Friday, February 23, 2007

Solace in spirals

I'm knitting two projects at the moment, both in the round. One is giving me fits. It's the Mohican Hat from Morehouse Farm Merino. I'm using my leftover red and gray yarn from the rescue sweater. The pattern is simple, really. But for some reason I have managed to miscount stitches or "spike" placement on every round and have ripped out as many of the pesky spikes as I've properly placed. Now that I have about 3 inches of hat completed, I'm beginning to have serious doubts about whether it will fit either child. It looks small to me.

The other project is Cinxia from Knitty, Fall 2005. It hasn't been a barrel of laughs either. I think it was a needle/yarn compatability issue, but the body of the sweater, knit back and forth all in one piece (195 stitches) was super tight on my Bryspun needles. It may just be the twisted stitch pattern. It creates a very stiff fabric.

Now I'm working on the first sleeve, knit up in the round. The slip stitch pattern is great. Again, it could be because I'm on bamboo now. I'm very curious to see how it feels when I get to the twisted stitch again.

The yarn, incidentally, is my last purchase of 2006: Rowan DK Tweed, 50% off. I got it from Yarn Quest in Traverse City (MI) while we were vacationing there between Christmas and New Years. I couldn't pass up the price but wasn't sure what to do with it. I flipped through patterns I've earmarked and this seemed to be a good fit. As it comes along I'm very happy with my choice. The tweed and the texture go well together.


Tuesday, February 20, 2007

What color is your blood's parachute?

Over the past few years I have noted a big change in the start of my monthly bleeding. It used to dilly dally around for at least half a day to 24 hours before things really got underway. How convenient. I'd know before leaving for work to pack a few pads. Or to make sure I'd prepared for sleeping at night.

Now, however, my blood arrives like Kramer on Seinfeld. One minute nothing, the next it's kicked in the door, grabbed a beer and has its feet propped up on the sofa. Well hello.

As I was contemplating this change -- is it related to age, having had children, changes in exercise? -- I couldn't get this human-form image of my blood out of my head. I realized I have a pretty deep knowledge of my blood and its preferences. My blood is a large but not obese gal with fair skin and freckles. It has shoulder length reddish-brown hair. It wears cowboy boots and tight jeans. It likes beer from a can and can kick ass if necessary.

In the spirit of the Vagina Monologues, I am curious to know if anyone else has a deep knowledge of their menstrual blood.

What is its theme song? Its favorite cereal? Its dream vacation?

Does it prefer dogs or cats? Action movies or romances? Raves or dinner parties?


Monday, February 19, 2007

ACOG strongly opposes births that will undermine OB income

If the internet is to be believed, this is the content of a recent ACOG position paper on homebirth:

ACOG Statement of PolicyAs issued by the ACOG Executive Board

Labor and delivery is a physiologic process that most women experience without complications. Ongoing surveillance of the mother and fetus is essential because serious intrapartum complications may arise with little or no warning, even in low risk pregnancies. In some of these instances, the availability of expertise and interventions on .an urgent or emergent basis may be life-saving for the mother, the fetus or the newborn and may reduce the likelihood of an adverse outcome. For these reasons, the American College of Obstetricians and Gynecologists (ACOG) believes that the hospital, including a birthing center within a hospital complex, that conforms to the standards outlined by American Academy of Pediatrics and ACOG,1 is the safest setting for labor, delivery, and the immediate postpartum period. ACOG also strongly supports providing conditions that will improve the birthing experience for women and their families without compromising safety.

Studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous. The development of well-designed research studies of sufficient size, prepared in consultation with obstetric departments and approved by institutional review boards, might clarify the comparative safety of births in different settings. Until the results of such studies are convincing, ACOG strongly opposes out-of-hospital births. Although ACOG acknowledges a woman’s right to make informed decisions regarding her delivery, ACOG does not support programs or individuals that advocate for or who provide out-of-hospital births.

1American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, 5th Edition. Elk Grove Village, IL, AAP/ACOG, 2002.

Approved by the Executive Board October 2006
The American College of Obstetricians and Gynecologists409 12th Street, SW, PO Box 96920.Washington, DC 20090-6920

Are we surprised?

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Thursday, February 15, 2007

The Myth of the Less-Busy Future You

I am a chronic over-committer. This has been true for as long as I can remember. I certainly am not alone.

Over-commitment is a subjective standard. What appears to be a full plate to some is boringly empty for others. And cover-commitment can be contextual, too. Some people over-commit at work but manage to keep their home lives peaceful. Then there are people like my mother for whom a vacation to the beach isn't complete without cleaning the condo top to bottom -- even at the expense of quiet reading on the porch.

In the past year I have identified one of the pitfalls -- perhaps the pitfall -- to my planning, scheduling, commiting. It is this that leads to my being stretched too thin: I always imagine I will be less busy in the future than I am now.

How often do all of us do this? "If I can just get through X [Christmas, exams, the surgery, moving] life will settle down and I'll be able to get on top of Y again."

Kids, life won't settle down. In fact, it will probably get busier. If you have two free nights a week now, what makes you think you'll have four in June?

A correllary to this pitfall is the deceptive calendar. I look at the planner even a month from now and it's clean, empty. But most of the things that fill up time -- sick kids, emergency trips to Home Depot, laundry backlogs, longer-than-expected blog posts -- neither get scheduled nor get written down in retrospect. Last month's calendar in no way reflects how frantic you felt.

And so I am working to adopt a new scheduling checks and balances system. If I wouldn't/couldn't do it in the next 2 weeks, I can assume I won't/can't do it any number of months from now.

Recently this led me to cancel a doula interview with a woman I was just dying to meet. She's a first-time mother expecting twins in June. She wanted a midwife birth and is now in a high-risk OB practice. The day of our scheduled interview, however, I got home from work and thought, "there is no way I can head back out tonight." My plan was to call and beg to reschedule.

Then I applied the new rule and realized if I don't have time and energy to give to an interview, I sure won't have it for prenatals and a twin birth! Tough as always to say no, but at least I did it now instead of four months from now. Or, worse yet, completely fall apart physically or mentally from being over-extended.


Thursday, February 08, 2007

Damnable Yeast

In the sphere of birth and newborn care I am an optimist. Except. Except where yeast is concerned. Nothing rings the death knell of breastfeeding to me quite like a diagnosis of breast yeast.

Partly this stems from my own experience: five weeks of nystatin, Dr. Newman's nipple cream, diflucan, diet change, pumping and pain, pain, PAIN. The classic description of breast yeast pain is the sensation of crushed class in the breast. True, sister, true.

But back up. Where does yeast come from? We have it in our bodies always. When it becomes problematic, it's not a case of yeast colonizing a previous pristine body. Rather, it is an overabundance of yeast in its usual places and its appearance in places it might not ordinarily be. This can happen because of antibiotics administered in labor (or to the baby after labor). It can arise because hormones and fatigue and any other combinations of factors have one's whole system out of whack. In the baby, it often appears in the mouth (thrush), where the sugars of breast milk remain in a dark, warm environment. From baby's mouth to mother's nipple to the milk ducts inside.

So the acquisition of yeast is pretty easy, really. It's the bringing back into balance of it that is so difficult.

One of my biggest pet peeves is that health care providers so often fail to follow the first rule of yeast treatment: TREAT THE MOTHER AND THE BABY. I don't know how many times a mother has reported that her baby has thrush and when I ask is she being treated, too, get a blank look. If the baby has yeast and is being breastfed, the yeast is likely to travel from baby to mother.

Similarly, I know some women who have yeast but cannot get their pediatrician to prescribe a treatment for the baby because the baby is asymptomatic. How can one expect to clear the yeast from one's breasts if the baby who latches on to them 10 times a day is a repository for yeast-tainted milk?

The best results are often through family practice doctors. Because they care for both members of the breastfeeding team, their treatment is for the unit, not the parts. Though even then I've seen some family practice doctors treat only one half of the pair.

Once yeast is established in the milk ducts, it is very stubborn about leaving. Dr. Newman's diflucan protocol is a very hard-hitting systemic dose (because how do you get medicine just to the breast?):

"Your prescription will be for fluconazole 400 mg as a first dose, followed by 100 mg twice daily until you are pain free for a full week, which usually means at least two weeks. This seems, on the basis of our experience, a fairly good guarantee against relapse. However, this means that although most mothers require only the usual two weeks, some need longer treatment. Occasionally it may take up to seven to ten days for the pain to even start going away. Call if there is no relief in seven days. If there is no relief in 10 days, none at all, it is very unlikely fluconazole is going to be of any help.

Note: The mother’s two week prescription is likely to cost between $300 and $350, though there is now a generic fluconazole available which is less expensive."
This last point is an important one, too. At the time I was plagued with yeast, our insurance refused to cover the prescription because it was much higher than medically necessary. !!

And remember that for every feeding, for the duration of the feeding, through the weeks that this last-line treatment is underway, the pain is excruciating. Breasts feel as though they are being lanced from the inside out.

When my yeast infection hit, my son was five months old. He was nursing at 3 hour intervals during the day and not during the night. When yeast appears in new mothers (as it has in my most recent client), babies are often nursing every two hours round the clock. The pain of nursing leads to anxiety. Compound that with sleep deprivation and the situation often feels unbearable. To tell a woman that she may experience relief anywhere from 3-10 days after starting diflucan (if her doctor will even prescribe it) might result in her throwing a copy of "The Womanly Art of Breastfeeding" at your head. Chances are she's already been through several weeks of pain before the diflucan option is presented.

For many women in this position weaning is the only way out. That was my final decision. When the diflucan was too expensive (my husband was in grad school, after all), I began to eliminate feedings. Within a week things were much improved. At that point my son was nursing three times a day and getting formula for his remaining feedings. That was the routine we maintained until he abruptly self-weaned at 11 months.

All of that was fine with me. I'd have liked to breastfeed exclusively, but felt happy that I was still providing breastmilk three times a day. After all, he was already late in his infancy. Had he been 5 weeks old, I don't know what I'd have done. I actually think I'd have thrown in the towel sooner.

I'm crossing my fingers for my client. She's starting the diflucan routine and her baby is on the same medicine.

I realize this is a lot of posting space devoted, basically, to a rant. I just wish breast yeast was taken more seriously. I'd like to see research into managing it as well as more on-the-ball reactions from caregivers when they encounter it. Just as there are few true obstetric emergencies, there are also few real breastfeeding emergencies. In my mind the appearance of yeast, however modest, in either part of the breastfeeding team, is an emergency.

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Friday, February 02, 2007

Silent Poetry Reading

Organized here.

Second Sowing

For whom
The milk ungiven in the breast
When the child is gone?

For whom
The love locked up in the heart
That is left alone?
That golden yield
Split sod once, overflowed an August field,
Threshed out in pain upon September's floor,
Now hoarded high in barns, a sterile store.

Break down the bolted door;
Rip open, spread and pour
The grain upon the barren ground
Wherever crack in clod is found.

There is no harvest for the heart alone:
The seed of love must be

--Ann Morrow Lindberg

This poem has been in my mind a lot the past few months. I think of it when I think of my clients whose baby died last August. And I think of them often. I also thought of, but did not re-read, Second Sowing after my own pregnancy loss.

Ironically, I first heard this poem at my wedding. My husband and I had asked a writing professor from our shared undergraduate program to be one of the readers. We had to laugh when he gave us two choices of poems. The first was a beautiful one, "A Blessing," by James Wright. I loved it.

But this Professor was known for his obsession academic interest in the end of life. So much so that he was openly called "Dr. Death." We felt it was only fitting that he read a poem inspired by death. We couldn't have known the degree to which it would foreshadow our own experience. Dr. Death couldn't have known the degree to which his "homily" about the redemptive power of love would be something I remembered as clearly as the poem, and clung to and believed in after Louis died.

We made the right choice in the poem we selected. But I wanted to share with you the other option, too.

A Blessing

Just off the highway to Rochester, Minnesota,
Twilight bounds softly forth on the grass.
And the eyes of those two Indian ponies
Darken with kindness.
They have come gladly out of the willows
To welcome my friend and me.
We step over the barbed wire into the pasture
Where they have been grazing all day, alone.
They ripple tensely, they can hardly contain their happiness
That we have come.
They bow shyly as wet swans. They love each other.
There is no loneliness like theirs.
At home once more,
They begin munching the young tufts of spring in the darkness.
I would like to hold the slenderer one in my arms,
For she has walked over to me
And nuzzled my left hand.
She is black and white,
Her mane falls wild on her forehead,
And the light breeze moves me to caress her long ear
That is delicate as the skin over a girl's wrist.
Suddenly I realize
That if I stepped out of my body I would break
Into blossom.

--James Wright

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