A little tingly, and awkward

I feel like an eighth-grader that just sent a love-letter to a boy I like. I guess it is not too far from the truth.

The mom of our milk brother, the baby who had been taking our milk until he was six months old, gave me this huge gift basket before she left town for the holidays. Her name is Lucy and she gave it to me out in the parking lot behind the cafe where we had lunch together. In the basket, there was chocolate, cookie mix, organic wine, a gift card, a thank-you letter, and a few other things, and the basket was wrapped with clear plastic and tied with a ribbon. I had my son on my back and mist in my eyes; she got in her car, and I got on the bus, boy on my back and gift basket in my arms.

Lucy and I have a tumultuous history, which I will not go into here. Suffice it to say, like a fox and a hound, we make an unexpected duo to be friends.

When she was pregnant, and we had lunch together with my then-little baby, who knew it would become so much more? I found out a week after Lucy's son was born that there was too little milk. I had been donating my extra milk to the San Jose Mother's Milk Bank for about two months by then, so it was automatic that I offered the extra milk to her. She accepted, and thus formed our bond.

Even after that, it was a little strange to hang out. Lucy is one of the strongest and most determined women I have ever met. I cannot seem to shake this shyness and awkwardness when I am around her. My limbs suddenly seem too lanky; I bump into stuff; my balance is off; that filter between my brain and my mouth which keeps me from spouting nonsense stops functioning. The first time I ever met her, I made a pyramid on the restaurant table with the utensils, glasses, and condiments. While cackling. I am a little better now, but not much.

Months passed; she would pick up milk at our house, or I would bring it by to her. It was not much: maybe half a serving or a serving of milk a day. When her son was six months old, we met for lunch and told me they were weaning him off my milk. I knew this day was coming, and I knew my milk was not their staple, because there was so little of it, but it still made me sad. My son was about ten months old. "Who will I pump for now?" I thought. Preemies from the milk bank need preemie milk, not milk intended for ten-month-olds.

Lucy and I met for lunch once more before she left on an extended vacation. That was when she gave me the gift basket.

I wrote Lucy a letter in which I said how much I appreciate and value our intimate bond. In writing the letter, as in receiving her gift, I was touched. And like an eighth-grader confessing her love to a boy, I felt a little tingly, and awkward.

One of my mother's friends has a saying: "Who would have thought that I, a plain Russian Jew, would be watching New York from the top of the Empire State Building?" or, "Who would have thought that I, a plain Russian Jew, would be dancing Flamenco at the New Years Eve party?" or some other unpredictable event. It means it is a surprising turn of events, given the background.

Who would have thought that I, a plain Russian Jew, would be friends with Lucy, after all these years?

I still have about a hundred ounces of milk in my freezer.

The hideously expensive visit to a nurse practitioner

For our nine-month checkup, we went to a women's clinic nearby because we don't want to be slammed with the $800 immunization bill. I figured, you know, a clinic would be cheaper. Nope!

I got the statement from insurance today: the office visit alone, to see a nurse practitioner, was $237.00 as charged to my insurance.

Seeing the family practice doctor (MD) in the medical foundation was much cheaper: only $161.00.

The women's clinic we went to specializes in caring for low-income, un-insured, and under-insured women and their small children. As such, it has tons of patients lining up in the tiny waiting room, coughing on one-another. Our wait time was just over an hour from the time our appointment was scheduled. But hey, it's a small price to pay for what I thought would be cheaper service!

Why is it that in every other industry, you know up front how much you will pay, but in the medical field it is all up in the air? You never go to a pizza place and order a pizza without knowing how much it will cost, or even get your car serviced without a written estimate. Why are doctor's visits so different?

We are coming back for immunizations next week (we had to wait for the paperwork to transfer to the clinic from the doctor's office). We shall see if they are as expensive as at the medical foundation! Wish us luck.

The $800 immunizations: Part 4

It's been 90 days since I was first billed for my son's immunizations. Now, the $800 immunizations story comes to a close.

See The $800 immunizations: part 1, part 2, part 3.

I called the billing department to get that "settlement offer" of 10%.

"The what?" the customer service representative asked.

"The settlement offer that I was told about."

"We don't have such a thing."

I explained what I was told before, the last time I called, and was put on hold for a full ten minutes.

When the representative returned, she said, "Because the previous person you talked to promised you a settlement offer, we must uphold this agreement, but we do not have such an offer in place."

I agreed to pay the bill in full, minus ten percent, which came to over $1100 and thanked the representative.

Needless to say, we will not need this offer ever again, because we do not intend to go to the medical group ever again.

Going bare: The plight of the uninsured

I cannot afford to insure my son through my grad school plan.

The insurance premium for dependents on my graduate student health insurance plan (GSHIP) has increased from $860 to $1120 for a single quarter (3-month period).

My stipend as a teaching assistant or researcher is $5000 for a quarter, and the job comes with GSHIP coverage for myself.

Well-child visits fall under my insurance, and the annual-year (September to September) maximum is $750. I have blogged about this -- a single well-child visit the clinic that we used to go to runs around $800 as billed to the insurance.

And so, I have declined coverage for my dependent through the GSHIP. I told the insurance office I cannot afford it.

In actuality, my spouse's new company (he works for a start-up) will take off within a few months, and health insurance is part of the package. Until now, he has worked for a different start-up of six employees, and health insurance was not offered. We just have to hold out for a few months!

Without insurance at all, going to well-child visits seems risky. More than likely, everything will be fine. But what if the well-child check finds something wrong, like diabetes? Without his own insurance, there is a chance I can never get him insured again... and he is only 9 months old.

After shopping around, I found catastrophic insurance for $58/month instead -- over six times less than what the graduate school suggests I buy.

Now, I just have to build a bubble for my son to live in while we wait!

My work: "Who on earth would care?"

Why is it mothers are so hard to please?

I have been sending out feelers in the professional communities with which my project could be identified, to see if my research idea is of any interest to people in the field, and have met great results. Everyone I have spoken to has been excited and supportive. One professor in the medical field, for example, has offered to sponsor me for an upcoming conference (more on that in another post). Several professors in human-computer interaction (HCI) and women's issues have been helpful as well. One professor in my department, who is not on my committee, offered to have me over at her house, with my infant, for brainstorming if I like.

Yesterday, my mother and I had the following exchange.

I had just finished telling my mother about the fantastic feedback I have been getting, and how excited people in four different fields are about my research.

"I have these same thoughts about your research as I do about some of my friends' hobbies: I think, 'Who on earth would care?'"

"What if I were working on verifiability of system-on-a-chip designs? Would you have the same attitude about my work then?"

"Well, no! That would be real work."

And so, my complex work (that is, not real -- get it? math joke!) continues. I can only hope my work makes enough of an impact on the world, and on women, that the ones I love notice and appreciate the work.

After all, sometimes, pleasing our parents is the greatest honor of all.

My first birth: a doula's-eye birth story

This is the story of my first doula experience. It was an unmedicated birth. Early labor lasted days; active labor was about 3 hours; second stage was 2 hours.

My first client was a good friend whom I had known for several years as a technical woman. I will call her Sue, and her husband Joe.

(As an aside: I am really going overboard on accepting this term, "technical woman," which I heard at the Grace Hopper Celebration for Women in Computing. There was a montage shown at the beginning of the conference with women singly, in pairs, and in groups saying, in English and other languages, "I am a technical woman," all too enthusiastically. So now, all women in computer science and engineering are "technical women," and I have a mental image of them saying, with a grin, "I am a technical woman!")

Sue was waiting for a long time to go into labor. When she had contractions every day for the last five weeks of her pregnancy, each day seemed like it would be the last: today is the day! Any day now! But alas; the little boy inside of her hung on tightly to life in utero.

After a failed induction (who knew Cervadil could just fall out?), Sue went home, sad and dejected. But she was hardly home a few hours before the light, Braxton-Hicks contractions intensified. Timing them, Sue and Joe saw they were about three minutes apart -- and they went back to the birth center.

I got the call at 10:45pm and was on my way to the birth center at 11:15pm. I was nervous, and a little embarrassed knowing I had performance anxiety. This was my first birth! How can I help my woman-friend handle her labor when I could not even handle my own labor? I remembered how scary it was to be on uncharted territory, when the pains of labor ebb and flow. I was scared she would call me on it when I tried to comfort her: "How would you know?"

When I arrived, everyone was exhausted. Joe, having been up the previous night from a combination of the uncomfortable guest bed in the birth center room and nurses coming every few hours to check on Sue, was struggling to keep his eyes open in the bright lights of the triage room. Sue stood and hummed through short, frequent contractions.

The nurse came and checked Sue, and admitted her. The room was one of the few with a large jacuzzi tub, with jets and fancy fixtures and detachable shower head, and large, warm tiles on the walls. Quietly, we rejoiced between contractions, and marveled at our excellent luck.

"I'd better really be in labor this time," Sue said. "We've hit tub jackpot." Sue climbed onto the bed and raised her rump in the air during a contraction.

The nurse came and offered Sue a sleeping pill to rest.

"If you're not really in labor, the pill will help you sleep. You'll need the rest in the morning. There's a chance that in the morning, when you wake up, you'll suddenly -- wham! -- be in active labor," the nurse said encouragingly.

"And what if she is already in labor -- what will the pill do?" I asked.

"Then she may be able to rest between contractions."

So Sue took the pill, and I dimmed the lights and pulled out the inflatable futon. Joe lay on the guest bed and was asleep within seconds. I helped Sue get settled on the rocking chair, where she was hooked up to an external fetal monitor. I lay down on the futon, and within a few minutes could hear the even snoring of my client and friend. Every few minutes the snoring would stop and the chair would rock back and forth. Then, the chair would stop, and the snoring would resume. It was graceful.

At 6:00am the nurse returned.

"Your labor isn't progressing," she said. "You are still a centimeter-and-a-half dilated, and the contractions aren't strong enough to open your cervix."

I went home to nap and to feed my son.

At 10:45am, exactly twelve hours after the first call, Joe called again.

"We've decided to have our waters broken," he said.

"Great," I replied, and reminded him of the pros and cons while pulling on my jeans.

When I arrived at 11:15am, the sunlight was streaming in the birth center's floor-to-ceiling windows onto the polished hardwood floor. Sue stood in the middle of the room, moaning, her thick, black bangs covering her eyes. Joe stood beside her and rubbed her back. Sue's membranes had not been broken for fifteen minutes, but her contractions were really working.

I put down my gear on a counter and observed a few contractions. Noticing she liked to stand, I suggested some standing positions, such as leaning over the birth ball on the bed, or leaning on Joe. I asked if her back hurt. Sue shook her head. No back labor: great.

Suddenly, Sue tore off her hospital gown and stood leaning against the wall, her elbows over her head, and moaned. Joe rubbed her back in brisk circles. This is it, I thought. Active labor, when the clothes come off.

The nurse came and started a heplock (the IV without anything going in) and monitored the baby. She left the room with the monitors still attached because she needed twenty minutes of continuous monitoring. A few minutes after the nurse left, Sue stood up off the bed, exclaiming that the bed is a terrible place to labor. Joe and I watched the contractions on the tape spike and multiply. One of two things happened: either the monitor's output was unreliable in the standing and leaning-forward positions (very likely), or the contractions intensified immensely (equally likely).

When the nurse returned, she sighed at the ruined tape but did not make Sue repeat the procedure. She asked Sue how she felt.

"The tub," Sue roared. But Sue's nurse, the one that remains in contact with Sue's obstetrician, was out, and this one could not give Sue the go-ahead to get in the tub. The nurse went back to her station. Joe and I tried to soothe Sue in other ways, but with each contraction Sue told herself and us that she counts the minutes until she can get in the tub.

I went to the nurse's station to see what was the holdup.

"Sue's nurse is at lunch," said the nurse that came to check on us. "She will be back very soon. Just hang in there. Go ahead and fill the tub with warm water so it's all ready when she gets back." Great advice! I went back into our room and did just that.

In a few minutes, Sue's nurse indeed returned, and by 1:00pm Sue was lounging in the tub, moaning with each contraction, her belly turned to the right and her head to the left. As the minutes slipped by, the door into the bathroom closed more and more, leaving us in a dark, echoey room. Every hour or so the nurse would come to see how we were doing. Once, she brought an LED candle that flickered peacefully, but Sue's eyes were closed tightly. Joe held her hand above the water to keep the heplock dry, and stroked her forearm during contractions. Sue moaned.

"Guys, I'm not kidding," she suddenly said between contractions. "I want drugs."

Joe turned on the tub and looked at me, eyebrows raised. I tightened my lips and shook my head slightly. "You're doing so well. You're rocking this," I said. Joe nodded, turning back to face Sue.

"You're doing great," he said gently to the dark, round form in the water below his face.

"I don't want to be doing great. I want to not be in pain."

I knew this would come up. Sue and I talked about pain management in detail in the weeks before the birth. She knew the pros and cons of pain medication, and, more importantly, knew how violently her own body reacts to medication. We decided to work together to have a drug-free birth. She told me, in our conversations, to question her and deny her drugs; to remind her of her birth plan; to tell her how well she is doing; to do whatever it takes to keep her from choosing an epidural or anything else.

But now, she was pleading with us. She said please. She said it over and over. She told us she was suffering (we had both read in a book that laboring women that were doing well may be in pain, but they were not suffering -- so this was particularly touching to me).

I persisted: "You're doing great. You're in transition. This is the part that sucks." And all the time I was wondering: am I doing the right thing? And I was scared: what if she says, "How would you know?"

One notable thing about her drug requests is she never asked for drugs from the nurse. This is one way I knew she did not mean it. The other way I knew is that Joe never once turned around again. He kept all of his focus on Sue, and we all moaned with her.

An epidural is a fantastic medicine that can be used at a point of exhaustion in the mom, to let her sleep. This is arguably the epidural's best use. Other good uses are later in active labor, but not too late, so that the drugs wear off before pushing, so that mom can feel the baby, and so that baby would be awake for the active part of his or her own birth.

Sue was in transition, and it had only been three hours since the breaking of her waters. She was doing great.

When the nurse came in again at 1:45, she offered to check Sue's progress. With the door ajar and more light in the room, Joe and I could see fresh blood in the water near Sue's bottom. I turned to Joe and said, "See the blood? That means the end is near." Climbing over the tub and balancing on the far edge, in a perfect model of alacrity, the nurse meanwhile checked and exclaimed: 7cm! Just then a flurry of contractions hit, and Sue was again carried off by the tidal wave of labor.

Joe and I tried to keep up with Sue's contractions. I felt distant from her; she was lying motionless in the water between contractions; the water was chilly. When I said something, I did not know if she heard me. But she was so relaxed both between and during contractions, just like I had seen in dozens of birth videos, that I thought she was doing well. Mostly, Joe and I moaned with her. A couple of times, we did not. I had no idea if it was annoying or helpful to have us make noise. Later, Sue confessed she felt lonely when she was the only one vocalizing; she appreciated us all moaning together.

The next time the nurse came in, it was 2:30, and Sue's bath water was icy cold. Sue's moans had turned into yells. She paused at the peak of the contractions, her breath held. A sharp smell trickled into the air from the bath. The nurse again balanced on the edge of the tub and checked.

"You're complete."

She gave Sue the option of staying in the water to try to push, or getting out. Sue decided to get out. Later, she told me she promised herself that she would only get out of the water for two reasons: drugs, or pushing.

On the birthing stool, which is like a chair with no bottom, she gave her first mighty pushes. During one, her bangs temporarily parted and she looked me in the eyes as she roared. She was the strongest woman I had ever seen, and I was a little taken aback. She roared, throwing her head back, powerfully, as blood oozed onto the floor.

The nurse's shift was over. She left, and two young nurses came to take her place. They looked terrified of the raw power we had in our room. They attached monitors to Sue's belly and looked at her progress. Then, they gave her some advise to help the pushing go faster: tuck your head in; make a C with your spine; hold your breath. It is the last few moments of pushing that really moves the baby. They started to count to ten. Three count-to-ten pushes per contraction. Let's do this. They moved Joe behind Sue so she could lean back on him between contractions to rest. I sat by her knee and held a cup with ice chips and a spoon.

The baby was really coming now. Sue gripped the squat stool and pulled it up toward her head, making a perfect C with her spine, and holding her breath as Joe counted softly behind her head. I could see the head quartering. I said, "Reach down and feel your baby." Sue reached her hand down and startled, pulling it away and yelping. I laughed, my eyes filling with tears a little.

The nurses suddenly realized that the baby was not far.

"Oh!" said the older nurse. "We need to get you on the bed. I could catch the baby, but I don't feel comfortable doing it in this position, and we need to wait for the doctor." The younger nurse ran out of the room to fetch the doctor. "We need to slow down the descent to, uh, to protect your perineum. Let's get you on the bed." She looked frightened.

So Sue got up from her squatting position and put one knee on the bed. Several contractions nailed her into this position. She tried not to push. Eventually she made it on the bed, and immediately the doctor walked into the room. She did not rush, she did not waltz, but really unremarkably just walked into the room. The nurses dropped the bottom of the bed.

"What are you guys doing in here?" she asked. Baffled, we looked at her. "Having a baby? Great!" she said, and put on a gown and gloves.

Barely having a chance to sit down, the older nurse grabbed Sue's right leg, I grabbed her left leg (Joe was at her head as usual, holding her hand), and with one more mighty push, the baby was born. It was just after 4:20pm. The nurse placed the baby on Sue's belly.

"Baby!" said Sue in her normal voice.

And, as I expected, my eyes filled with tears again. But I was busy: I grabbed the camera and started recording. For a long time, the baby lay on Sue's breast, still attached. Then, Joe unceremoniously yet very paternally cut the cord, and the baby was free: a life of his own.

So, where was I useful, as a doula? I honestly did not feel I did anything remarkable. There were no heroic measures, no advice I provided nor did Sue do anything I suggested. I asked Sue later how I could have been helpful when Joe was there with her, doing everything right: holding her hand, speaking to her in that tone of voice she loves, rubbing her back, and being strong. She said with me there, he felt empowered to do these things. He followed my lead. Since I remained calm, he knew everything was going well; he provided support when I provided support; he moaned when I moaned. Hearing that, I felt strong, and useful.

And boy, was I glad Sue never said, "How would you know?"

I cannot wait to support another mom in childbirth.

Grace Hopper Celebration of Women in Computing 2009

This year I had the pleasure of attending the 9th Grace Hopper Celebration of Women in Computing. This was a sold-out event with 1600 technical women in attendance from all walks of academia and industry.

For me, it was an event at which I could talk babies with computer science and computer engineering women! Well, and network with other women in my field, and learn about new trends in the industry, and see what the powerful women of technology today are doing.

I met Brenda Laurel, a sassy human-centered designer of a multitude of projects, ranging from energy conservation in low-income homes to a toy bee that teaches 6-year-olds about power and battery life to a video game for girls which was bought and killed by Mattel.

Unfortunately, I do not think Dr Laurel was particularly wowed by my thesis idea (though she tried to appear interested when I pitched it). Several grad students, particularly those with children or in a child-care field, however, came to chat with me about it.

At the end of Jen Mankoff's talk, I asked how one goes about finding interdisciplinary collaborators, and, though shyly, spoke briefly into the microphone about my research idea. I received several good answers, both from Jen and later through e-mail from another professor that was attending the talk. But the most startling thing for me was when I got up to leave, at the end of the talk -- I was nearly sprinting out the door because it had been several hours since I nursed my son, who was in the free, sponsored day care. Three women intercepted me and began asking about my work. I was so happy... and proud!

Now, I know that I have yet to blog about what the research is, but hang tight. Let me get some preliminary prototypes going, and some preliminary results, and I will tell you all about it.

The $800 immunizations: Part 3

The next bill arrived... the one for our six-month checkup. And there is a mistake on it -- in our favor -- to the tune of a whopping grand total of six dollars.

Oh yes. Six dollars. I will get these dollars back.

The per-immunization administration fee "Immun Admin Im/Sq/Id/Perc" costs $44 and does not take into account that our child is under eight years old. It should read "Immun Admin PT Under 8 Yo Im/Sq/Perc" and should be only $42.

There were three immunizations, so $2 times 3 is $6.

The billing department will hear from me tomorrow.

Book report: Baby Catcher

Vincent, Peggy. Baby Catcher: Chronicles of a Modern Midwife

My score

6/10

My review

Peggy was a Berkeley midwife for nearly three decades. In these memoirs, she picks out the funniest, saddest, and most memorable births she has had the privilege of catching. Wittily written (sometimes too much so), this book is light-hearted and engaging. Peggy reminisces about her early days as a L&D nurse, about her carpool rides to midwifery school with a "real hippie," about the cat that attacked her all through her delivery of a particular baby, about the goose she kicked in rage.

Peggy's career hit an untimely end. There was an unfortunate incident with a prolapsed cord and insurance settlement that put her out of business. (Yet another testament to the faulty insurance practices here in the US).

Nonetheless, Peggy's positive attitude prevails. She never loses her sense of humor and her ability to laugh at herself. It seems like Berkeley has really turned the midwestern gal in her Zen.

Book report: Motherwit

Onnie Lee Logan (as told to Katherine Clark). Motherwit: An Alabama Midwife's Story, 1991

My score

2/10

My review

This is not an inspirational book. This is a book that seeds a few ugly, shocking birth stories, while attempting at some history. It is hard to read, anticlimactic, and lacking useful information.

Imagine a hot summer day, humidity in the high-nineties. You are on the front porch of a hand-built house in the middle of rural Alabama. There are 14 or so children running around -- all borne from the same mother. On the porch swing sits Onnie, a large black woman in her sixties, sipping sweet iced tea with fresh mint, the ice cubes ringing gaily in her glass. Onnie's slow, southern drawl is telling you her life story. Slowly. Meanwhile, mosquitoes as big as your fist are buzzing around your head, and you have a nagging feeling you have to be somewhere else.

The tone of Motherwit is just that: Onnie Lee Logan dictating her memoirs. The southern drawl, the slang, and the verbal self-corrections are all immaculately captured. I literally had to read the book aloud to myself on several occasions to see what on earth some words were supposed to be. Pick'n some co'n -- oh!

Onnie portrays a black-hating, rural, poverty-ridden world in Alabama. She introduces her large family (her mother spent almost all her adult life pregnant), and talks about her early days as first a home-care, and, later, midwife assistant.

In the second half of the book, however, the tone takes a turn for the worse. Since when did "memoirs" become synonymous with "here, let me describe to you the things that were so awful, so terrible, so heart-wrenching, that I cannot get them out of my mind -- and you should suffer with me?" That which has been read, cannot be unread.

Unlike Ina May's guides, which are full of information for anyone interested in how midwives function, or in labor, or in labor customs, Onnie's memoirs have virtually no useful information. I was hoping to discover the labor techniques for poor women living in squalor, or read some inspiring or heartening birth stories told from a black midwife's perspective, but alas. The setting was a background on which to paint an ugly canvas and dig up painful memories that just will not die.

I hate posting bad reviews of books, and I was hesitant to post this one. But there you go.

Book report: Spiritual Midwifery

Gaskin, Ina May, Spiritual Midwifery, Fourth Edition

My score

7/10

My review

Oh, Ina May... If you only pick up this book to flip through and look at all the photos of laboring hippies, do it. Even after four editions of the book, she still talks about feeling telepathic with all laboring mothers ever, how childbirth is so heavy, and uses her own terminology, such as "butt-hole" for anus, "taint" for perineum -- because "'taint what's above and 'taint what's below", or "cootchie" (what is that?). Spiritual Midwifery will teach you how to be a midwife in the astral sense of the word, using your inner peace to deliver the baby not only in the physical plane but energetically as well.

As with Ina May's Guide to Childbirth (see my review), the first half of Spiritual Midwifery is birth stories, including the story of Ina May's own tragic first birth. This section of the book is a history lesson on how The Farm came into being and how the hundreds of people traveled across the country in school busses, birthing babies along the way and picking up the knowledge they would need to become the birthing community they are today. Some birth stories are long, some are short; some end beautifully while others end tragically. All are inspirational.

The second half of Spiritual Midwifery focuses on the medical side of giving birth: how to conduct prenatal exams, how to turn a breech baby, how to sew up a tear, how to revive an asphyxiated baby, and so on. The figures are numerous and informative. After reading Ina May's descriptions, I feel intimately familiar with the procedures that go on in a delivery room.

Ina May has shared with me natural birth as it is meant to happen, introduced me to many unlikely complications for moms and their fetuses (and what is normally done about it), and has given an in-depth, heartfelt tour of the midwife's maternity and birthing room.

Any day now

Any day now: This was my standard post-37-weeks answer when anyone would ask, gazing at my large, round form, when my baby was due. Even knowing that most first-time mothers do not deliver before 40 weeks (I think 41 is the mean), somehow I knew that, at 38 weeks, it was "any day now." I delivered at 38 1/2 weeks.

My first doula client is due any day now. That is, she is about 35 1/2 weeks along but it is becoming clear that it will be soon. Her baby has dropped ("lightening") and is in position. She has been having fairly consistent Braxton-Hicks contractions for six days, getting progressively stronger. And at home, she has been boiling diapers and hanging clothes lines. Sure, it could take another month, but probably not. If she holds out until Sunday, she can deliver at the birth center rather than the hospital. Hang in there, girl!

As the time draws near, I am both excited for her and apprehensive about my own role as her doula. She is my first client, and I have quite a bit of performance anxiety. What if I do not fulfill her expectations? What if I say or do something wrong? And my biggest fear -- what if she feels unsupported, afraid, and alone?

There is only one way, short of those hypnosis re-trainers of dubious credentials, to get over something, and that is to do it. My mind tells me I will be a fine doula for her. I know her well, and we have discussed all aspects of her pregnancy at length. She is as overprepared as I am. Yet as my mind is certain I am ready (and prepared) to be a strong and gentle support person in her labor, my emotions are raging. I have even been having anxiety dreams!

Do doulas get labor support -- while on the job? Maybe I should hire one for myself!

The $800 immunizations: Part 2

The bill arrived today: $644.42 for my son's four-month checkup.

I called the insurance company (BlueCross/Aetna Prudent Buyer PPO). As expected, they said there is nothing they can do; I went over my $750 annual limit for well-child care. In the future I should make sure I stay under the limit.

Next, I called the business office of the doctor's group. I expected them to discount some of the charges. Why? I don't know -- out of the kindness of their hearts, perhaps.

The lady in customer service said no, there are no discounts for which I am eligible. In some instances, there is a 25% discount for prompt payment, but not in this case. This is a balance due to going over a benefit maximum -- that is, it already has been touched by insurance -- and therefore is ineligible for the 25% discount. There are no discounts that apply...

Except one!

If I let my balance due go over 90 days, I am eligible for a 10% "settlement offer." After 90 days of my balance being due, I can call the business office and ask for the settlement offer. I will be given a 10% discount, which, for me, will be $60-$70 per round of vaccines.

The catch is that after 90 days, past-due balances are sent to a collections agency. In order to avoid collections, I must call and pay between 90 days past-due and 99 days past-due. One day more and collections will receive my balance, and the 10% discount is gone.

I asked the lady one more question.

"How," I asked, "am I supposed to know how much a doctor's visit will cost, so that I can plan ahead in the future?"

"You can call the doctor," she replied, "and ask for the exact procedure codes for each procedure that will be done at the visit. Then you can call us at the business office and read off the procedure codes. We can calculate what the visit will cost." We shall call this item A.

Next, I would take this information to the insurance company. I would call and ask which procedures are covered, and how much. I would ask how close I am to meeting my maximum benefit. This is item B.

Finally, I would subtract item B from item A and get item C -- the amount the well-child visit would cost me out of pocket.

Oh, a simple four-step process. Excuse me as I drip with sarcasm.

I told the lady that unfortunately, for financial reasons, we will not be returning to the medical group for any of our medical needs, and will seek another doctor.

She was unfazed.

Another case of the baby brains

The "baby brains" is a condition recognized by new parents and, unfortunately, everyone they interact with.

From sleep deprivation and the necessity to pay constant attention to the baby, the brains undergo a transformation that makes one seem dumber. But it is not idiocy: it is the inability to multi-task.

Take, for example, my husband. Just this week, his baby brains were to blame for the following blunders.

• On Monday, he left his coffee at the sandwich shop. It took him 20 minutes of walking to track it down.
• On Tuesday, he put shaving cream in his hair. In his defense, it comes out of a can, just like his mousse.
• On Wednesday, he filled the water-filter pitcher and then immediately poured its contents over his head, trying to drink from the spout.
• On Thursday, he lost his belt somewhere. This is the second belt to go missing this month. Where is he removing his pants? No one knows.

It is now Friday. I have yet to see what happened today, but I am sure it will not disappoint!

Relaxation in labor

Check out this fantastic video of a contraction from YouTube.

Breathing During Contractions

Pay attention to this woman's shoulders. See how wonderfully loose she is in her shoulders, her neck, and her throat. Even at the peak of the contraction, she is doing fantastically.

Five more things to have on hand: Preparing for childbirth

You can find lists of things to pack in your hospital bag for when you have your child. Or lists of things have ready in the nursery (or wherever the baby will sleep) for when your child comes home.

Here are five lesser-known things to prepare for the first days.

1. Coconut oil, vegetable oil, olive oil (thanks, anonymous commenter!), or vaseline, for putting on the diaper area so you can get the meconium off easier. Otherwise you spend about 5 minutes rubbing their poor sensitive bums. Bring this to the hospital (put it in your for-baby bag). Apply liberally after every diaper change until the meconium is gone.
2. Disposable diapers, even if you plan on using cloth diapers. Use disposables during the first few days, while meconium is coming out. You do not want to scrub tar-poo in the sink... plus, the vaseline may stain cloth. Some birth centers provide organic disposable diapers, and the local hospitals provides diapers for the stay (and you can ask to take some home), so you should not have to purchase any. Otherwise, a pack of diapers is fairly cheap. Anonymous commenter (below) suggested asking for a cloth diaper service as a baby shower gift, if you are set on using cloth diapers.
3. Disposable breast pads, even if you plan on using cloth ones, because you do not want to have to wash your bras or breast pads in the first days. The first days are for laying in bed with the new baby and having people bring you food.
4. Lots of changes of t-shirts for you to sleep in. You will sweat like a pig at night (because all of the pregnancy fluids are finally getting out), and will likely want to change shirts when you get up to feed your lil'un.
5. Rags, rags, rags for spraying breastmilk. One side feeds the baby, the other side hoses down your bedroom. Your body thinks it is feeding octuplets. I like receiving blankets and kitchen towels. What comes out is mostly foremilk, which is low on fats, and comes out in the wash.

Closure

I had the opportunity to go with a client and her partner to her prenatal appointment with her obstetrician.

The obstetrician, incidentally, delivered my baby six months prior. She delivered him, but she was not our care provider; she was the on-call OB when it was time to deliver.

At the question and answer portion of the appointment, my client was asking about the routine procedures that she and her other partners use during delivery.

"We like to have things go normally and naturally," the OB replied. "We don't want you to have a c-section. We try not to cut episiotomies unless they're really, really necessary."

I know, maybe she says that to everyone. It is entirely possible that she was just toeing the line.

When I heard that, I got instant closure. For me, she had cut a "surprise" episiotomy that tore to a third-degree laceration, and I had secretly or subconsciously wondered if it was really necessary (even though all of the reading I had done said it likely was). Hearing her say that, I instantly felt better about my own birth experience. It was unexpected -- but very nice. And now I trust her so much more with my client.

The rating system

Here it is: the breakdown of my rating system for books.

• 10/10: A must-own book for a lay-professional in the field.
• 9/10: A desirable book for the bookshelf of a lay-professional.
• 8/10: Will certainly reread this book.
• 7/10: This book has some great information, and I will likely reread it.
• 6/10: This book was worth a once-through, but I would not reread it.
• 5/10: I would recommend skimming this book and/or looking at the pictures.
• 4/10: There were a couple of good points, but not more than a couple.
• 3/10: I can see the value of a book like this, but it is unreadable and/or terrible -- not even worth skimming.
• 2/10: Reading this book was a waste of time; it contributed nothing to the discussion and was poorly written and/or unreadable.
• 1/10: Even the cover was a waste of time.

The $800 immunizations, part 1

Why does a set of immunizations cost $800 (and cost me, the consumer and new parent, $650 out of pocket)?

I got a letter from my insurance company a few days ago saying that it is my responsibility to pay around $800 -- no wait, we negotiated it down for you, to $650 -- for my son's four-month checkup and set of routine immunizations.

Before the four-month well-child (or "well-baby") visit, I had read The Vaccine Book, and I knew the risks and benefits of each vaccine my son was going to receive. Still, I decided that the benefits outweighed the risks for us, and we got all of the immunizations that were recommended by the American Association of Pediatrics (AAP).

So, at the well-child visit, we got the following vaccines (combined into three shots and an oral), as recommended by the AAP. These are the same vaccines as we got at our two-month well-child visit.

• Second DTaP (diptheria, tetanus, pertussis) vaccine
• Second polio vaccine
• Second Hib (Haemophilus influenzae type b) vaccine
• Second hepatitis B vaccine (since the first was done at one month, not birth)
• Second rotavirus vaccine

The letter that I received from the insurance company lists the following. I have broken it down by vaccine and administration fee as listed on our doctor's bill from our two-month well-child visit.

Preventitive Service

• Total billed: $161.00.
• Amount exceeding the benefit maximum: $64.00
• In excess of the allowed expense: $48.90
• Claims payment: $31.28

Immunization: DTaP/Hib/Ipv (polio) Vaccine (Pentacel)

• Total billed: $84.00
• Amount exceeding the benefit maximum: $84.00

Immunization: administration of the first vaccine (injection)

• Total billed: $65.00
• Amount exceeding the benefit maximum: $65.00

Immunization: Pneumococcal Conjugate Vaccine

• Total billed: $211.00
• Amount exceeding the benefit maximum: $211.00

Immunization: administration of 2+ vaccines (injection)

• Total billed: $42.00
• Amount exceeding the benefit maximum: $42.00

Immunization: Rotavirus vaccine (Pentavalent)

• Total billed: $104.00
• Amount exceeding the benefit maximum: $104.00

Immunization: administration of 2+ vaccines (oral)

• Total billed: $38.00
• Amount exceeding the benefit maximum: $38.00

Immunization: Hep B vaccine

• Total billed: $85.00
• Amount exceeding the benefit maximum: $85.00

Immunization: administration of 2+ vaccines (injection)

• Total billed: $42.00
• Amount exceeding the benefit maximum: $42.00

It is your responsibility to pay: $654.42

It is not your responsibility to pay: $147.30 (How kind of them to allow us "patient savings!")

I thought this was kind of ridiculous. Especially since these are not frivolous expenses -- these are immunizations that all infants should get. I called the insurance company to see if there was some mistake. The result? No, it's no mistake: the benefit maximum per year for immunizations is $750. Dollars. Per year. It is worth noting that my quarterly premium is around $700 for my son.

In the first year, infant immunizations are part of the well-child checkups at one month, two months, four months, six months, nine months, and 12 months. Check out the government article on well-child visits.

This means that the first and second round of shots -- at one month and two months, respectively -- cost around $750, were covered by insurance, but consumed my entire allowable for vaccinations for the year. The next round -- at four months, about which I am writing -- cost around $800, but were negotiated down to around $650, and will in all likelihood have to be paid out of pocket. The six-month round of vaccinations, which we just got two days ago, will be another $650 out of pocket. And... there is still one more visit to go before the end of the benefit year, on September 20.

The really depressing thing is that this is the insurance provided to graduate students here at the university. And I have to pay -- through the nose, as where is a grad student going to come up with $700 each quarter? -- for my son's premium.

Be warned, moms of new babies. I do not want to sound like Michael Moore, but it feels like I should be choosing the immunizations that are the least expensive, not the ones that are most important.

Congratulations, Anthem Blue Cross. You have transformed thinking about vaccinations from a risk-benefits analysis to a cost-benefit analysis.

Book report: Nighttime Parenting

Sears, W., Nighttime Parenting, 1985

My score

6/10

My review

It is a little old, but the lessons discussed in Nighttime Parenting are still valid today. In fact, I think this little book became an entire chapter in The Baby Book, part of the Sears library. Nighttime Parenting urges parents to try co-sleeping (that is, sleeping in the same bed with their children). Sears argues that babies and toddlers do not and should not be expected to sleep through the night; that nighttime nursing is essential for their emotional development; that parenting does not end with the setting of the sun, but continues into nighttime. Children should be "parented to sleep."

As a wholehearted supporter of co-sleeping, and of night nursing, I was amused to find among the pages of this book photographs depicting our exact sleeping arrangment throughout the last several months: first, a co-sleeper; usually, bed sharing; and finally, a crib attached to the queen-sized bed. I picked up this book (at a used book sale) for advice on how to handle constant nighttime nursing on night wakings, how to move the baby into the crib (which is attached to our highly-preferred bed), and tips on how to cut out some of the hourly (or less!) night nursings that had creeped into our nighttime routine. What I got was not answers, but instead support for whatever the baby decides is right for him, as long as it works for the parents.

So, does it work for the parents? It works, and it doesn't. There are nights that he wakes every two hours (which are the good nights) and nights in which he nurses nearly constantly. Although on average, we have found ways to deal with it, it could be better, and hence I am not over-eager to try other methods.

On the bad nights, nursing is punctuated with occasional yells. This book and others on the same topic suggest teething pain to be the culprit. Time heals all wounds, the books say. I guess we will wait it out and see what crumbles first: my steadfast support of co-sleeping, or the desire for daytime energy.

Book report: Mothering Your Nursing Toddler

Bumgarner and La Leche League International, Mothering Your Nursing Toddler, 2000

My score

8/10

Amazon link

Mothering Your Nursing Toddler

My review

A handy reference! This is like 300 pages of things to tell people when they question a mother that is nursing her child "too long." List of benefits of breastfeeding? Check. Historical evidence of late weaning? Check. Comparison to other large primates, and extrapolation of weaning age? Check. This is the book mothers under scrutiny should read for support. What it really comes down to is if the mother is enjoying it, the children are enjoying it, and it works for the family, then more power to ya. The author provides strategies to keep breastfeeding going as long as the children want -- child-led weaning is the main topic here. If you are looking for a book that encourage weaning, look elsewhere. The purpose of this book is to make you, the reader, feel good about your lengthy nursing relationship.

The American Association of Pediatrics (AAP) recommends breastfeeding for at least one year. The World Health Organization (WHO) recommends breastfeeding for at least two years. That should keep me covered for a while. After that, here are some comebacks I plan to employ.

• The Jewish Angle: In ancient Israel, prophets, merchants, and shepherds alike nursed for two years. Sarah and Abraham weaned Isaac at two, but Moses was nursed for three years.
• The Primate Angle: Large primates wean when the young has either tripled its birth weight or is a quarter of its adult weight (for humans, that translates to between 2 years and 6 years, respectively). Or, large primates nurse for around six times the length of gestation of their young (six times 9 months = 54 months, or over 5 years for humans). Or, weaning in primates can be predicted is when the first permanent molars come in (in humans, that happens around 6 years old).
• The Health Angle: A human child's immune system is mature around 6 years old. Until then, children continue to benefit from the antibodies present in breast milk.
• The Average Angle: A 1989-91 study of La Leche League conference participants in the United States reported an average weaning age of 3 years. That's the same as the minimum natural weaning age in cultures that allow self-weaning.

Although, at times, a little on the defensive side, the book does bring up good points about the benefits of continued nursing, especially for working mothers, and the practical implications thereof. In the end, there is a thorough discussion of weaning, as well as several gentle weaning strategies. A good support book, it has a very -- I don't know -- compassionate approach to childrearing in general and nursing in particular.

Milestones: Birth to 6 months

When you're a new parent, the days are long but the weeks fly by. People say it gets easier... and it does. Here are the milestones that were monumental for me -- when it really did get easier, seemingly overnight.

1. Nursing (3 1/2 weeks): They say that 3 weeks is a really hard time for new parents. Sleep deprivation is at its peak, the novelty of a new baby has worn off, visiting relatives have left, and the parents are left with a cold, stark realization of their new life. It sounds grim, but sometimes it is that bad. By now, nursing patterns have been established. For me, nursing was one of the more painful things I have ever done. I do not want to say that we had trouble nursing. We had a consistent child-driven schedule of nursing every two hours, and he was gaining weight beautifully. His latch was perfect. I was overproducing. He had a voracious appetite: his little limbs were filling out with delicious baby fat. But for me, nursing was excruciatingly painful. At times, I thought it was worse than labor. With the help of our lactation consultants, we worked out a way to let my poor nipples heal. This was a turning point for me, because I could start enjoying nursing and looking forward to my son's eager meals.
2. Smiling (6 weeks): Until he learned to smile, our interaction was largely one-sided. I would talk to my son, play with him, sing to him, change him, and nurse him, but he never responded. The days he was learning to smile were indescribably beautiful: he was really trying. Over the course of several days, he learned to master his facial muscles, and each day his small smile would widen until he could produce a huge toothless grin. I would joke that when he saw his dad, my son would smile, but when he saw me, he would open his mouth really wide. In any case, it was a sigh of relief for me when I finally got some feedback for all the hard work I had been putting in.
3. Rolling back-to-tummy (5 1/2 months): Suddenly, tummy time became much more enjoyable. When he mastered rolling to his tummy, I could place him on the floor on a blanket surrounded with toys, and he could occupy himself -- without me! -- for several minutes at a time. Just enough time to wash the dishes or compose an e-mail or post to my blog. On the other hand, as he was learning to roll to his tummy, he would wake up every 20 minutes throughout the night in a panic: "Help! I'm on my tummy!" (He grew out of this as his mastery increased.)
4. Sitting slightly supported (6 months): Bath time is so fun when you can sit in the tub with the baby, and support him with one hand while eating berries.

I went to the small babies (0-3 months) support group this morning with my six-month-old son. I placed him, belly down, in the middle of a blanket and he amused himself for almost two full hours by slowly turning around in a circle on the blanket and watching all the little babies. I even got to hold his milk-brother for the first time while my son was engaged in cooing at one of the moms. It felt like we were showing off a little... and I suppose we were. We deserve a few minutes of fame after the last six months, right?

Book report: Cesarean Section

Moore, M. and de Costa, C., Cesarean Section: Understanding and Celebrating Your Baby's Birth, 2003

My score

5/10

My review

After reading Pushed (see review), I wanted to pick up a book specifically about c-sections. This book is written for the moms of nearly one-third of the babies born: by Cesarean. Unapologetically and reassuringly, the authors try to cover the medical side of c-sections: why they happen, and what the doctors do while performing a c-section. The book lightly discusses the risks and benefits of the options available during Cesarean section, such as the methods of anaesthesia and postpartum pain management. In each chapter there are several quotes from moms having undergone c-section and their thoughts and feelings on their birth experience.

Happily, the book is supportive; the authors repeatedly express that it is not the mother's fault that she had a c-section, that she did not fail in labor, and that Cesarean is just another way to birth a baby. In fact, a baby born by c-section, just like a baby born vaginally, is born head-first, followed by the shoulders and then the rest of the body. I am giving this book a high score for the supportive attitude alone. Women having undergone a c-section need all the emotional support they can get, especially if they were planning and preparing for a vaginal birth.

There is a brief chapter on vaginal delivery after c-section (VBAC), which may be a welcome read for some women having undergone a Cesarean.

Appendix A, Questions to Ask Your Doctor, includes a comprehensive list of questions as well as the reasoning behind each question. These questions are well thought-out and, though perhaps an unpleasant topic for an expectant parent going for a vaginal birth, hopefully elicit some truthful answers from the doctor.

My criticisms of the book are as follows.

The mothers' stories are unconnected; they do not flow with the rest of the chapter of passage in which they fall. Even in short, three-sentence-long birth stories, everyone has a name (half-way through the book, I feel as though they're running out of simple names to choose from), and the individuals are referenced later in the book -- but it's hard to remember everyone. "You remember Jan and Paul from the introduction?" the tenth chapter begins. No, not really.

The birth stories leave out the difficulty of coping with major abdominal surgery as well as an infant in the first weeks post-partum. One birth story relates a mom coming home with her third child (all three by c-section) as well as a torn bladder. After the catheter was removed ten days after the birth, her bladder and urinary tract were "good as new." And the catheter? Oh, it "saved [her] having to get up to pee at night." Score one for positive thinking, score zero for the reality of a torn bladder, third c-section, and infant at home.

The whole book reminds me of a short pamphlet, maybe with the name So You're Going To Have a C-Section. Or the transcript to a fifteen-minute informational film: "These mothers have one thing in common: they delivered their baby by c-section." Dum-dum-dahhh.

Ways to reduce the risk of c-section are not discussed. Several of the birth stories, ending in c-section, have the mom arrive at the hospital too early (before 3cm dilation) -- that is, right after her water breaks, just like in the movies -- and, after a Pitocin drip does not dilate her fast enough (she nearly always asks for an epidural after the Pitocin is started), she is wheeled to the OR. The book would be smart to encourage women, with the support of their doctor or midwife, labor at home until active labor.

The book leaves out (in my opinion) some important details. The doctor puts some medicine in the IV. He is trained in fixing the problem with a special tool. What medicine, what tool? Please don't dumb down the information I feel is required.

Finally, for all the pages spent on the actual operation, the book barely touches on the postpartum healing period. Hire a doula, eat well, exercise a little, and -- controversially -- put out for your partner even if you do not want to. Wow, really? The point is hammered in a subsequent, lengthy chapter on contraception.

Wear the baby

Wearing the baby has always seemed like the right thing to do. And I've really been trying. Through the last five months, I have tried several baby carriers, with one notable exception: the ring sling, which has been highly -- highly! -- recommended by the Attachment Parenting book (see my review). At first, I did not have one, and now my son weighs around 17 pounds (less if he has pood recently)... which, although within the guidelines, is too much for my poor shoulders to try.

Baby Bjorn Air

Lent to me by a friend, I tried the Baby Bjorn Air as soon as my son was 19.5" long, the minimum length at which you can wear a child in the carrier. Happily, I followed the instructions to the letter on how to adjust the device and put it on simultaneously with the baby. Finally in, he grunted, startled awake, and cried. He hated it.

I tried again a few weeks later. This time, my son liked the carrier much more, but I was concerned: all his weight was placed on the little area between his legs. Granted, he did not weigh much at the time, and prior to that he had all his weight pressing down on the top of his skull, but nevertheless I was worried. Was I smushing his balls?

We went around the block and ran some errands. Near the end, my back was killing me -- after only an hour, and the baby weighing in at under ten pounds, I was done with this device.

My score
4/10

Pros

• Inconspicuous under a jacket
• Easy assembly
• Quiet buckles -- almost too quiet, if you know what I mean
• Allows the baby to face towards the chest or away

Cons

• Holy moly, my poor back -- places the weight directly on the shoulders
• Probably some ball-squishing going on for small infants
• Can not breastfeed with this carrier -- have to remove the infant, and possibly the carrier too, to get at the breast
  

Infantino SlingRider

This was a very kind baby shower gift. Actually, I had seen this exact baby carrier in Japan, when I was just weeks pregnant with my son. The padding on the strap, the soft Velcro on the inside (there is a Velcro safety belt for the baby), and the elegant design caught my eye. How my friend knew to get this very thing for me at the shower, I do not know, but he kind of read my mind.

I used this carrier almost exclusively in the first weeks of my son's life. I took him to class with me up on campus. When he was awake, I would let his head peek out over the side. When he would fall asleep, I would tuck his head in and let the sling wobble at my thighs as I walked, like a heavy purse. However, he wheezed in his sleep when in the carrier. I asked my lactation consultant about that; she suggested a rolled-up receiving blanket behind his neck. She said perhaps he is too small for the carrier. I tried that, but it did not help. Oh well, he did not spend much time asleep anyway.

The biggest bonus for the SlingRider is the ability to take off the carrier with the baby still inside, without waking him. Take off the sling, put it on the bed, and enjoy the ten minutes of peace before he figures out that his mom is not there.

My score

5/10

Pros

• Ability to remove the carrier without waking the infant
• Large padded strap
• Can breastfeed in the carrier
• Has a strap for the infant so he cannot roll out (is it necessary?)
• Can switch sides easily to avoid muscle fatigue
• Looks nice

Cons

• Hard to adjust
• Did I say hard? Dang near impossible to adjust
• Wheezing problems with the sleeping infant
• Prolonged use leads to shoulder pain on one side -- again, no back support
  
• Has a pocket for a cell phone right next to baby's genitals... great idea, guys

Ergo

All this talk about back support leads us directly to the Ergo. We have the organic kind, a couple of seasons old. The Ergo has thick, padded straps and a thick, padded, wide waist band that hugs the hips. If you are limber, you can adjust the Ergo one-handed. If you possess alacrity, you can get your baby into it without help.

For infants smaller than about four months, Ergo recommends the Infant Insert. I watched the video that shows the infant being placed into the donned Ergo ("...and now I accept my baby.") and scoffed: "That thing looks like a blanket!" So I grabbed a thick blanket and my infant and accepted my baby into the front-pouch.

I wore the Ergo for almost five months. What started out a diagonal pseudo-reclining position with the blanket, at first, later evolved into a squat for the baby. I would roll the blanket up on the bottom of the pouch and shove his little feet into the blanket, into a little squat. He stayed in there all day as I went from class to class, and from bus to bus. He slept; I ate; it was a great symbiosis. Eventually we removed the blanket and he continued his kneel. Sometimes he would stick one foot out and let it flop around in the breeze, in rhythm to my constant walking. Nothing hurt.

Then, something happened. I think it was the magical 15-pound mark. I would try to get him to sit normally in the front-pack, legs askew, but he would cry so I would stop and try again in a few weeks. But at 15 pounds, he was able to sit normally. But he did not like it because he could not see. I would sit him on top of the pack, facing out, legs dangling over the sides. The straps would have to be loosened all the way. All the weight was on my shoulders and none on my hips; the straps would fall off my shoulders one at a time; moreover, the tab that holds the straps together in the back would dig into my spine at the base of my neck. Ouch!

Any normal person would say, "Just sit him properly, and you will not have this problem." Yes, that is very true. But neither of us enjoyed that. He would get hot and grumpy; I would have to take him out to soothe him.

But for four months, I loved this pack. I nursed with it on the bus. I even nursed in it while walking several times.

My score
8/10

Pros

• Great back support
• Great shoulder support
• When worn properly, can be worn for hours without pain or discomfort
• Great nursing capabilities
• Can be worn improperly for short periods
• Easy to adjust
  

Cons

• Only one way to wear the infant (toddlers can be worn as a backpack)
• Baby can not see out
• Is it really OK to sit the baby in the splits like that?
• Does not work well for smaller-framed people

Moby Wrap

I saved the best for last. After my son's five-month birthday, after I had had enough of the Ergo and the perpetual bruises on the back of my neck and the straps falling off my shoulders, I decided something had to change. I had just been to a support group at the local birthing center, and talked to the four out of six women that were sporting various-colored Moby wraps. (The fifth had an Ergo, but did not bring it.) They swore up and down that this was the best wrap ever. Meanwhile, a local baby shop had a sale on Moby wraps... and I was sold. I bought the standard Moby wrap in Sienna, which is a fantastic bright orange color (my favorite)!

This carrier provides the best of all worlds. There is ample back support as the wide fabric spreads the pressure across the shoulders, back, and hips. The baby can face in, out, be cradled, or even be on the hip. I was a little worried about not being able to figure out the wrap, but after one attempt I had it down -- it is very simple. The important thing is to make sure the fabric does not twist too much.

You do not have to re-tie the wrap on your body every time you take the baby out.

The cuteness factor of my son has gone way up. When I took him out in the Ergo, even when he was front-facing, contrary to the Ergo instructions, he would get maybe 6 awws or coos from passer-bys as we walked to the coffee shop from my house and back. Using this distance as a metric, with the Moby, he gets closer to 18. The Moby more than doubled the cuteness factor!

My biggest regret is that I did not get the Moby when my son was first born. Dang, I love this thing.

My score

9/10

Pros

• Holy moly comfortable
• Fashionable -- looks like a shawl
• Comfortable for baby
• Versatile -- the basic wrap can face the baby in, out, cradle; feet covered or exposed
• Can wrap baby to the parent when the baby is asleep, and go about the day (I have not tried this; my son no longer falls asleep on me)
• Can do a hip-hold for older babies (I have not tried this, but plan to)

Cons

• A little tricky to breastfeed in the wrap -- not having mastered this, I take the baby out
• Need to use a mirror at first to make sure it is on comfortably for everyone
• Hand wash only? Really?

Movie review: Breasts

Spadola, M., Breasts: A Documentary, 1996

My score

6/10

The continuum: Theatre - Matinee - Rental - Discount rental - Library

I would rent this movie with a coupon or discount.

IMDB link

Breasts

My review

For a 50-minute film, this has spunk. It's just short enough that the interviews are entertaining -- women talking about puberty, older ladies discussing sagging, women with implants, a woman with reduction surgery, a stripper, and even a man -- each interviewee discusses her relationship with her breasts. I love the 40s and 50s cartoons and footage throughout the film. However, I wish the interviews were longer; I wish more topics were covered; I wish there were more women... and more boobies.

Book report: Pushed

Block, Jennifer, Pushed: The Painful Truth About Childbirth And Modern Maternity Care, 2007

My score

7/10

My review

"The painful truth" indeed. Starting out as a lesson in current events and history, the book takes a heartbreaking turn somewhere mid-way through. Near the end, the book is a depressing commentary on the dismal childbirth system, with no hope for the future.

Maybe the author sought out the most extreme cases for her examples of unassisted home birth, maternal mortality, newborn resuscitation, and forced c-sections. But the more I read, the sicker I felt about our national maternity and childbirth system.

The biggest problem for maternity care is the insurance. Insurance companies can choose who and what to cover. If an insurer refuses to serve midwives, or refuses to cover vaginal delivery after cesarian (VBAC), in the end, it's the expectant parents (and mothers in particular) that face the brunt of the decision. Mothers that are forced into having procedures that are arguably riskier than the uncovered alternative; procedures they do not want.

It is clear by research that the average low-risk woman with a low-risk pregnancy is better off with a midwife than an obstetrician. Maternal and infant mortality rates are lower with midwifery care, and maternal morbidity rates are much, much lower for women that choose midwives. However, midwives are few and far between, and only 8% of women deliver with a midwife nationally.

The final chapter of the book discusses the legal implications of fetal rights. The author reframes the age-old question of when does a fetus become a human, with human rights, as follows: When does the expectant mother cease having rights -- when is it OK to disregard a woman's health and livelihood to exctract her unborn child? I think this is a question for the rabbis.

My opinion on the matter of the state of the childbirth system? The expectant parents should have access to information and the freedom to make their own informed decisions. Their doctor or midwife should discuss with them the pros and cons and offer their professional, legal, and personal opinions (which could all be different). Then, for a low-risk, healthy pregnancy, it is the doctor's duty to follow through with what the parents have decided. A doctor is a hired professional. If he or she cannot or will not, for whatever reason, do the job, the parents should be free to find someone who shall.

As a doula (in training), it is my duty to give to the parent(s) the birth experience they desire. All things being equal (that is, having made safe decisions, and having been informed), why should a doctor's duty be any different?

Movie review: The First Years Last Forever

The First Years Last Forever. Directed by Rob Reiner.

My score

6/10

The continuum: Theatre - Matinee - Rental - Discount rental - Library

I would rent this movie.

Amazon link

The First Years Last Forever

My review

I rolled my eyes so hard when someone told me to watch this movie. My son is almost five months old now. What can I learn from this DVD, which came free in a box of new-baby literature at a second-grade reading level? But... I was relieved: my time was not wasted!

The First Years Last Forever is a light, refreshing 30-minute film providing practical advice about the newborn. As I mentioned, I watched this film when my son was nearly five months old, and it was still applicable and interesting. The movie talks about how to build strong attachments to a child, without giving any real advice on parenting style.

The movie is forward-thinking and touches on aspects of parenthood not only pertaining to the small week-old infant, but also to the child that has learned the word "no," and to the toddler. It was fun to see the interactions between parent and baby, and watch as babies of different ages were shown interacting with their parents.

Book report: The Breastfeeding Answer Book

Mohrbacher and La Leche League International, The Breastfeeding Answer Book, Third Revised Edition, 2003

My score

10/10

Amazon link

The Breastfeeding Answer Book

My review

This is a hard-core reference book. This is the book our local lactation consultants use. It is the single most complete, amazing breastfeeding resource I have found. Of particular note are the first few chapters, which discuss changes in our knowledge of breast anatomy, and what we know now. Understanding how the breast works puts so many other breastfeeding problems into perspective. Written with the lactation consultant or other support person in mind, the book first addresses active listening and how to ask questions without prying

This reference really does answer most breastfeeding questions, from nursing in the early days to teething, from nursing strikes to weaning, to the practical issues of nursing a toddler. Answers are comprehensive and supported by cited, peer-reviewed papers. Each paragraph in the book has a one-sentence summary in the margin.

Anyone taking breastfeeding seriously, as an art as well as a science, should get this book. You wouldn't take a circuit design class without buying a circuits textbook... similarly, you wouldn't consult a woman on breastfeeding without this book.

Book report: The Doula Advantage

Gurevich, The Doula Advantage, 2003.

My score

9/10

Amazon link

The Doula Advantage

My review

Why this book wasn't recommended instead of The Doula Book, I don't know. This fabulous paperback introduces the idea of a labor companion, and spends a chapter discussing the importance of touch and support in labor, citing many of the same statistics. Unlike The Doula Book, however, The Doula Advantage refrains from getting all hippie on the reader. Instead, the book discusses the practical implications of having a doula: what a doula actually does for a woman; how a doula supports a woman who chooses to or must have pain medication; how a doula supports a woman with a c-section; what a doula does for a birth partner; and how to hire a doula, including examples of interview questions, how much doulas charge, and how to cut doula costs by bartering and hiring doulas in training (like me!).

The Doula Advantage goes on to talks about postpartum doulas and what they do, and how they differ from lactation consultants, babysitters or nannies, and maids. The purpose of a postpartum doula is, just as a birth doula, to support the new mother. The postpartum doula does whatever is necessary for the mother or around the house to make the mother calm, content, relaxed, and focused on her new task at hand: taking good care of her newborn. Sometimes the task is to help with lactation; sometimes, she must help with older siblings or hold the new baby while mom takes a long shower; sometimes the mother's stress level is proportionate with the mess in the house or the number of dishes in the sink. Then, the doula will pick up the house, clean the kitchen, and prepare a healthy meal.

Another type of doula discussed is the antepartum doula. Slowly gaining popularity and recognition, the antepartum doula serves the mother-to-be before the onset of labor (although such a doula may stay and support the mother during the birth). Women on bedrest or with particularly difficult pregnancies benefit from antepartum doula support, as do single mothers and teens. An antepartum doula will meet the emotional needs of the mother-to-be, coming over to talk, cook some meals, and help prepare for the baby. She may hold a one-on-one childbirth class with the new mom.

I am a big fan of Rachel Gurevich's book as a practical overview of the benefits of having a trained labor companion and how to obtain one. If I were to teach a childbirth class, I would put this book on the reading list... and recommend it to all my clients.

Four months: a retrospective

Around four months ago, my son was born.

When they put him on my belly, immediately after birth, I was stunned. Was this squirmy, hot, wet thing the same thing that was my pregnant belly? No, you read that right: pregnancy was my belly, not what was inside it; the baby, outside it, bawling, came seemingly from out of nowhere. Why was he so hot and wet? And why was he crying?

Now he's four months old, drooling, laughing, and putting everything in his mouth.

At first I thought that six weeks was my favorite age. He was so portable. I took him with me everywhere: to classes, to meetings, even to a conference. He would ride in my little pouch on the bus and the motion of the bus would put him to sleep. He had no opinions. He was happy being fed every two hours (every. two. hours.) and changed when he pooed (every. two. hours.) and so alert, looking around with his enormous eyes.

But now, at four months, when he giggles and coos when he sees his papa and opens wide when he sees his mama; when he gets excited when he sees boobies (I guess most men do); when he grunts to indicate bedtime --- I think this is my favorite age. It's delightful to sort out his preferences, to play, to interact. That's something we didn't have at six weeks.

He's a puzzle, and the pieces are still forming. But as they do, we can snap them into place. The landscape that is my son is growing, and it's an exciting time.

Movie review: The Business of Being Born

The Business of Being Born. Directed by Abbey Epstein

My score

8/10

The continuum: Theatre - Matinee - Rental - Discount rental - Library

I would watch this movie at a matinee.

Amazon link

The Business of Being Born

My review

Why does the United States have a higher maternal and infant mortality rate than other first-world (and even some third-world) countries? Why didn't the midwives move into the hospital when births did? Why has the home birth rate fallen from over 90% to less than 1% in just a hundred years?

Ricki Lake and her cohort answer these questions in several ways. First, like everything else, it's economics. C-section rates are around 30% because it's fast, clean, efficient. Induction and augmentation rates are high because it gets the beds filled and emptied faster. Doctors charge more than midwives. Second, it's the marketing. Not only does "midwife" have a bad connotation whereas "OB/Gyn" has a good one, but also the entertainment industry as a whole shows labor and childbirth as a grueling, terrifying, awful process. Movie stars opt out of natural birth and schedule c-sections. Third, it's the education. Women simply do not know what their options are, what the hospital procedures are at the location they choose to give birth, and many OBs have never attended a normal, natural birth before.

Now, we take this one step further.

Most women in the US miss out on the critical moment of mother-child bonding. That is, the flow of oxytocin, the love hormone --- the largest amount of oxytocin a mother ever experiences in her lifetime, that happens the moment after birth. Women miss out because oxytocin is formed as a response to the pain of labor and subsequent birth. With an epidural, pain is dulled; the bonding hormone does not flow in such great volume.

A monkey momma has no interest in her baby if the baby is delivered via c-section.

I'm not saying we as humans don't overcome this. We do. Oxytocin is also released when breastfeeding. And what human momma doesn't think her offspring is adorable? But breastfeeding rates drop for babies delivered with an epidural, and especially for c-sectioned babies. We can see how effective, on a benefits-to-baby scale, a particular birthing method or establishment is by studying how long, on average, a mother nurses her young.

If as many mothers birthed at home here in the US as in the Netherlands, for example, more babies would be breastfed for longer.

So, overall, a good movie, and informative. I would have liked more of a research element. I had to dock a point for the graphic c-section footage (ew!).