We've lived in our house about 6 years, and throughout our time here I have always claimed that it never felt like our home. A few weeks after we moved in, cracks started appearing in the walls. Long story short, the previous owners, who had lived here for over 30 years, had chosen not to disclose to us that the house had significant settlement issues, going so far as to cover up all evidence of it. We had put a good chunk of money into purchasing the house (this was 2005, after all), and Scott was very worried that there were structural issues. Fortunately, the only effects of the settlement were cosmetic, but the stress of the situation prevented us from emotionally attaching to the house at the time, and for some reason our detachment persisted. It is relatively barren in terms of furniture and decoration. We have only six pictures hung in the house, in total.
Recently, a constellation of factors have converged to make a move the reasonable choice. We're not going far, only 15-20 miles away. Still, it will bring a host of benefits to ourselves and our children, and both Scott and I have come to the conclusion separately and together, pragmatically and intuitively, that this is the right choice for us at this time.
So, here I find myself, packing boxes, shocked to be nostalgic. I've been looking forward to moving since about 8 weeks after we moved in, yet in packing up rooms, I see Kesenia's first steps. Eliana's first written word scrawled on a magnadoodle. Birthday candles lit, anniversary gifts given. The last time Kesenia nursed, turning away the breast for my newly short hair. Wine and friends. Forgiving myself for being an imperfect mother, and again, and again. Learning my niece-or-nephew was a niece and a nephew. Our decision-making process about midwifery school. Donovan's birth. The first time he nursed, newborn-crawling across my belly, minutes old, naked and sticky. Butterfly kisses, group snuggles, piggyback rides. Laughter.
I'm surprised that I've linked these sweet and salty memories to this place. The truth of the matter is that the memories are of limitless love which follows us wherever we go. Still, I am committed to making our next house a real home. It has a different sense now. I will embrace it from the get-go as the backdrop of where love happens.
Thursday, June 30, 2011
Monday, June 27, 2011
Happy buttday to you!
Eliana managed to sit on a cactus at day camp on her birthday. Not just any cactus... one of the furry kind with teeeny tiny spines very close together. So hard to see and grab with tweezers, and she had about 10 left by the time I got to her (not sure how many the camp counselor got out). She held very still and didn't complain too much (typical).
I suggested I could call her "Cactus Butt" ala The Lion King, but she said, "Mom, it's my birthday, you can't joke with me in embarrassing ways." So I started singing "Happy buttday to you, happy buttday to you!" and she laughed. So I got to sing that to her for the rest of the day.
I was so above bathroom humor as a kid. I'm sure making up for it as a mom...
I suggested I could call her "Cactus Butt" ala The Lion King, but she said, "Mom, it's my birthday, you can't joke with me in embarrassing ways." So I started singing "Happy buttday to you, happy buttday to you!" and she laughed. So I got to sing that to her for the rest of the day.
I was so above bathroom humor as a kid. I'm sure making up for it as a mom...
Friday, June 24, 2011
I've been a mommy...
...for eight years.
Cheers to the kid who changed every preconceived notion I had of my parenting style - and abilities. Keep challenging me, love. You are remarkable. Happy birthday, Eliana Rose.
Cheers to the kid who changed every preconceived notion I had of my parenting style - and abilities. Keep challenging me, love. You are remarkable. Happy birthday, Eliana Rose.
Thursday, June 16, 2011
Donovan language
Donowan - Donovan
fwimmin - swimming
fwing - swing
donitoe - dinosaur
namilla = vanilla
-er words end in -y
helicoppy - helicopter
couny - counter
beddy - better
tinggy - finger
pliddy - computer
dinny - dinner
Atemby - September
"Me Donowan like a fwog." "Me Donowan like a donitoe." "Me Donowan like a alligady."
"Me need a kitt you on da moup." "Me need you neck." (He puts a hand on my neck as a cuddle spot.)
"No tange me dipee! No wipe I penit! Me no ha poopies on a butt." (I heard on the radio that kids start lying at 3.5 years old. No way, man. Kids start lying as soon as they can talk.)
"Yeah do!" "No me not."
"A cake it yummy. A you lite it, Tudin?" (Do you like it, Susan? to my mom)
fwimmin - swimming
fwing - swing
donitoe - dinosaur
namilla = vanilla
-er words end in -y
helicoppy - helicopter
couny - counter
beddy - better
tinggy - finger
pliddy - computer
dinny - dinner
Atemby - September
"Me Donowan like a fwog." "Me Donowan like a donitoe." "Me Donowan like a alligady."
"Me need a kitt you on da moup." "Me need you neck." (He puts a hand on my neck as a cuddle spot.)
"No tange me dipee! No wipe I penit! Me no ha poopies on a butt." (I heard on the radio that kids start lying at 3.5 years old. No way, man. Kids start lying as soon as they can talk.)
"Yeah do!" "No me not."
"A cake it yummy. A you lite it, Tudin?" (Do you like it, Susan? to my mom)
Sunday, June 12, 2011
Routine ultrasound for presentation at term
A reader left a comment on my Surprise Breech post suggesting that we might have used ultrasound prenatally in order to prevent the surprise. It's a bit snarky for my taste, but here it is, followed by my response (which I didn't include in comments on that piece):
"lisa said... Ahem: an ultrasound or two might have been a good idea? Just sayin'....this isn't the Dark Ages. We have modern medicine now."
We love modern medicine! We're so thankful that it exists when we need it. And in fact, if we'd had the slightest question in our minds about this baby being head down or not, we would have referred her to an ultrasonographer. We use ultrasound as necessary, just like we access every other medical intervention as necessary.
Actually, standard of care in modern medicine includes an ultrasound at around 20 weeks, so early that babies are still swimming around in utero, and their position is inconsequential. Most obstetricians still use their hands to assess fetal presentation at term. (Most do a vaginal exam to feel for baby's head.) So, even current medical standards don't include your suggestion.
That said, the tides are turning. More and more obstetric practices are not touching women at all, using ultrasound at every visit to assess fetal growth, and to assess fetal presentation at term. Some hospitals are indeed doing an ultrasound on each woman in labor to check that the baby is vertex. Serial ultrasounds, in fact routine ultrasounds of any type, are not recommended in pregnancy even by the professional organizations that you might think would recommend them. Feel free to google for guidelines, and you will see that each notes that ultrasound is to be used as medically indicated. The FDA advocates for the "prudent use" of ultrasound. Unfortunately, many practitioners misconstrue the vague guidelines about what constitutes necessity; for example, the guideline to use ultrasound to assess fetal growth has been perverted to mean it should be used at every visit rather than in the instance that a concern about fetal growth has arisen in other medical assessments. (Just because I love metaphors: I don't need my children to get an MRI at every well-baby visit; measuring head circumference will do.)
Is this safe? What untoward effects might serial ultrasound have? We really don't know. We know babies aren't being born with missing fingers or with severe mental retardation. But, we haven't studied it well enough to know what less obvious effects might be occurring. We do know that ultrasound changes cells - and I am going to go out on a limb here and say that since fetal cells are generally normal, to say that ultrasound changes them is to say that ultrasound damages them. Several studies have shown an increase in left-handedness in children who were exposed to ultrasound in utero. Who cares about left-handedness, you might say... but what this study tells us is that ultrasound changes the fetal brain. Anecdotally - and I'm not a fan of anecdotal evidence, but in this instance it's pretty striking - over half of the children I know personally who had serial ultrasounds in utero have significant issues that affect their lives, including hearing loss, behavioral issues, and learning disabilities.
So, should our practice adopt a policy of routine ultrasounds at the end of pregnancy to catch breeches? Let's apply some math. (Yes, I'm a geek, it should be well established.) This was my preceptor's first surprise breech in her career of over 450 births. According to the flawed study that all but ended vaginal breech birth in the United States, which I will quote here since it is the standard quoted study despite its flaws, planned vaginal breech birth carries a 5% incidence of perinatal mortality or serious neonatal morbidity, or an incidence of 1 in 20 of any undesirable outcome including those that can be overcome with time. 20 x 450 = 9000, so there is a 1 in 9000 chance of anything at all bad happening, even something temporarily bad as opposed to death or permanent disability, because we don't diagnose fetal presentation with ultrasound. A 2009 study found that there was a 0.2% incidence of perinatal death for breeches, so 1 in 450 x 500 = a 1 in 225,000 chance of a baby dying because we didn't do an ultrasound for presentation at term. Compare that to asking every one of those 225,000 women and babies to expose themselves to the unknown risks of ultrasound, the known evidence around ultrasound radiation, and the costs - well, let's not even discuss money here - the answer is no. No, I don't see us recommending an ultrasound or two at term for all our mamas and babies.
I haven't even touched upon the most important issue. The hallmark of midwifery care is client-centered care. We offer our clients information and they make their own decisions. The potential for an unanticipated malpresentation is in our informed consent to home birth. If a client desired an ultrasound at term for presentation, we'd discuss all of the above and then respect their decision.
"lisa said... Ahem: an ultrasound or two might have been a good idea? Just sayin'....this isn't the Dark Ages. We have modern medicine now."
We love modern medicine! We're so thankful that it exists when we need it. And in fact, if we'd had the slightest question in our minds about this baby being head down or not, we would have referred her to an ultrasonographer. We use ultrasound as necessary, just like we access every other medical intervention as necessary.
Actually, standard of care in modern medicine includes an ultrasound at around 20 weeks, so early that babies are still swimming around in utero, and their position is inconsequential. Most obstetricians still use their hands to assess fetal presentation at term. (Most do a vaginal exam to feel for baby's head.) So, even current medical standards don't include your suggestion.
That said, the tides are turning. More and more obstetric practices are not touching women at all, using ultrasound at every visit to assess fetal growth, and to assess fetal presentation at term. Some hospitals are indeed doing an ultrasound on each woman in labor to check that the baby is vertex. Serial ultrasounds, in fact routine ultrasounds of any type, are not recommended in pregnancy even by the professional organizations that you might think would recommend them. Feel free to google for guidelines, and you will see that each notes that ultrasound is to be used as medically indicated. The FDA advocates for the "prudent use" of ultrasound. Unfortunately, many practitioners misconstrue the vague guidelines about what constitutes necessity; for example, the guideline to use ultrasound to assess fetal growth has been perverted to mean it should be used at every visit rather than in the instance that a concern about fetal growth has arisen in other medical assessments. (Just because I love metaphors: I don't need my children to get an MRI at every well-baby visit; measuring head circumference will do.)
Is this safe? What untoward effects might serial ultrasound have? We really don't know. We know babies aren't being born with missing fingers or with severe mental retardation. But, we haven't studied it well enough to know what less obvious effects might be occurring. We do know that ultrasound changes cells - and I am going to go out on a limb here and say that since fetal cells are generally normal, to say that ultrasound changes them is to say that ultrasound damages them. Several studies have shown an increase in left-handedness in children who were exposed to ultrasound in utero. Who cares about left-handedness, you might say... but what this study tells us is that ultrasound changes the fetal brain. Anecdotally - and I'm not a fan of anecdotal evidence, but in this instance it's pretty striking - over half of the children I know personally who had serial ultrasounds in utero have significant issues that affect their lives, including hearing loss, behavioral issues, and learning disabilities.
So, should our practice adopt a policy of routine ultrasounds at the end of pregnancy to catch breeches? Let's apply some math. (Yes, I'm a geek, it should be well established.) This was my preceptor's first surprise breech in her career of over 450 births. According to the flawed study that all but ended vaginal breech birth in the United States, which I will quote here since it is the standard quoted study despite its flaws, planned vaginal breech birth carries a 5% incidence of perinatal mortality or serious neonatal morbidity, or an incidence of 1 in 20 of any undesirable outcome including those that can be overcome with time. 20 x 450 = 9000, so there is a 1 in 9000 chance of anything at all bad happening, even something temporarily bad as opposed to death or permanent disability, because we don't diagnose fetal presentation with ultrasound. A 2009 study found that there was a 0.2% incidence of perinatal death for breeches, so 1 in 450 x 500 = a 1 in 225,000 chance of a baby dying because we didn't do an ultrasound for presentation at term. Compare that to asking every one of those 225,000 women and babies to expose themselves to the unknown risks of ultrasound, the known evidence around ultrasound radiation, and the costs - well, let's not even discuss money here - the answer is no. No, I don't see us recommending an ultrasound or two at term for all our mamas and babies.
I haven't even touched upon the most important issue. The hallmark of midwifery care is client-centered care. We offer our clients information and they make their own decisions. The potential for an unanticipated malpresentation is in our informed consent to home birth. If a client desired an ultrasound at term for presentation, we'd discuss all of the above and then respect their decision.
Wednesday, June 8, 2011
Surprise breech
Recently, we had a surprise breech at home. I've been rolling around in my head the value of sharing this story publicly, both to share a positive breech story and to show to student midwives and midwives the variation of breech that fooled us, and so a few days ago I got up the nerve to ask the mama for permission to post about it here. She agreed, and has previewed and approved sharing these words and photos.
Prenatally, there was no suspicion that the baby was breech at any time in the third trimester by any one of the two midwives or two apprentices. When we palpated the baby at term, s/he felt like a vertex baby whose head had descended into the pelvis so far as to be unballottable. During the vaginal exam during labor, the presenting part was at +3 and felt round and slightly edematous, like a head descending with caput.
We suspected nothing until, while mom was pushing, when Mollie checked for descent and positioning, her glove got covered in what can only be described as breech meconium. (Vertex baby meconium is mixed with amniotic fluid before it can show itself and is more accurately named as meconium-stained fluid. Breech meconium doesn’t have much opportunity to mix and looks like newly born baby meconium.) Within a push after that, we were seeing the baby’s skin... the baby’s very very bald skin. Yet still, this was nothing like what a breech “should” look or feel like. Mollie and I both extensively checked all around in a circle as deep as we could, looking for a butt crack, an anus, or any sign of something that felt like buttocks, and neither of us found anything except this big round baby part, still feeling like a head with caput. Still, we prepared ourselves mentally for a breech birth given the completely undiluted meconium. Baby was descending quickly, and we knew we did not have time to transport.
Soon, we saw a small quarter-sphere baby part at the edge of the presenting part. It looked like the baby’s shoulder was presenting next to its head, but that being impossible, we now had absolutely no idea what we were seeing. A few minutes later everything became clear as that small round part grew in length and popped out - with toes. Breech!
We brought mom to the edge of the bed, so that the baby could be born hanging downward off the edge of the bed. (This is the classic way for breeches to be born, because it facilitates flexion of the baby’s head to navigate under the pubic bone; then the baby is lifted by a care provider to facilitate extension.) The round presenting part was the left hip, with the left knee pulled up and the left foot tucked up next to the bum. As the hip was born, the knee released and the leg was born. Only then did the asynclitism right itself, showing us first labia, then her right buttock and right foot. (Unlike most pictures of complete breech babies, her legs were not crossed. Tuck position rather than cannonball.) Then her right leg was born and her right hip, emerging to just below the waist. Mom’s pushes with the next contraction brought her out to her chest. I gently held a warm blanket over her, hands at her hips waiting to safely help lift her when needed. When the next contraction did not bring her arms, Mollie reached up inside for them and brought them out one at a time. A minute or so later, she flexed all her limbs; I’ll never forget the sensation of feeling this baby, not quite born, move like that in my hands as I held that blanket on her. With the next contraction, we could see the lower part of her skull, and Mollie asked me to raise her body as she helped deliver her head, but it wasn’t ready, so we moved her back into the hanging position. Before the next contraction, I could feel her body lose its tone, starting to become limp. She was still pink but I was now more than ready for her to be born. I’m not sure whether Mollie saw how limp she was getting but I know Mollie was more than ready for her head to be out as well! With the next contraction, her ear started showing, which revealed that her head was transverse. Mollie told me to lift her toward the side, and Mollie directed her head at that angle, and she was born.
She breathed immediately, and as I quickly got the stethoscope on her, I counted her heartrate at 140 bpm. She started rooting by the time she was a couple of minutes old, and latched and nursed vigorously at eight minutes old. The only sequelae we noted from her mode of arrival were the bruises on her left buttock and hip, left labia, and left foot, and her breech baby posture which confirmed for us that we’d missed her position prenatally.
Bruise and "caput" on left buttock from hip to labia, none on right side.
Bruised left foot.
Posture and head shape. This cutie was never vertex.
Many, many thanks to the parents for allowing me to share this.
Prenatally, there was no suspicion that the baby was breech at any time in the third trimester by any one of the two midwives or two apprentices. When we palpated the baby at term, s/he felt like a vertex baby whose head had descended into the pelvis so far as to be unballottable. During the vaginal exam during labor, the presenting part was at +3 and felt round and slightly edematous, like a head descending with caput.
We suspected nothing until, while mom was pushing, when Mollie checked for descent and positioning, her glove got covered in what can only be described as breech meconium. (Vertex baby meconium is mixed with amniotic fluid before it can show itself and is more accurately named as meconium-stained fluid. Breech meconium doesn’t have much opportunity to mix and looks like newly born baby meconium.) Within a push after that, we were seeing the baby’s skin... the baby’s very very bald skin. Yet still, this was nothing like what a breech “should” look or feel like. Mollie and I both extensively checked all around in a circle as deep as we could, looking for a butt crack, an anus, or any sign of something that felt like buttocks, and neither of us found anything except this big round baby part, still feeling like a head with caput. Still, we prepared ourselves mentally for a breech birth given the completely undiluted meconium. Baby was descending quickly, and we knew we did not have time to transport.
Soon, we saw a small quarter-sphere baby part at the edge of the presenting part. It looked like the baby’s shoulder was presenting next to its head, but that being impossible, we now had absolutely no idea what we were seeing. A few minutes later everything became clear as that small round part grew in length and popped out - with toes. Breech!
We brought mom to the edge of the bed, so that the baby could be born hanging downward off the edge of the bed. (This is the classic way for breeches to be born, because it facilitates flexion of the baby’s head to navigate under the pubic bone; then the baby is lifted by a care provider to facilitate extension.) The round presenting part was the left hip, with the left knee pulled up and the left foot tucked up next to the bum. As the hip was born, the knee released and the leg was born. Only then did the asynclitism right itself, showing us first labia, then her right buttock and right foot. (Unlike most pictures of complete breech babies, her legs were not crossed. Tuck position rather than cannonball.) Then her right leg was born and her right hip, emerging to just below the waist. Mom’s pushes with the next contraction brought her out to her chest. I gently held a warm blanket over her, hands at her hips waiting to safely help lift her when needed. When the next contraction did not bring her arms, Mollie reached up inside for them and brought them out one at a time. A minute or so later, she flexed all her limbs; I’ll never forget the sensation of feeling this baby, not quite born, move like that in my hands as I held that blanket on her. With the next contraction, we could see the lower part of her skull, and Mollie asked me to raise her body as she helped deliver her head, but it wasn’t ready, so we moved her back into the hanging position. Before the next contraction, I could feel her body lose its tone, starting to become limp. She was still pink but I was now more than ready for her to be born. I’m not sure whether Mollie saw how limp she was getting but I know Mollie was more than ready for her head to be out as well! With the next contraction, her ear started showing, which revealed that her head was transverse. Mollie told me to lift her toward the side, and Mollie directed her head at that angle, and she was born.
She breathed immediately, and as I quickly got the stethoscope on her, I counted her heartrate at 140 bpm. She started rooting by the time she was a couple of minutes old, and latched and nursed vigorously at eight minutes old. The only sequelae we noted from her mode of arrival were the bruises on her left buttock and hip, left labia, and left foot, and her breech baby posture which confirmed for us that we’d missed her position prenatally.
Bruise and "caput" on left buttock from hip to labia, none on right side.
Bruised left foot.
Posture and head shape. This cutie was never vertex.
Many, many thanks to the parents for allowing me to share this.
Friday, June 3, 2011
Childhood for sale
Marion has been my best friend since junior high, and her dad's house is for sale. It's proving more emotional for me than if my own parents were selling their house. I can only imagine how she feels.
In this house, all our friends gathered...
We played Darn, chugged more soda and ate more pizza than I care to remember, watched silly movies and horror flicks.
Marion and I watched Schindler's list for the first time, together, knowing we'd need the support. I haven't seen it since.
We complained about our teachers and school work.
We were awoken in the morning after sleepovers by Marion's dad announcing one of our parents had arrived to end our togetherness.
We videotaped a Valentine's Day music video - my two best friends and I competing for the affections of the camera to The Cardigans' "Lovefool" - and sent it off to Scott, away at college.
We planned and brought to fruition countless school projects - as many as possible in the form of plays and movies.
We held party after party. One Halloween, we haunted several rooms of the house - open to the public.
We played video games. We played truth or dare. We played games of our own creation.
I drank my first alcohol, a gin and tonic.
We spent every Independence Day lighting fireworks in the front driveway.
We tended the fireplace, pet cats on our laps, and stayed up all night talking about our fears, our dreams, our futures.
And then our dreams and futures started to happen. We now ranted and raved about our professors and strategized how to earn a living on our own. Marion hosted my bridal shower and Eliana's baby shower in the living room and backyard. Her dad - a towering Marine colonel I had met when I was twelve - told me I should call him Philip. (I still can't.) My own children ran through the parklike backyard with abandon. We talked about Marion's acting career instead of her acting aspirations, about PhD programs, about entrepreuneurship. We drank fine wine at the behest of the colonel at night, and made and finished breakfast before he awoke in the morning.
The house is officially on the market now. The saddest part is that every other home that has sold in the area recently has been torn down and the large lot used to create a mega-mansion estate. This is a truly beautiful, Old World style home; our hope is that its charm will make someone fall in love with it and maintain its original design. Otherwise, the setting of our memories will become only a memory.
In this house, all our friends gathered...
We played Darn, chugged more soda and ate more pizza than I care to remember, watched silly movies and horror flicks.
Marion and I watched Schindler's list for the first time, together, knowing we'd need the support. I haven't seen it since.
We complained about our teachers and school work.
We were awoken in the morning after sleepovers by Marion's dad announcing one of our parents had arrived to end our togetherness.
We videotaped a Valentine's Day music video - my two best friends and I competing for the affections of the camera to The Cardigans' "Lovefool" - and sent it off to Scott, away at college.
We planned and brought to fruition countless school projects - as many as possible in the form of plays and movies.
We held party after party. One Halloween, we haunted several rooms of the house - open to the public.
We played video games. We played truth or dare. We played games of our own creation.
I drank my first alcohol, a gin and tonic.
We spent every Independence Day lighting fireworks in the front driveway.
We tended the fireplace, pet cats on our laps, and stayed up all night talking about our fears, our dreams, our futures.
And then our dreams and futures started to happen. We now ranted and raved about our professors and strategized how to earn a living on our own. Marion hosted my bridal shower and Eliana's baby shower in the living room and backyard. Her dad - a towering Marine colonel I had met when I was twelve - told me I should call him Philip. (I still can't.) My own children ran through the parklike backyard with abandon. We talked about Marion's acting career instead of her acting aspirations, about PhD programs, about entrepreuneurship. We drank fine wine at the behest of the colonel at night, and made and finished breakfast before he awoke in the morning.
The house is officially on the market now. The saddest part is that every other home that has sold in the area recently has been torn down and the large lot used to create a mega-mansion estate. This is a truly beautiful, Old World style home; our hope is that its charm will make someone fall in love with it and maintain its original design. Otherwise, the setting of our memories will become only a memory.
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