy. I wanted to do everything I possibly could to increase my odds of a healthy outcome for me and my baby. Whether home birth inspires women to be healthier or healthier women choose home birth, I say it's a win-win either way.

Reducing Infant Mortality

Great 17 minute film! Thanks for the heads-up, Jill.

Reducing Infant Mortality from Debby Takikawa on Vimeo.

Defining Female Empowerment?

The whole battle between the two camps is due to the faiure [sic] of women in the country to fight for real empowerment. They take up an 'easy' cause, child birth and child raising, to fight for with the enemy that does not exist, other women. Rather than fight men for equal pay (the ERA is STILL not ratified in this country!), equal opportunity, fight sexism, fight discrimination, they pick easy 'battles' with no true winners. My partner calls the breast-home birth-epidural-vaccination battles 'Hen Chatter'. No real substance or results. These arguments do nothing to better the lives and livelihoods of women or our daughters. Filled with hystrionics [sic] and personal anecdotes they are just busy work, like darning once was, for women. Keeps the little women busy and from tackling the real fights. Keep it up ladies and we will remain in the 1960's for another half century. Empowering women is not about how you have a baby!

-Ali (excerpt from her comment in response to "Pushing Back: Has the natural childbirth movement gone too far?" by Lisa Selin Davis)

I linked over to Lisa Selin Davis' essay from the Citizens for Midwifery blog. Initially I expected the article itself to get me riled up. But it turned out to be fairly balanced. Just a few painful jabs. Then I started reading the comments. Why do I let myself read the comments? The essay's title is quite fitting, in fact. Except Jennifer Block's title was making reference to the way women as a whole are "pushed" into less than ideal maternity care. This essay refers to the way women "push" each other. And, after reading the comment by "Ali" above, I certainly did feel as though I had been violently shoved to the ground.

My immediate reaction was... I have to write a blogpost! So I opened-up this window, poised to spill my reaction on the blank screen with gusto. But I stopped myself. I knew I needed to take a breather so I could express myself with a level head.

So I folded our (massive) piles of laundry while my husband and kids scrubbed the toilets and cleaned the bathrooms. Then we all put our piles of clothes away. And we put more loads of laundry in the washer. Now, with my sweet babe napping, and my husband getting lunch ready, I think I'm ready to say what's on my mind. I do my best thinking while completing seemingly brainless tasks, I think--showering, housework, etc. Multi-tasking is fun, no?

Here's what I've been thinking about today...

4.3 million births were registered in the United States in 2006 (source). And the vast majority of women worldwide will give birth at some point in their lifetimes. That translates to a mind-boggling number of births. So, in my view, what happens to women in childbirth is an issue that should matter to all women everywhere.

But, of course, we are all in different stages of life. The issues that matter to each of us are usually those most pertinent to our circumstances. I happen to be in my childbearing years. I have spent the past six+ years totally immersed in childbirth and childrearing. That is where my head is. So I am well-versed in the abuses toward women (and babies) occurring within that sphere. On the flip side, most of my female age-mates have spent the last six years in graduate school and the workforce, building their careers. They would be well-versed in the abuses toward women within their spheres.

Doesn't it make sense for all women to work within their own spheres of influence? What good would I do championing the cause of females in the corporate world if I have absolutely no idea what it's like to be in their shoes? What good does it do for any woman to say, in essence, "What matters to you is meaningless! My crusade is so much better than yours!" It reminds me of the similar sentiment that my work as a "stay-at-home" mother is menial or pointless, or that my career choice is somehow harming the progress of womankind. It is attitudes such as these that have led me to eschew the "feminist" label.

"Ali" accuses me and other birth advocates of fighting with "the enemy that does not exist, other women." But what has she just done? Is she not attacking me and women like me? I have always tried to make it clear that I do what I do to educate, inspire, and empower other women. Not ever to attack them. And, yes, I said empower.

Let's talk about empowerment. I can't tell you how many times I've heard women say, following the birth of their child, "That was the most empowering experience of my life!" I would love to see the day that childbirth is empowering for every woman, and never disempowering, as it is for too many. "Ali" may not be aware just yet, but women across the country are abused daily by their maternity care providers (many of them males). Can't we agree that needs to change?

Women can be empowered in a multitude of ways. Having a salary equivalent to a male executive is only one of them. Shouldn't "feminism" be about what matters to all women, not just about what matters to one small niche of them? Who is Ali to decide what ought to be empowering to other women? Aren't we all entitled to decide that for ourselves?

The fact of the matter is that the childbirth experience is a huge, often life-changing rite of passage for women. And what happens during that special experience matters deeply to many women, and rightly so. How does it harm the progress of womankind for us childbirth advocates to focus our efforts on maximizing the empowerment of that pivotal, life-changing experience? Can "Ali" and her partner really believe these issues are "hen chatter" or "histrionics"? Or that our efforts "do nothing to better the lives and livelihoods of women or our daughters." It is, in large part, because of my love for my daughters that I continue my crusade.

Furthermore, I happen to believe that darning is a valuable lost art--one I very much wish I had. Oh how many hole-filled socks I could have made wearable again!

So, "Ali" wants to get women away from their "needlework" and out fighting the "real fights" in the feminist agenda. I'm glad there are women like her fighting for equality in their realm of experience. But if you imagine all of womankind as a whole, perched on a tabletop, doesn't it make sense that we can't just raise one corner? Shouldn't we all "stand close together and lift where we stand" and improve every aspect of women's lives simultaneously, each exerting our efforts in the areas most suited to us? You work over there, I'll work over here, and together we'll all make a difference? Isn't that how it should be?

Monitoring

Emily passed along a link to a NY Times article: "Updating a Standard: Fetal Monitoring," by Jane E. Brody.

Electronic fetal monitoring (EFM), rolled-out in the 70's, hasn't done what doctors thought it would do--"reduce the risk of cerebral palsy and death resulting from inadequate oxygen to the fetal brain." In fact, EFM has had some negative consequences. The NY Times article reports:

¶Electronic monitoring has led to a significant increase in both Caesarean deliveries and forceps vaginal deliveries.

¶Monitoring results are widely used by lawyers to bolster malpractice cases of spurious merit, which has led to soaring costs for malpractice insurance and, in turn, prompted many obstetricians to stop delivering babies.

¶Electronic monitoring has not reduced the risk of either cerebral palsy or fetal deaths.(source)

I wish it were possible for hospital staff to implement intermittent monitoring by human beings. I've said it before, and I'll say it again... the best "monitor" for childbirth is a trained person, not a machine. Unfortunately, most nurses are too busy to spend the necessary time personally listening to fetal heart tones on multiple patients, and few doctors are present before pushing time. So EFM isn't likely to be replaced by person-al monitoring anytime soon (or ever).

So improving the use of this technology is definitely in order. I'm heartened by the efforts of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and Dr. George A. Macones who are encouraging obstetricians to refine and improve the way they interpret electronic fetal monitor tracings. Especially considering the somewhat frightening inconsistency of doctors' interpretations of EFM tracings, as the NY Times article reports:

In a study in which four obstetricians examined 50 fetal heart rate tracings, they agreed in 22 percent of the cases. Two months later, the same four doctors re-evaluated the same 50 tracings and changed their interpretations on nearly one of every five. . . .

And in more than 99 percent of cases, predictions based on the tracings that the baby would have cerebral palsy have proved wrong.(source)

These new EFM recommendations sound like a step in the right direction. I love that OBs are being encouraged try "giving the mother oxygen, changing her position, treating her low blood pressure and stopping stimulation of labor if that is being done" before jumping to a cesarean for abnormal fetal heart tones.

It's so easy to get caught up in villainizing OBs and the medical establishment. It's too bad a few "bad eggs" can taint our view of the profession. So I'm always grateful to be reminded that there are docs and medical researchers working hard to protect women and babies. I hope to see the day when MDs, midwives, researchers, nurses, doulas, and parents can come together for the betterment of maternity care. I really hope to see that.

Big Push for Midwives Congressional Briefing on the Hill

Two great clips from the Big Push! First, Jennie Joseph speaks on her study showing midwives improve outcomes and close ethnic disparities:
And David Anderson, PhD, discusses economic benefits of midwifery and homebirth:

Misleading headlines

I don't generally read the newspaper. We only subscribe on Sundays (for the coupons). But I do, on occasion, scan through the Google News headlines in my Google Reader to stay somewhat informed of what's happening out there in the world. Quite often I never click to read the full articles. I generally only click on the ones that are pertinent to my locale, my circumstances, or my interests. I assume I'm not the only one who often doesn't read beyond the headline. Which is why headlines like this are extremely frustrating to me...

"Police probe home birth; baby died"

If all you do is scan the headlines, what are you going to assume? You may assume the author is using the term "home birth" in the usual sense--a baby intentionally born at home. The average person would then continue their thought process with... "See! That's why we have hospitals, people! Babies aren't supposed to be born at home! What a horrible, preventable tragedy!" And those people may never know that this mother was completely unaware she was pregnant until she saw a baby in her toilet... which means zero prenatal care, zero preparation for birth. And besides that... we don't even know the cause of death. Was the baby preterm? How long was the baby in the toilet? So many unanswered questions.

I would like to think the article's authors were unaware that their use of the term "home birth" in connection with "baby died" was loaded and misleading. But, unfortunately, I think they knew exactly what they were doing.

On a happier note... my brother and sister-in-law welcomed their beautiful new baby girl yesterday afternoon. She was born at home with the assistance of midwives, surrounded by loved ones. They did experience some scary complications following the birth, but the midwives handled them, and everyone is doing well... trying to get some much-needed rest. Thank goodness for skilled birth attendants. I am eager to hear the birth story in detail!

Baby killers?

Every so often I like to plug "home birth" into a google news search and see what's out there. This morning I found something that has consumed my thoughts all day: "New study indicates hospital delivery safer for babies than home birth." What?! I hadn't heard anything about this study, so I checked it out.

Here's an excerpt describing the study's findings:

"The risk of neonatal death (dying during or shortly after birth) with a hospital delivery for a baby at term (between 37 and 42 weeks) was approximately 0.06%. The risk with a home delivery with a certified nurse midwife was almost double at 0.1% and with a non-certified midwife at home that number jumped to 0.18%. Low Apgar scores, a reflection of oxygen levels at birth, were also more common with home deliveries than in the hospital"(source).

Those are some disturbing numbers. Especially considering that they conflict with the growing body of evidence already published in peer-reviewed journals about the safety of home birth for low-risk women. Obviously I wanted to know more. So I poked around the internet off and on all day trying to find an original source for this study. All I could find were a few articles reporting about it. For example...

"Safety of midwife-attended home births questioned," from Canada.com
"Analysis Finds Risks With Midwife-Attended Home Births," from redOrbit.com

There were several other similar links. They all seem to be regurgitating the same words, but none of them directs me to more information. (It appears that this study has not yet been published in a peer-reviewed journal.) I want to know details!

Based on their findings, the researchers concluded that "the safest setting for the delivery of babies is in a hospital attended by a certified nurse midwife"(source). While the media grasped onto the home birth headline, they could just as easily have written: "New Study Shows Nurse-Midwives Safer Birth-attendants than Doctors." Except, while the press release willingly shared the neonatal death rates of the midwife-attended births, the only information we get about the doctor-attended neonatal death rate is: "Malloy hypothesized that in-hospital deliveries attended by certified nurse midwives had lower mortality risks in his study than in-hospital physician deliveries because the physicians were delivering babies at higher risk"(source). Wait a second... only a few paragraphs earlier, we're told that they limited the analysis to "low risk" births, which they define as full-term vaginal deliveries. If the only births included were "low risk," how could "high risk" babies explain why doctors were less safe?

Other questions I have about this study...

Were babies born with conditions or defects incompatible with life included?
Where did they find the records for these births?
What was the death rate for the babies delivered by doctors?
What about the birth center rate?
When was the "recent 5-year time period" they pulled data from?

I also have a hard time with their limiting the study to full-term vaginal deliveries. It seems sort of ridiculous to imagine including cesareans in such a comparison, but think about it... One of the reasons mothers choose home birth midwives is to avoid unnecessary interventions--for example, unnecessary cesareans. How many women began labor as "low risk," but ended up having their babies surgically removed because their labors were derailed by the bright lighting, immobility, strangers, or drug side effects? What about neonatal deaths preceded by cesareans that were brought about through iatrogenic complications? Excluding those neonatal deaths by removing cesareans from the study analysis removes one of the largest strikes against hospital birth in the minds of home birth proponents--the "cascade of interventions" leading to cesareans and increased risks for both mother and baby.

Clearly it's difficult to compare home birth and hospital birth. They're two completely different species. And there's no perfect way to structure a study's cohort to make home and hospital birth comparable.

But here's what we do know... at present, the published body of peer-reviewed research indicates that home birth is just as safe for low-risk women as hospital birth. We also know that home birth would be even safer than it is if hospitals and doctors would collaborate more fully with midwives in creating a better system for handling those rare emergency transfers (as we see in many European countries). Home birth would also be safer if practicing midwifery weren't illegal in some areas of the U.S.

Couldn't we focus on making all births safer instead of bickering about who's better? Couldn't we collaborate with each other in working to provide women and babies with the absolute best care possible? Couldn't we incorporate practices that facilitate healthy births in all settings? When will we demand that our care be evidence-based?

As for me, I knew giving birth to my son at home was the right choice for us regardless of the research. God trumps research... even studies of 12 million births.

If you have any more details about this recent home birth study, please let me know.

New Feature: Quote of the Day

Hey friends,

Just a heads-up that I've decided to add a new feature to my sidebar. Sometimes I read an article or a study, and I want to let people know about it, but I don't have the time or energy to write a whole blogpost. In those instances, I'll be featuring an excerpt in my "Quote of the Day" with a link to the original source. So, if you're subscribed through a reader, be sure to visit my actual blog on occasion to check out what I'm sharing!

Today's comes from a post by Henci Goer. Gosh I love that woman!

Hugs!
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