Friends Only Journal!
Comment to be added :)
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chipper
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entered the blog contest.
http://www.redcanuck.com/2009/11/o…
Please click the link to the host site if you read my blog entry, thanks!
Please click the link to the host site if you read my blog entry, thanks!
Downsizing - a public post
Well, I did a bit of downsizing my Fl last night, didn't mean to but the kids were clicking buttons on the laptop, and it got me thinking about it so I went through. I hate doing cuts because I don't want to hurt people's feelings, hell, it always hurts me to be cut. But I was pushing 200 people on my FL, and it was just insane. I didn't feel I could keep up well with everyone (hell, I missed the home birth announcement I'd been waiting for! I'm still so sad). I decided as I went through user names that if I couldn't think of 3 things about that person (name, any kids, funny story, ect) than I obviously wasn't being a very good friend to them and let them go. I didn't make these decisions lightly, it was hard. I used the LJ top commentor list, and I also went back through my own journal and noticed who commented, because, and I'll be honest enough to admit this, sometimes when I post it hurts that with 200+ people on my FL, I get few responses. Heck, barely half of my FL posted to welcome Ainsley to the world, and, well, that sucked. So there you have it. I'm very open to re-adding, if I cut someone who really does read but just never comments. I just need to know, ya know? Anyways, there you have it. I'm so sorry to anyone I hurt :(
ETA: Please, also if you are wanting to cut me, please feel free. I understand, I swear. Also, for everyone - i hope to get back to my previously abundant writing, so if you don't particularly want to see a whole slew of my thoughts and drivel on your FL every day, now would be a great time to opt out ;)
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ETA: Please, also if you are wanting to cut me, please feel free. I understand, I swear. Also, for everyone - i hope to get back to my previously abundant writing, so if you don't particularly want to see a whole slew of my thoughts and drivel on your FL every day, now would be a great time to opt out ;)
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CD's for sale!
Ainsley's about ready to move up to the next size in CD's, so I thought I'd ask here first to see if anyone is interested in some NB dipes? If interested, I'll take pics right away, if not then I can leisurely do it before I put them for sale on diaperswappers! lol. It would be nice to have them go in multiples. I need to finance her small stash! They'd go out in the mail early next week, we could work out the details if interested.
9 KLO's in EUC, 1 of each colour, and 4 naturals ($9 each for the colours, $7 for the naturals or take all 9 for $70)
1 Sm natural happy hempy stuffable fitted in VGUC ($10)
1 NB BSWW in the girlie flower print, EEUC ($9)
2 sumbums AIOs, EEUC. These are so crazy small Ainsley only ever wore them once ($9 each)
2 Essential Salts babies (http://www.esbaby.net/) covers, EUC ($7 each)
ETA: we can figure out shipping if you are interested, I can mail them from the states so it wouldn't be too much $$ - I have to go to NY on wed. to pick up Ainsley's PB chair
9 KLO's in EUC, 1 of each colour, and 4 naturals ($9 each for the colours, $7 for the naturals or take all 9 for $70)
1 Sm natural happy hempy stuffable fitted in VGUC ($10)
1 NB BSWW in the girlie flower print, EEUC ($9)
2 sumbums AIOs, EEUC. These are so crazy small Ainsley only ever wore them once ($9 each)
2 Essential Salts babies (http://www.esbaby.net/) covers, EUC ($7 each)
ETA: we can figure out shipping if you are interested, I can mail them from the states so it wouldn't be too much $$ - I have to go to NY on wed. to pick up Ainsley's PB chair
BMI home birth risks
January 8, 2008
Dear * Midwives
During my previous appointment, IK attempted to address a concern the midwives had in regards to my planned Home Birth. Unfortunately, due to a severe Sinus infection, I was unable at the time respond appropriately to the issue and was forced to delay my reaction until now.
In the intervening month, I have spent a considerable amount of time in thought and research about the little information I had gathered during the last appointment with I. It is my understanding that LH brought forth the concern that my elevated BMI was of concern to her and she feels my elevated BMI would result in an increase and unacceptable risk of maternal postpartum hemorrhaging, infant macrosomia, and infant shoulder dystocia. L’s concern with regards to my BMI and these three conditions, from my understanding during my brief interview with I, resulted in the * Midwives advising they do not feel comfortable facilitating a home birth for me.
To say I am disappointed in having these concerns addressed so late in my pregnancy, in such a finite manner, is an understatement. My intention to achieve a home birth has been discussed from my first prenatal appointment at 7 weeks gestation, with 2 visits between that initial visit and my previous visit. During all three appointments my intention to home birth was acknowledged, and no issues were presented, other than during my very first appointment when an unusually high temporary Blood Pressure reading had L commenting on that being a barrier to Home Birth. I was taken aback at this statement, as I was 7 weeks pregnant, and had explained I had had a stressful trip to the appointment and had my toddler son accompanying me. Nothing more was said about the comment, and my blood pressure readings have since been consistently normal.
This is my second pregnancy, labour and delivery, and has been completely normal, as was my first pregnancy. I did not develop Gestational Diabetes while pregnant with my son, and delivered him vaginally with a minimal amount of pushing. My pregnancy this time has been similar, and while I have yet to be tested for Gestational Diabetes, I am confident that at this point in time it need not be included as an issue.
With the background firmly established, I will address each issue L stated separately for clarity sake.
Postpartum hemorrhaging is listed as occurring during 2-4% of pregnancies/deliveries. Obesity has been listed as contributing to a small increase in occurrences, although that conclusion has been debated in many scientific studies. Where it is addressed, the studies show that obese woman (BMI > 30) had an increased risk over woman of average BMI of a very small amount for postpartum hemorrhaging. One specific study did state that BMI itself was not the specific risk factor, but should be specifically stated as obesity in combination with gestational diabetes and or pre-eclamsia and chronic hypertension. In addition, these studies do not differentiate between Nulliparas and Multiparas, which in studies that do differentiate between the two, show a significant less risk when multiparas.
The pregnancy and labour situations that have been defined to put the mother most at risk for Post Partum hemorrhaging include an induced labour, often augmented by pitocin, having a multiple birth, having birthed more than 5 previous children, failure to deliver a complete placenta, forced removal of placenta and trauma to the genital tract from instrument use (such as forceps). NONE of these risk factors pertain to an increased BMI, or to my personal situation. It is recorded that as many as two thirds of women with postpartum hemorrhaging have had no identifiable risk factors.
While my first labour was augmented with pitocin, I did not need instrumental assistance to deliver my son, I delivered a whole (multi-lobed) placenta unassisted and I did not have any signs of postpartum hemorrhaging. My birth track record, as well as the identified risk factors included in these major studies, place me in a relatively low risk frame for postpartum hemorrhaging. This conclusion leads me to argue with L’s conclusion that simply because of my elevated BMI, I am not a candidate for home birth due to a perceived risk of Post Partum Hemorrhaging. I feel that by taking such a simplified view, as I perceive L’s view of my BMI, it neglects to consider the true risk factors for the conditions, and instead places the blame on a situation that in and of itself is not a cause for such concern.
Research shows that prompt response to heavy postpartum bleeding reduces overall health issues. A shot of oxytocin, uterine massage, uterine pressure and breastfeeding are all mainstream measures that are successful at limiting postpartum hemorrhaging. Alternative medicine advocates the mother hold a piece of the placenta in her cheek as the hormones in the placenta are ideal to encourage the uterus to clamp down, reducing postpartum hemorrhaging. I am confident that with these measures any risk factor for postpartum hemorrhaging I may present is acceptable.
Macrosomia is a condition that in scientific literature is most commonly coupled with the occurrence of Gestational Diabetes and family history of large babies. For mothers with gestational diabetes, the ability to control their blood sugar coincides with the extent of macrosomia their newborns are born with.
Obesity in and of itself is not an identifiable risk factor for Macrosomia, other than the obese woman’s increase risk of Gestational Diabetes. As I have yet to complete the diabetes testing, and as I was not diabetic in my previous pregnancy, I feel that my risk of an infant with Macrocomia is negligible. Couple this with my son’s average birth weight of 8lbs and 3 oz, and it is apparent that this need not be an issue until and if such a time occurs that I am diagnosed with Gestational Diabetes.
Numerous studies agree that there is no reliable way to assess the infant’s birth size before birth. Ultrasonic measurements are notoriously inaccurate, up to an average of a difference of 1 pound. It has been recommended that ultrasounds not be utilized to assess full-term babies size, as the outcome is inaccurate and has been shown to contribute to many unnecessary interventions such as an increase in caesarian sections.
In the event that Macrosomia occurs, this issue is not, and should not, be the cause for the exclusion of a Home Birth. Particularly with a second (or more) time mother, it is perfectly manageable to birth a larger size baby at home without complications. The use of alternative birth positions, such as on all fours, or an assisted squat, allows the pelvis to open fully. A hospital birth, with a delivery laying down, is the worse scenario for a mother attempting to vaginally deliver a macrosomia newborn. Hospital policy, and the increased chance of epidural use, limit a woman’s ability to move and limits her choice of birthing position which leads to an increase chance that a large baby will be a difficult birth. A home birth can thus be seen as one of the safest way in which a suspected larger baby can be born, due to the ability of the mother to move as she feels the need and to not be limited by numbing medicines as to the position she births in. A midwife is invaluable in suggesting alternative positions that allow the pelvis to open fully and allows gravity to play an important role in assisting birth.
The use of forceps or vacuum assisted devices, during labor, are the key issues affecting the development of shoulder dystocia in newborns. In women who are short statured, develop gestational diabetes and women with a pre-existing pelvic complication, there is an increased risk of shoulder dystocia during labor and delivery. Many recent studies have shown that Shoulder dystocia can occur equally commonly in macrosomia newborns as newborns of average size , and is thus not an identifiable risk.
A hospital birth setting does not decrease the risks associated with a newborn presenting with shoulder dystocia. Once the newborn’s head has been delivered there is no intervention that a hospital can offer than can not be offered in a home birth situation. In almost all cases, a home birth situation can allow the mother the freedom to change positions to allow for a larger pelvis opening, as well as the ability to do such maneuvers as the McRoberts maneuver and Gaskin maneuver. Labouring at home has also shown to be favourable over a hospital labour as the increased movement a mother experiences can allow the newborn to move into a more favourable birthing position. Shoulder Dystocia does carry a risk of oxygen deprivation to the newborn, which is not as issue as home birth midwives have basic resuscitation equipement available to them, as well as a competent emergency response system available for emergency transfers to a hospital for oxygen assistance.
I believe that I have acceptably addressed Leslie’s concerns that my increased BMI would negatively affect my risks for a home birth. I am comfortable with whatever perceived risks remain, and if anything my research has shown me that a home birth is by far favourable to a hospital birth. I am dedicated to having a home birth, and it is my hope that after reviewing my arguments, the * Midwives practice will support this.
In conclusion, I am not willing to compromise on a home birth. My experience with a hospital birth with my son has solidified my intention to never put my body in the control of “hospital policy” as it was with my son. I am a mature, educated woman who is confident in her body’s ability to normally birth a child. Not only do I believe firmly in the advantages of a home birth, but I have numerous aversions to a hospital birth. My aversions to a hospital birth come as a result of my first hand experience and academic research. These objections include:
I refuse to subject myself to continual fetal monitoring, as the research has shown it is in fact detrimental to a successful vaginal birth. Labour attendants are often not interpreting the statistics and information continual fetal monitoring provides accurately, resulting in an increase in interventions. I refuse any internal monitoring as well. My son has, and will have for the rest of his life, a large scar on his scalp from a misplaced probe, and I will not subject future children to the same treatment. In addition, I do not wish a routine IV, which would interfere with my ability to move throughout labour. I would not cooperate with hospital policy that would have me laboring in a hospital bed, only to increase my chance of epidural use and pain medication, not to mention the research that shows laboring in one position slows down labour progress and makes it more difficult for the newborn to achieve an optimal birth position. I do not accept the regular and unrestricted use of antibiotics during labour, unless otherwise noted. Finally, I will not deliver on my back, which increases the risk for tears and further interventions, not to mention hampering the assistance gravity can be for delivery and the blockage of movement for the newborn into optimal birthing position.
I feel a certain loyalty to the * Midwives practice after the birth of my son, but would not hesitate to locate and transfer my prenatal care and birth to a midwife who agrees with my view of a successful homebirth. I do not make this decision lightly, as I hope that the * Midwives practice do not take my objections lightly. I hope that my arguments can be addressed in such a manner as to open the lines of communication and allow for a joint exchange of information and opinions.
Thank you for taking the time to read and discuss these issues with me.
Sincerely,
A
Dear * Midwives
During my previous appointment, IK attempted to address a concern the midwives had in regards to my planned Home Birth. Unfortunately, due to a severe Sinus infection, I was unable at the time respond appropriately to the issue and was forced to delay my reaction until now.
In the intervening month, I have spent a considerable amount of time in thought and research about the little information I had gathered during the last appointment with I. It is my understanding that LH brought forth the concern that my elevated BMI was of concern to her and she feels my elevated BMI would result in an increase and unacceptable risk of maternal postpartum hemorrhaging, infant macrosomia, and infant shoulder dystocia. L’s concern with regards to my BMI and these three conditions, from my understanding during my brief interview with I, resulted in the * Midwives advising they do not feel comfortable facilitating a home birth for me.
To say I am disappointed in having these concerns addressed so late in my pregnancy, in such a finite manner, is an understatement. My intention to achieve a home birth has been discussed from my first prenatal appointment at 7 weeks gestation, with 2 visits between that initial visit and my previous visit. During all three appointments my intention to home birth was acknowledged, and no issues were presented, other than during my very first appointment when an unusually high temporary Blood Pressure reading had L commenting on that being a barrier to Home Birth. I was taken aback at this statement, as I was 7 weeks pregnant, and had explained I had had a stressful trip to the appointment and had my toddler son accompanying me. Nothing more was said about the comment, and my blood pressure readings have since been consistently normal.
This is my second pregnancy, labour and delivery, and has been completely normal, as was my first pregnancy. I did not develop Gestational Diabetes while pregnant with my son, and delivered him vaginally with a minimal amount of pushing. My pregnancy this time has been similar, and while I have yet to be tested for Gestational Diabetes, I am confident that at this point in time it need not be included as an issue.
With the background firmly established, I will address each issue L stated separately for clarity sake.
Postpartum hemorrhaging is listed as occurring during 2-4% of pregnancies/deliveries. Obesity has been listed as contributing to a small increase in occurrences, although that conclusion has been debated in many scientific studies. Where it is addressed, the studies show that obese woman (BMI > 30) had an increased risk over woman of average BMI of a very small amount for postpartum hemorrhaging. One specific study did state that BMI itself was not the specific risk factor, but should be specifically stated as obesity in combination with gestational diabetes and or pre-eclamsia and chronic hypertension. In addition, these studies do not differentiate between Nulliparas and Multiparas, which in studies that do differentiate between the two, show a significant less risk when multiparas.
The pregnancy and labour situations that have been defined to put the mother most at risk for Post Partum hemorrhaging include an induced labour, often augmented by pitocin, having a multiple birth, having birthed more than 5 previous children, failure to deliver a complete placenta, forced removal of placenta and trauma to the genital tract from instrument use (such as forceps). NONE of these risk factors pertain to an increased BMI, or to my personal situation. It is recorded that as many as two thirds of women with postpartum hemorrhaging have had no identifiable risk factors.
While my first labour was augmented with pitocin, I did not need instrumental assistance to deliver my son, I delivered a whole (multi-lobed) placenta unassisted and I did not have any signs of postpartum hemorrhaging. My birth track record, as well as the identified risk factors included in these major studies, place me in a relatively low risk frame for postpartum hemorrhaging. This conclusion leads me to argue with L’s conclusion that simply because of my elevated BMI, I am not a candidate for home birth due to a perceived risk of Post Partum Hemorrhaging. I feel that by taking such a simplified view, as I perceive L’s view of my BMI, it neglects to consider the true risk factors for the conditions, and instead places the blame on a situation that in and of itself is not a cause for such concern.
Research shows that prompt response to heavy postpartum bleeding reduces overall health issues. A shot of oxytocin, uterine massage, uterine pressure and breastfeeding are all mainstream measures that are successful at limiting postpartum hemorrhaging. Alternative medicine advocates the mother hold a piece of the placenta in her cheek as the hormones in the placenta are ideal to encourage the uterus to clamp down, reducing postpartum hemorrhaging. I am confident that with these measures any risk factor for postpartum hemorrhaging I may present is acceptable.
Macrosomia is a condition that in scientific literature is most commonly coupled with the occurrence of Gestational Diabetes and family history of large babies. For mothers with gestational diabetes, the ability to control their blood sugar coincides with the extent of macrosomia their newborns are born with.
Obesity in and of itself is not an identifiable risk factor for Macrosomia, other than the obese woman’s increase risk of Gestational Diabetes. As I have yet to complete the diabetes testing, and as I was not diabetic in my previous pregnancy, I feel that my risk of an infant with Macrocomia is negligible. Couple this with my son’s average birth weight of 8lbs and 3 oz, and it is apparent that this need not be an issue until and if such a time occurs that I am diagnosed with Gestational Diabetes.
Numerous studies agree that there is no reliable way to assess the infant’s birth size before birth. Ultrasonic measurements are notoriously inaccurate, up to an average of a difference of 1 pound. It has been recommended that ultrasounds not be utilized to assess full-term babies size, as the outcome is inaccurate and has been shown to contribute to many unnecessary interventions such as an increase in caesarian sections.
In the event that Macrosomia occurs, this issue is not, and should not, be the cause for the exclusion of a Home Birth. Particularly with a second (or more) time mother, it is perfectly manageable to birth a larger size baby at home without complications. The use of alternative birth positions, such as on all fours, or an assisted squat, allows the pelvis to open fully. A hospital birth, with a delivery laying down, is the worse scenario for a mother attempting to vaginally deliver a macrosomia newborn. Hospital policy, and the increased chance of epidural use, limit a woman’s ability to move and limits her choice of birthing position which leads to an increase chance that a large baby will be a difficult birth. A home birth can thus be seen as one of the safest way in which a suspected larger baby can be born, due to the ability of the mother to move as she feels the need and to not be limited by numbing medicines as to the position she births in. A midwife is invaluable in suggesting alternative positions that allow the pelvis to open fully and allows gravity to play an important role in assisting birth.
The use of forceps or vacuum assisted devices, during labor, are the key issues affecting the development of shoulder dystocia in newborns. In women who are short statured, develop gestational diabetes and women with a pre-existing pelvic complication, there is an increased risk of shoulder dystocia during labor and delivery. Many recent studies have shown that Shoulder dystocia can occur equally commonly in macrosomia newborns as newborns of average size , and is thus not an identifiable risk.
A hospital birth setting does not decrease the risks associated with a newborn presenting with shoulder dystocia. Once the newborn’s head has been delivered there is no intervention that a hospital can offer than can not be offered in a home birth situation. In almost all cases, a home birth situation can allow the mother the freedom to change positions to allow for a larger pelvis opening, as well as the ability to do such maneuvers as the McRoberts maneuver and Gaskin maneuver. Labouring at home has also shown to be favourable over a hospital labour as the increased movement a mother experiences can allow the newborn to move into a more favourable birthing position. Shoulder Dystocia does carry a risk of oxygen deprivation to the newborn, which is not as issue as home birth midwives have basic resuscitation equipement available to them, as well as a competent emergency response system available for emergency transfers to a hospital for oxygen assistance.
I believe that I have acceptably addressed Leslie’s concerns that my increased BMI would negatively affect my risks for a home birth. I am comfortable with whatever perceived risks remain, and if anything my research has shown me that a home birth is by far favourable to a hospital birth. I am dedicated to having a home birth, and it is my hope that after reviewing my arguments, the * Midwives practice will support this.
In conclusion, I am not willing to compromise on a home birth. My experience with a hospital birth with my son has solidified my intention to never put my body in the control of “hospital policy” as it was with my son. I am a mature, educated woman who is confident in her body’s ability to normally birth a child. Not only do I believe firmly in the advantages of a home birth, but I have numerous aversions to a hospital birth. My aversions to a hospital birth come as a result of my first hand experience and academic research. These objections include:
I refuse to subject myself to continual fetal monitoring, as the research has shown it is in fact detrimental to a successful vaginal birth. Labour attendants are often not interpreting the statistics and information continual fetal monitoring provides accurately, resulting in an increase in interventions. I refuse any internal monitoring as well. My son has, and will have for the rest of his life, a large scar on his scalp from a misplaced probe, and I will not subject future children to the same treatment. In addition, I do not wish a routine IV, which would interfere with my ability to move throughout labour. I would not cooperate with hospital policy that would have me laboring in a hospital bed, only to increase my chance of epidural use and pain medication, not to mention the research that shows laboring in one position slows down labour progress and makes it more difficult for the newborn to achieve an optimal birth position. I do not accept the regular and unrestricted use of antibiotics during labour, unless otherwise noted. Finally, I will not deliver on my back, which increases the risk for tears and further interventions, not to mention hampering the assistance gravity can be for delivery and the blockage of movement for the newborn into optimal birthing position.
I feel a certain loyalty to the * Midwives practice after the birth of my son, but would not hesitate to locate and transfer my prenatal care and birth to a midwife who agrees with my view of a successful homebirth. I do not make this decision lightly, as I hope that the * Midwives practice do not take my objections lightly. I hope that my arguments can be addressed in such a manner as to open the lines of communication and allow for a joint exchange of information and opinions.
Thank you for taking the time to read and discuss these issues with me.
Sincerely,
A
(no subject)
Nursing Story
I wrote this as part of my application to become an
adopt_a_mom and thought I'd share it with everyone here. ( Collapse )
Success!! I am now officially an