Nine years ago today...

...that face Leila made when she was away from Sarah for the first time in her life.  It was only 14 minutes, and they've been inseparable ever since, but it was obviously traumatic for her. 

...that moment when I was laying in bed after pushing two babies out of my body and I still couldn't believe that there were two of them.  And that they were mine.

...that time when Jason realized he was Daddy to two sweet daughters. 

 ...that love that Matthew was feeling when he brought two of his most precious possessions as loving gifts (or peace offerings?) to his new little sisters.

...that moment when I looked at them for the hundredth time and marveled at the miracle of fresh, tiny babies.

...and especially that moment when I became a mother of twins.

Violet's Birth

August 14th came and went and there were no signs of baby.  Throughout this pregnancy I had told everyone that baby would arrive at the end of August.  I fully anticipated going to 42 weeks again.  The kids took bets on when baby would be born.  Most of my babies came at the end of the month (one on the 27th, two on the 28th, and two on the 30th) so we hoped that we might have a baby on August 29th or 31st.  No such luck.  When August ended, I was frustrated and really starting to feel impatient.  

On September 1st, I woke up to a mild crampy feeling and some pressure.  A friend texted me at 9:32 AM and said, "it's Labor Day!"  My response?  "Hopefully that means labor for me!"

I soon realized that the constant crampiness and pressure was exactly what I felt the morning before Seven was born.  By 10:02 AM I texted my friend to tell her that I was feeling constant cramps/pressure but no contractions and that I thought this was how it started with Amelia.  Sure enough, at 10:30 AM it became clear when I went to the bathroom and saw bloody show.  That was exactly the same as the day that Amelia arrived.  I texted my friend back, "definitely baby day."

I was relieved that Jason had the day off and was home to help with the kids.  I had breakfast, nursed Amelia, and started setting up the birth pool.  I was certain that baby would be coming.  I was hopeful that things would kick in soon but Baby #8 had been persistently posterior, so I knew I needed to be patient.  I rested in bed for a bit and then took a warm bath.  I figured labor would kick in when the kids went to bed that night.

I spent the day trying to get baby into a good position.  Jason used the rebozo and I crawled around on the floor on my hands and knees.  I did some of those inversions on the edge of the bed that I'd tried desperately during my labor with Seven.  Finally, I decided to fill up the birth pool.  By then it was early evening and I just wanted things to pick up.  They did.

I got into the pool for a bit.  Another friend texted me to check in and I let her know that it was probably baby day.  At 5:02 PM I told her that I'd let her know when things started to pick up so she could come over if she wanted.  Within a couple of hours, things got crazy.  I got in and out the pool a few times to use the bathroom, change positions, and walk around.  I really didn't leave my bathroom much after that point. 

I checked myself and I wasn't any more dilated than I had been a few weeks earlier.  My cervix was still posterior.  I was frustrated and didn't want to push out another posterior baby.  By 8 PM labor had really started.  I began having frequent, strong contractions.  I had Jason and the kids bring me something to drink and get the towels and supplies ready.  I was still texting back and forth with my friends but was starting to feel more serious.  This was it.

At 8:34 PM, I still wasn't any more dilated but my cervix had started to swell a bit in the front and was still very posterior.  I tried the "flip the lip" trick, which was made so much easier being in the water.  Things were sort of a blur after that.  I was starting to worry about my cervix swelling.  

At 9:16 PM, I decided I was DONE.  I announced it to anyone who would listen.  Thankfully, Jason knew that this meant baby was coming soon.  I did the same thing I did with my other homebirths... I tried to talk Jason into taking me to the hospital for my epidural!  Thankfully, he never listens or we'd have a lot of babies being born in our van.

My friend headed over to my house and arrived around 9:45 PM.  Just before she walked in the door, I broke my water.  I have some lingering guilt about this because I strongly believe in letting labor happen naturally and I'm not a fan of unnecessary interventions.  But I was DONE. I wasn't completely dilated but I could feel that baby's head was moving down.  I don't know why I did it, but I pinched the amniotic sac until it broke.  It took quite a few tries.  

Immediately, I felt the urge to push.  My friend came in and sat next to the pool.  I wanted Jason to hold my hand, unlike my previous births when I really didn't want to be touched and wanted to be left alone.  He later told me that I squeezed his hand pretty hard.  I had my friend gather up the kids and I soon had a crowd in the bathroom.  All seven kids, Jason, my friend, and my friend's teenage daughter watched as Baby #8 joined our family.

There was a strange moment when I pushed out the baby's head but her body turned and rotated inside me.  It was painful and I shouted "what is it doing?"  Then, relief.  Baby slid out into the water at 10:26 PM.  I caught her, untangled her from her cord that was wrapped all around her, and lifted her from the water.  She was covered in vernix and didn't look like a baby that was 18 days "overdue."  

We have some great video of the birth but the only still photos were on my cell phone, just after the birth.  Jason proudly proclaimed that Baby #8 was another girl as I lifted her from the water.  Just like with Amelia, I hadn't even thought to check the gender yet.  There were squeals of excitement from the kids as they learned they had a new baby sister.

Violet Isabelle

September 1, 2014

10:26 pm

9 lbs, 9 oz

22 inches

I birthed the placenta and got out of the pool and into my comfy bed.  I nursed my sweet baby for the first time and let family and friends know that she had arrived.  I've never felt so great after giving birth.  No soreness, no tears, no terrible afterpains!  It was wonderful.

We did a much better job at naming this last baby.  It took 3 days, not 3 weeks.  Violet wasn't on either of our name lists.  I wanted another name that ended in "a" or "ah."  Instead, Violet was the name that we both loved and Isabelle was Jason's choice for her middle name.  Anyone who knows me won't be surprised that I picked the name Violet, considering my fondness for all things purple.  I'm actually surprised it took me this long to use that name.

My sweet Violet looks a lot like her big sister Amelia.  And she is very loved by a bunch of big brothers and sisters.  She's obviously the youngest of eight because this girl can sleep through almost anything.  We are so blessed!

Baby Eight!

After my longest pregnancy that felt like it would never result in a baby, I finally went into labor on Labor Day.  I guess eighth babies like to be unpredictable.  While I was pretty sure I'd hit the 42 week mark again, I never even considered that this baby might not arrive in August!  At 42 weeks and 4 days, my September baby arrived... just 3 days before Nathan and Ryan's birthday.

I had another VBA2C and this sweet babe was born in the water, in my bathroom.  Just like Seven.

We have a sweet baby GIRL!  Just like Seven.

She weighed 9 lbs, 9 oz.  Just like Seven.

And she's got a head full of black hair and squishy cheeks.  Just like Seven.

Seven loves her but is also willing to give her sister away when she's annoyed.  Seven is not thrilled about sharing milk but will tolerate it because Mommy insists.  You could say there's a teensy bit of jealousy.

We are all thrilled to have another baby girl in the house.  I'm excited for Amelia to have a sister close in age and I'm sure these two little girls will end up being best friends.

We are doing well and this sweet girl is such a joy.  She does have a tongue tie/lip tie that will be revised soon but otherwise things have been pretty great.  I still can't believe she's finally here!

I am also pleased to announce that we were able to name this baby girl in just over 3 days.  That's a major improvement over the 3+ weeks it took us to name Amelia.  We ended up choosing a name that was not on either of our lists but just seemed to fit her perfectly...

Violet Isabelle

September 1, 2014

10:26 pm

9 lbs, 9 oz

22 inches 

Seven's Birth

If you don't want to read about birth or see pictures of birth, stop reading now.  I'm not posting the graphic birth pictures, but I do want to share some photos of Seven's birth.  I wish I hadn't ripped my bra off right before I started pushing.  I have some good pictures but I'm topless in all of them.

Oh, and be warned, this will be long...

For those who don't know, here's a very brief history of what led me to an unassisted birth.  My first birth was in a hospital, second birth was a planned homebirth that ended in a cesarean (no labor) after my midwife dropped me, third birth was my HBAC (homebirth after cesarean) with twin girls, and fourth birth was another planned homebirth that ended in another cesarean (no labor) for TTTS with twin boys.

That brings me to this pregnancy.  We are in yet another new state (Arizona) in a town that has an active VBAC ban.  The next closest hospital is around 90 miles away.  Midwives here can't attend VBACs and the birth center (also 90 miles away) doesn't allow VBACs either.  Talk about limiting birth choices...  For a mama with two previous cesareans, there are very few options.

As my due date came and passed, I tried to remain patient. When things finally started to happen, I texted back and forth with my friend who lives across the country.  Thanks to our text messages and a great birth video, I have a very good record of my labor and birth.

I had been nesting for weeks.  My tile floors and grout had been scrubbed twice.  I had washed the baseboards and kitchen cabinets.  I had inflated the birth pool and unpacked my birth supplies.  I had filled my freezer with meals and stocked the fridge with groceries.  I was totally ready.  But baby was not.

On Wednesday night, November 28th, I was emailing back and forth with my friend Brandi. She told me the moon was full and wondered if it was going to be that night.  I wrote back that nothing was happening and I didn't feel like anything would be happening anytime soon.  I went to bed, determined to be patient with my baby.  The next morning I woke up feeling crampy and emailed Brandi to tell her how mad I was waking up still pregnant.  I had it in my head that the labor and/or birth would happen at night so each morning brought disappointment that I was still pregnant.

By 10:45 am on November 29th, I emailed Brandi again to tell her that I was feeling really crampy.  I still wasn't having any contractions but at 41 weeks 6 days pregnant, even cramps were a welcome sign.  I finally started to think that today could be the day.  I tried not to get my hopes up since I thought there was a good chance it could still be a few days before the birth.

I took a shower and had several contractions while I was standing in the warm water.  I checked my cervix and was only disappointed.  I wasn't dilated at all (still only a fingertip, which is what I had been several weeks before at the only other time I'd checked during this pregnancy.)  My cervix was more effaced, but I still didn't think anything was progressing.  I knew I wasn't in active labor and that was hard to accept.

I was more than ready to meet Seven and I was starting to think about hitting 42 weeks and what that would mean to me.  I was really trying not to associate 42 weeks with any sort of deadline, but my memories of Joshua's pregnancy/delivery were hard to push out of my mind.  Over the last 8 years since his birth, I've accepted that my first cesarean was due to the midwifery regulations where we were living.  My care was abandoned at 42 weeks for no reason other than the date on the calendar.  And while Joshua was a big baby (11 lbs, 1 oz) with a nuchal cord, there really wasn't any reason I couldn't have at least attempted a vaginal birth.  An unnecessary cesarean is a tough pill to swallow and I kept finding my thoughts wandering back to that experience as the days ticked by before Seven's birth.  I desperately wanted not to see any similarities between Seven's pregnancy and Joshua's pregnancy.  I wanted this birth to be different.

By 1 pm I was having more and more irregular contractions.  They were sometimes short, sometimes long.  Sometimes they were far apart and sometimes they felt close together.  Some of them were surprisingly strong but most were only cramps that felt nothing like labor.  I still wasn't convinced that anything was really happening yet.

Just after 2 pm, I went to the bathroom and had some bloody show.  Ok, things were getting real now.  I finally felt excited and encouraged that labor may start soon.  Jason wasn't home and my kids were distracting so the hours passed quickly.  I set up my birth supplies and cleaned up around the house.  I tried to lay down and take a nap but the kids were loud and I had a few contractions that I just couldn't sleep through.

I finally got up and decided to start filling the birth pool.  I think this was the point when I realized that I was going to have a baby in the coming hours.  Jason came home just in time to help me and he made it his personal mission to keep the water at the appropriate temperature and make sure that I had everything I needed.  He was amazingly helpful.

My children soon realized that me being in the birth pool meant that Seven would be arriving soon.  They were in and out of the bathroom to check on me and give me love.  I tried to rest as the contractions were still irregular and somewhat far apart.  In fact, they felt more like painful cramps than contractions.  I had moments of intense pain as Seven tried to turn and change position.  This just confirmed what I already knew-Seven was posterior.  I had been trying to encourage good positioning and had been doing inversions and hands & knees positions for weeks.

At 7:35 pm I started texting Brandi to fill her in on what was happening.  I told her there was still no real labor yet.  I got out of the pool and walked around the house, stopping in the living room to try another inversion.  Seven was still trying to change positions but I could tell the poor positioning was the reason for this long, stop & go pre-labor that I was having.  At 8:08 pm I told Brandi that the baby was still not in a good position.  I was getting discouraged.  I checked my cervix and was disappointed that I was still only a fingertip dilated.  It felt like no progress.

A text message I sent at 8:24 pm simply read "Baby is trying to turn.  Not sure.  Hurts like hell.  Not dilating."    And then "Must be posterior again."

Suddenly, things changed.  I lit candles in the bathroom.  I got back into the pool.  My kids went to bed and I found that I wanted Jason nearby.  This was so much different than Leila & Sarah's birth when I wanted to labor alone.  Jason seemed so calm and soothing and I just liked knowing he was near me.  At this point I think I knew in the back of my mind that I was going to have a baby very soon, even though I wasn't even dilated yet.

My next text message was more dramatic.  At 8:59 pm I said "I'm dying."

The next, even more dramatic, text message just said "dyingggg."  I realized then that I was now in labor.  I heard myself saying the same things I said when I was about to give birth to Leila and Sarah.  I recognized myself reaching that point I've seen so many other mothers reach in their labor when they say they can't continue and I encourage them and remind them that those words mean they are almost done.  Jason did the same for me.  He knew I was close to having a baby and encouraged me to keep going.  So I did.

At 9:59 pm I texted Brandi to tell her that "I can't do this much longer."  She reminded me of what I already knew- that I was doing great and that I could do it.  A few minutes later I declared that I was exhausted.  I tried to sleep between contractions but they were starting to become more regular now and some of them were extremely painful as Seven kicked and twisted and turned inside me.

I got out of the pool and tried one contraction on my side on the bed.  I desperately wanted to sleep but of course I could not.  I tried a contraction on my knees, leaning over the foot of the bed but it was miserable.  (That was my favorite position when I gave birth to Leila and Sarah.)  I tried a contraction on the toilet and a contraction on my hands and knees.  Nothing felt right so I got back in the pool.  The only relief came from the warm water.

At 10:38 pm, I checked myself and felt the bag of water bulging, though I was only about 3 or 4 cm dilated.  By 10:52 pm I was actually dozing off in between contractions and the warm water was very relaxing.  I had a few contractions that turned my low moans into full-on screams, which I didn't like.  Things started to feel out of control.  I started telling Jason that I couldn't keep going.  Seven was trying to turn with each contraction and the only position I could tolerate was sitting completely upright in the pool.  I was so exhausted.

I started pushing at 11:30 pm.  It was completely involuntary.  I checked myself and still felt a good amount of cervix but it sort of melted when I touched it.  There was a firm lip of cervix left.  I told Jason and Brandi that my body was pushing but I wasn't complete.  I was a little worried that I was pushing before I was completely dilated but I had to trust my body.  I wouldn't even say that I was actually pushing at this point.  It was more of a sense that my body was bearing down and bringing the baby down too.  I didn't do anything.  I just didn't fight what my body was doing. It felt good to just breathe and grunt a little while my body did its thing.

At 12:56 am I reached down to feel Seven's head and my water broke in my hand. It was so amazing to feel the bag break under the water.  Seven's head was just 1 knuckle deep and moving down quickly.  I asked Jason to hand me a mirror but I ended up not using it because suddenly Seven was crowning.

I kept my hand on Seven's head as it emerged.  There wasn't really a ring of fire this time.  Just a lot of pressure as I felt my baby's head being born into my hand.  There was a break in between contractions as I sat there in the birth pool with a head about to come out of me.  It was very surreal.  I felt lots of hair and Seven's head continued to bulge out until it was half way out of me in the water.  Jason took a couple of pictures and our video camera was recording every moment of the birth.  Jason asked me "Do you feel the head yet?" I answered, "Yeah, the head's right here in my hand."

Another contraction and Seven's head was out.  As I had suspected, the baby was posterior and was looking up at me through the water with wide open eyes.  I pushed again and an arm popped out, followed by another arm.  I reached down and was completely amazed when Seven grabbed hold of my fingers.  My sweet baby was grasping my fingers in clenched little fists under the water.  In disbelief I said, "I'm holding my baby's hand."  It was such a powerful moment.

And just like that, the rest of Seven's body slipped out.  The umbilical cord was pretty long and was wrapped around Seven's shoulders, torso, and between the legs.   Seven stayed under water as I unwrapped the cord.  As I pulled my baby up, I looked down at those big, wide open eyes staring back at me from under the water.  It was a moment that I will never, ever forget.  It was incredible.  There are no words that can adequately describe that moment.

I pulled Seven up into my arms and Jason said "I think it's a girl."  I took a quick peek between her legs and confirmed.  "It's a girl!"  And then Jason turned to the video camera and, with a big smile, said "It's a girl!"

I sat in the water for several minutes, thinking the placenta might come.  It didn't.  Seven had passed some meconium on her way out (and passed even more into my hand as I held her) so after a few minutes she started to sound gurgly.  She was so perfect and pink when she came out but she didn't really cry until I cleared some of the junk out of her mouth with my finger.  I ended up using the bulb syringe to get the rest out and then she sounded great.  Jason got towels for us and  held Seven while we got out of the pool.  Still attached, we got into bed together.

We had one scary moment with Seven's breathing just after we got into bed but everything ended up being ok.  A few minutes later and she was nursing and laying on my chest.

I kept waiting for the placenta to come.  Jason brought me scissors and I cut the cord.  I took pictures of Seven and sent messages to friends and family.  A couple of hours passed.  I started to worry about why the placenta still wasn't coming.  I pulled gently on the cord and it didn't feel like the placenta had detached yet.  I ended up going into the bathroom and squatting and pushing for several minutes.

Finally, the placenta came out and I saw the reason it had taken so long.  It was huge!  And by huge, I mean it was bigger than the placenta with either set of twins.  This singleton placenta was larger than the placenta that grew nearly 15 pounds of baby.  Incredible.  It weighed 3.45 pounds!  We weighed Seven and she was 9lbs, 9.5 oz and 21.5 inches long.  She was much smaller than Joshua but still a full 2 pounds heavier than any of my other babies.  (Matthew was 7 lbs, 9 oz, Joshua was 11 lbs, 1 oz, Leila and Sarah were both 7 lbs, 6 oz, Nathan was 7 lbs, 9 oz, and Ryan was 6 lbs, 6 oz.  I think Matthew was small because of PIH and the medication I took for preterm labor.)  I still can't believe I pushed out a 9+ pound posterior baby.

I felt so much better after delivering the placenta.  I climbed back in bed and snuggled with my baby.  I was too excited to sleep much, even though I was deliriously exhausted.  When morning came, Jason had to take Matthew to have his cast removed.  He returned home with Starbucks coffee and a big, fat blueberry muffin.  It was the best food I've ever eaten.  I felt wonderful!

I can honestly say that this birth was everything I had hoped it would be... and more.  I had wanted to have a waterbirth since I was pregnant with Joshua.  This has been the best birth experience, the easiest recovery, and the most awesome babymoon.  My milk came in the day after Seven was born and we literally spent the first few days just laying together and nursing and getting to know each other.  She has fit right into our family so perfectly.  We are all in love.

Baby Seven

November 30, 2012

1:08am

9lbs, 9oz

 UBA2C!!!

Birth Matters

April is such a special month for me. It's the beginning of spring, the birth of new things. It's a fresh start. And five years ago, I gave birth to my first set of twins.

Yes, next week my twin girls will be five years old. As I sit wondering where the time has gone, I still can't believe that I have these two amazing little girls. And I still can't believe quite how much their birth transformed me.

April is Cesarean Awareness Month, and there was no time more fitting for my daughters to be born. When I became pregnant with Leila & Sarah, it had been just one year since Joshua's birth by cesarean. After a pretty standard hospital birth with Matthew, I opted for a homebirth with Joshua. Things didn't go as planned and I suddenly found myself recovering from an unexpected cesarean. After discovering I was pregnant again, I knew right away that I would plan another homebirth. What I didn't know was that I was carrying twins.

An ultrasound at 22 weeks confirmed my midwife's suspicions... I was expecting two babies, not just the one big baby I had thought. And suddenly, everything was complicated. Georgia is not a homebirth-friendly state and the midwife that I had hired was not willing to attend a twin birth. My previous cesarean made it even more difficult to find a midwife willing to care for me. Despite the evidence that VBAC (vaginal birth after cesarean) is no riskier with twins than with a singleton, I felt like everyone viewed me as a ticking time bomb. When I hit 38 weeks, my back-up OB scheduled my cesarean. I never showed up for the surgery.

By the grace of God, a series of small miracles led to a knock at my front door when I was in labor. Two amazing midwives came into my bedroom and, a few hours later, helped me give birth to my twin girls. The experience was life-changing. The birth was perfect. I could not believe how incredibly wonderful these midwives were, that they were willing to drive hours to come to my birth, that they trusted in my ability to give birth naturally. My homebirth was one of the most powerful, awesome experiences of my life.

Homebirth is not for everyone... but having a choice is every woman's right.

Nobody should have to drive to another state to have the birth they desire. Nobody should have surgery because they feels it's their only option. Nobody should receive substandard care because of insurance regulations or because of their ability (or inability) to pay for treatment.

In our country today, woman are frequently being denied the right to choose where (and how) they give birth. The cesarean rate is soaring as roughly 1/3 of U.S. women give birth via major abdominal surgery. Women are even being forced into surgery against their will. There is often no informed consent, as women are not accurately told of the risks and benefits to the many procedures performed during a typical hospital birth. Cesarean sections have become the most common major surgical procedure in the U.S., yet many falsely believe that it is a safer way to give birth. Our country's neonatal mortality rates are behind those of 33 other nations, despite the growing cesarean rate. Our maternal mortality rate ranks behind at least 40 other nations, yet we spend more money on maternity care than any other country in the world.

All of this needs to change.

If you have ever read anything about midwifery, you have probably heard of Ina May Gaskin. Ina May has been a midwife for nearly 40 years and is probably the most influential midwife in history. Her midwifery center (The Farm) has been a prime example of what birth can,and should, look like using the midwifery model of care. With low cesarean rates, low rates of postpartum hemorrhage, high success rates for vaginal breech births , and a high VBAC success rate, her midwifery practice illustrates the excellent outcomes that are possible with skilled midwives attending births.

The author of several books, Ina May Gaskin's newest book is called "Birth Matters." I find the title to be very fitting. Although many people will say "all that matters is a healthy baby", this is simply not true. A healthy mother is of the utmost importance as well. When you consider the maternal mortality rate and neonatal mortality rate in the U.S., it is clear that birth does matter. It matters for mothers and it matters for babies.

I recently read "Birth Matters" and had a chance to ask Ina May a few questions about the book. Before I share what she said, I want to point out one thing. "Birth Matters" paints a clear picture of birth in the U.S. today... and it isn't pretty. This book is one that appeals to all women, regardless of whether you're pregnant or not and regardless of whether you support homebirth, hospital birth, or both. This book is about the importance of birth in our society and how modern maternity care is changing, at the expense of mothers and babies.



Discussing "Birth Matters" with Ina May Gaskin
Me: In your book, you discuss the basic, manual skills that many new obstetricians lack. You point out that they are not being taught to palpate the fetus or to turn a breech manually, let alone to deliver a breech vaginally. Yet there are still some older doctors that have held onto this knowledge. I had the honor of witnessing an unmedicated, vaginal breech birth by one such OB and a young resident. After the successful birth, the OB asked the resident whether she would use what she had just learned to deliver breech babies vaginally when she began practicing. Her answer was “No way.” I don’t understand it. What will happen when the newest generation of obstetricians is unable to learn these skills? You wrote about speaking to groups of ob-gyn residents. Is this a good way to bring about change? Can obstetricians stand to learn these skills from experienced midwives?

IMG: To answer your first question, more women will have unnecessary cesareans. To answer your second, talking to ob-gyn residents might not change this trend, but it could keep some from panicking if confronted with an undiagnosed breech that is coming too fast for a cesarean. A nurse told me about such a case in which the baby’s body had been born just as the anesthesiologist walked in the room, whereupon the panicked ob-gyn asked the anesthesiologist to put the woman under general anesthesia. That baby did not survive, and the nurse (who had more experience with vaginal breech birth than the ob-gyn) was sure that the baby could have been born if the doctor hadn’t panicked and asked for anesthesia when it wasn’t necessary.

The answer to your third question is yes, I think that obstetricians can stand to learn these skills from midwives, but we’ll have to get certain barriers out of the way before this can happen.

I just had a conversation with an obstetrician who is nearing retirement about the de-skilling of his profession that has been on-going since the late 1970s. He thinks it likely that if current trends continue, there will be no obstetricians in the future—only surgeons to do the cesareans. This truly is a race to the bottom. One of our problems is that most people don’t understand that it was insurance companies refusing to provide malpractice coverage to teaching hospitals that allowed doctors who were skilled at breech from teaching residents these same time-honored skills that caused this problem. I can’t think of any good reason why insurance companies should be allowed to have power over what doctors and midwives are allowed to know.

There will continue to be women with breech presentations who will insist that midwives provide the services that obstetricians refuse to provide. Increasingly, midwives are recognizing that someone has to keep knowledge and skills about how to deal with breech presentations alive, so leading midwifery educators are accepting this responsibility. It is important to recognize that there are obstetricians and family physicians who are philosophically opposed to the downgrading of their respective professions represented by the loss of traditional obstetrical skills. What has to change is medical education here. European medical and midwifery education has never abandoned the teaching of manual skills, including how to deal with breech presentations, even though these cases comprise less than 5% of the total. Instead of depending upon students being able to witness such births, they rely on teaching the various maneuvers using mannequins and dolls. Such mannequins have to be well-crafted to mimic what happens in real life as a baby is pushed through the pelvis, but I have found at least one great one that was made in Germany.

Me: One of most important things that I took away from reading your book was the need for our country to establish a system of reporting maternal deaths. You discuss this in great detail and you created the Safe Motherhood Quilt Project to work towards this goal. What can we (as mothers, activists, the general public, etc.) do to help bring about this change? What things can we do on an individual basis that can help make a difference?

IMG: Join Amnesty International USA’s Demand Dignity Campaign.

www.amnestyusa.org


Dear Human Rights Activist,

The Demand Dignity Campaign was excited to see so many activists from around the nation willing to raise their voice to pressure congressional leaders to protect the right to maternal health at this year's inspirations Youth Summit and Annual General Meeting. As we continue to take action to fight poverty with human rights, we are pressing onward with our agenda to help reduce rates of maternal mortality in the US and around the world. But we cannot do this alone .

With Mother’s Day just around the corner, it is important to let domestic and international decision-makers know that we care about ensuring that the right of every woman to a safe pregnancy and childbirth is fulfilled. This is where you must get involved. In the four weeks surrounding Mother’s Day – April 23 rd to May 22nd – Amnesty International activists from around the country will be holding Mother’s Day card-writing events, visiting their congressional representatives, hosting film screenings, and more. You can join this fight to demand dignity for mothers and get decision-makers to hear our voice by:

1. Writing Mother’s Day cards.
Individuals and groups can register to host a card-writing event at amnestyusa.org/mothersday to receive copies of our cards and case sheets.

2. Lobbying during our spring in-district lobby week.
In March, Rep. John Conyers (D-MI) introduced the Maternal Health Accountability Act of 2011 to protect women’s health in the United States. From April 29th through May 8th, you can lead or join a delegation to lobby your congressional representatives to support this vital piece of legislation. Register at amnestyusa.org/lobby .

3. Using the power of film to raise awareness in your community .
· Host a party to watch the network premier of Christy Turlington Burns’ new documentary on maternal health, No Woman, No Cry (May 7 at 9:30 PM ET/PT on OWN).
· Screen the BBC documentary, Dead Mums Don’t Cry (any time between April 23 and May 22).

Register at amnestyusa.org/mothersday to request a copy of Dead Mums Don’t Cry and film guides for both movies.

You can also check amnestyusa.org/mothersday to find more events to join to support other activists in your community.

Don’t wait. Shine a light on maternal health this Mother’s Day by joining the fight to save the lives of mothers everywhere. Take action now!

In Solidarity,
The Demand Dignity Campaign Team



"Birth Matters" discusses several other initiatives aimed at changing maternity care today. The Safe Motherhood Quilt Project's goal is the creation of a system for reporting and reviewing maternal deaths. The Coalition for Improving Maternity Services seeks to promote a wellness model of maternity care that will improve birth outcomes and reduce costs. (Can you say "midwives?")

Did you know that in the industrialized countries with the best perinatal outcomes, midwives attend the vast majority of births? Yet in our country, most births are attended by surgeons. OBs are skilled surgeons, yet they are providing most of the care for low-risk women who do not need surgery. Midwives attend only a small fraction of the births in the U.S., despite the evidence that midwifery care is most appropriate for the majority of women. Women in the U.S. today are more like to die in childbirth than their mothers were.

For those who want to learn more about the safety of homebirth, "Birth Matters" exposes the flaws in the recent "Wax study" that claimed that planned home births had higher neonatal mortality rates than planned hospital births. Ina May does an excellent job of explaining the defects of this "study" and shares the data to back it up. Her discussion of the tactics used by those who seek to put an end to midwifery and homebirth is quite eye-opening.

What it boils down to is this: midwifery care and homebirth should be valid options for low-risk women. Maternity care in the U.S. is being controlled by those with special interests-the insurance companies, trade organizations- without regard for what is safest for mothers and babies. Women should have autonomy when it comes to their bodies and their births.

"Birth Matters" is really a must-read for women everywhere. These issues impact us, our children, and the future of our culture. The way that we treat mothers and babies speaks volumes about our society as a whole.

"Birth Matters" is available now in stores. I'm also giving away a copy on my review blog, just in time for Cesarean Awareness Month and my daughters' birthday (and the anniversary of my twin HBAC!)

The Big Two Turned Four

Today is the big day!

Leila and Sarah turned four today. I can't believe it's been 4 years...
Four years ago right now I was just an hour away from meeting my baby girls for the first time. I had no idea what the future held. I wasn't sure how I'd mother two daughters. I was excited and terrified at the same time. I was still in disbelief that I was having twins. Two babies at once?! Seriously?
And here they are today.

My sweet girls have been on this earth for four years and yet I don't remember life without them. I don't remember what it's like to hold a single baby. I only know life in pairs. My days have become repetitive... change two diapers, nurse two babies, hold two hands, carry two children in my arms, and share my bed with two sets of twins. I can't believe how blessed I am to be the mother of these amazing children!

Sarah has decided that she's ready to be a big girl. She has been accident-free for nearly a week. (Don't get too excited, we've gone through this before.) She's always been attached to her mama and has always wanted to sleep near me and twirl my hair. Sarah is rough and tumble and can hold her own with her four brothers, but she's a princess and she knows it.

Leila is always my fiercely independent, yet reserved, little diva. The slightest scratch can induce a blood-curdling scream. She likes to be beautiful and she's always been a clean eater. She hates to be dirty. She is also Daddy's girl and he has him wrapped around her dainty little finger. She and Sarah are opposites in many ways, yet they are so much alike too.

These girls love to play together all day and share secrets. They can sometimes disappear into their own little world when they are playing pretend. Their bond is unlike anything I've ever experienced myself and it never ceases to amaze me. They are such special little girls!

In honor of Cesarean Awareness Month, I'm going to share some memories of the girls' birth. If you don't want to see the harsh reality of a pregnancy with multiples, turn away now. (You've been warned!)


This is what 90 lbs of weight gain can do to a body. It's not pretty. It feels pretty miserable too. But, this body held two babies inside it so it was all worth it!
This is what I looked like the day before I gave birth to Leila and Sarah. I was 39 weeks pregnant the day I took this photo. That night I went to bed, as usual, feeling like I was never going to have these babies and that I wasn't even really pregnant and it was a sick, cruel joke.

Just before 1 am, my water broke. It was actually more of an explosion all over my bed. I had been asleep on my left side and I was drenched from my knees to my neck. The "pop" actually woke me from my sleep. When I stood up from the bed a huge splash hit the floor and my poor dog who was sleeping next to the bed. Everything was wet and Jason mumbled something about me ruining our new mattress.

I'll spare you the details, but if you want to read the whole story you can find it here.

I labored alone for pretty much my entire labor. I let Jason and the boys sleep. Matthew was 3 and Joshua was not even 2 yet, so they played in the other room once they woke up. I retreated to my bedroom and waited for the midwives to arrive so I could hurry up and have the babies already!

Around breakfast time my midwives arrived. I was uncomfortable and couldn't find a good place to labor. I spent a few contractions in the shower (nice) and then a few on the toilet (miserable) and then a few on the bed (terrible) and finally just got on my hands and knees. When I reached a break in my contractions the midwives went into the kitchen. I could hear them talking about me and my labor and how the contractions must have spaced out. I was sitting quietly in Jason's office chair, next to my bed, as the contractions rolled through my body like waves. I was silent.

Suddenly the urge to bear down hit me like a ton of bricks. I was pushing. There was no thinking, no hesitation, no stopping it. I dropped to my knees out of the chair and draped my upper body across the foot of my bed. And I pushed. And I pushed. And pushed some more.

The midwives rushed into the room and Jason brought Matthew and Joshua to see me. After a few big pushes, I reached down and felt Leila's slippery body shoot out into my hands. The midwives helped me lift her but her cord was too short. They cut her cord and I held her as they checked the position of "Baby B" (aka Sarah.) Sarah's hand was presenting which caused a bit of excitement and they took Leila from my arms so that I could push again.
I hated pushing out the second baby. I was irritated that I had push again so soon. I just wanted a break. I buried my face in the bed covers and cursed. I even tried to flat out refuse. "I'm not doing this again. I need a break! I just had a baby!" But there was no break, and 14 minutes later, Sarah was born.

The midwives helped me climb back into Jason's chair (and he was silently cringing at the sight of my fat, naked, bloody butt in his precious chair) where I held both girls for the first time. I nursed them both and delivered the placenta. Then the midwives helped me climb into bed.

I marveled at the fact that I'd just given birth to twins, at home, after a previous cesarean. It was such a healing experience. It restored my faith in natural birth and it really made me feel as though I could accomplish anything. It was, quite literally, a birth high. I've often tried to use my experience to help encourage other mothers who are considering homebirth, or even just a natural birth with twins. The difference between a cesarean and a homebirth (especially with twins) is just incredible. I was up and walking and feeling remarkable, just hours after giving birth at home. It was just completely awesome!
We spent the rest of the day staring in wonder at the two little girls who had just entered our lives. Matthew helped us name the girls. We had decided on their names but had not decided which baby would get which name. Matthew decided that Leila was the first born and so we named her Leila Beth. "Baby B" became Sarah Grace.We could tell them apart easily because of their color difference due to TTTS. Even so, it was odd to have two babies that looked and sounded just alike. It was still sinking in... we had TWINS!

I find it especially humorous now to remember my apprehension at the thought of having two babies. I was so unsure of what life would be like with twins. And now... well, now I just have to giggle.
Happy Birthday Leila and Sarah! I hope someday you realize how blessed we are to be your parents and special you are to our family. We love you so much.

(ETA: By the way, head on over to Kate's blog and wish her twin girls a happy birthday too! They are the older of her two sets of twins and they share the same birthday as Leila and Sarah!)

Spiders, Snow, and Special Surprises

I hate, hate, hate spiders. I really despise them! I love snakes and used to have them as pets. I can tolerate mice. I just cannot handle spiders. You want to hear me scream like a girl? Show me a spider. My dad thought it was hilarious when we were hiking in California together and a tarantula crossed our path. I almost soiled myself. It wasn't pretty.

Yesterday I was in the basement trying to organize our playroom. While I was putting away some of the babies' toys, my hand brushed against a spider. Specifically, it brushed against a black widow. Oh, I'm good at spotting those nasty, shiny, black creatures with the telltale red hourglass. In 25 years, I had never seen a widow. Then we moved to Georgia. We had them in the kids' sandbox, in the garage, and all over the backyard. Just never in the house, fortunately.

In Arizona I freaked out when I saw one on the front porch and I made Jason smash it. When we got to Virginia I kept finding them in the yard. One day I found one in the basement and I found one upstairs. I chalked it up to the fact that this house was a foreclosure that sat vacant for several months before we moved in here. I figured they'd clear out when we cleaned and unpacked. Not quite.

Needless to say, I called Jason in near hysterics. I was ready to buy a new back door, call an exterminator, or just sell and move out. Jason talked some sense into me (as usual) and I just decided to weatherproof the back door. That and clean up the 2,000 toys that were strewn about as if a tornado has struck our basement.
It took all morning, but I got it cleaned up. It helped that we'd gotten several inches of snow on Saturday and I'd decided we weren't going to church. We stayed home and cleaned. And painted.

Have you ever tried to paint with 6 young children under foot? No? Well, then you are smarter than me.
My sister-in-law, being the fabulous and generous person she is, came to help. We painted some of my foyer and the family room. It's amazing how a little paint can cheer a person up. I woke up this morning eager to start the day. Now I just need to paint the other 15 rooms.

For now, I'll settle for this!

The snow made our Saturday more adventurous as I was planning to drive up to Baltimore for a birth film fundraiser for ICAN of Baltimore. It's been a long, long time since I've done anything "birthy." For awhile, my heart wasn't in it. And of course I've just been so busy trying to survive and all. But I was able to be a part of a panel of women who spoke after a film screening of "Singing the Bones." The film was great and it was more exciting when the power went out several times in the middle of the show. I had the babies with me and they were so quiet, just nursing for most of the entire 2 hours.

Afterward, we discussed twin birth, homebirth, and the state of modern obstetrics. I got to share a bit of my story and my journey to homebirth, specifically the HBAC of Leila and Sarah. I sat next to a lawyer (and pregnant mom) who works with CIMS and had to giggle. She had a copy of Jennifer Block's book "Pushed" which actually has a very brief mention of my birth in it.

I also sat next to a fellow twin mom who had her twins at home 2 years ago. We know each other from several online forums and through our local multiples club. It was so awesome to see her twin toddlers climb onto her lap and demand to nurse together as she was speaking. Such is life with twins!

When we left the film screening it was snowing heavily. My mom had taken Matthew, Joshua, Leila, and Sarah to have breakfast with Santa at Ft. Meade. They had a great time and they picked me and the babies up. As I drove my mom back to her house, the snow kept coming. My kids were freaking out! Remember, we moved from Maryland when Matthew was a baby. Since then we've lived in California, Texas, Georgia, and Arizona. My kids have never lived in a place where it snows. Our cat had never even seen snow before! It was awesome!
And yes, we got our tree. (More about that tomorrow!) I decorated it but "forgot" to put the star on top. I'm saving that for Jason. every year he lifts up one of the kids so they can stick that star up on the tippy top of our Christmas tree. This year they think he's not going to be here so I told them I wasn't putting the star up yet because I can't reach. Little do they know...

Cesarean Awareness Month (CAM)

April is Cesarean Awareness Month!

I'm proud to say that I submitted a proclamation to our governor and he signed it! Last year he didn't sign it so I was pleasantly surprised. I sent copies of it to the local media and hopefully someone will pick up the story. I'm going to have Jason take a picture of me with the signed proclamation so I can post it.

ICAN is making a big impact this year with the new website, publicity from the Trust Birth conference, and some recent studies that have shown the safety of VBAC. This is all great news but there is still much work left to be done.

Rixa has highlighted some of the recent studies on her blog so you can check those out here. She also posted about the article that has been making news regarding cost of ERCS versus VBAC. This is an interesting read but you can check out the highlights here on her blog.

I also want to point out a fantastic article that Kmom wrote about women of size and VBAC. You can find the article here. Kmom is the creator of the wonderful resource Plus-Size Pregnancy. This website has a wealth of information for EVERY woman, not just plus-size women. Her information is well-researched and very thorough. I urge you to check it out.

I also wanted to share a link to a friend's blog where she recently posted about her cesarean experience. You can read it here. It was very difficult for me to read because I met Christy in person and shed tears with her as she shared her story with me.

April is not only CAM but also the month of the girls' birth. I can honestly say that 2 years ago as I anticipated their arrival, I never expected to be sitting here, pregnant with twins again. I am unsure what the future holds for me this time but I am hoping and praying that it ends with 2 healthy babies and another peaceful birth.