Catch-all

Here's another uninspired -- or at least unfocused -- post.

First, knitting. I am taking comfort in the number of other knitters who seem to be in a bit of a funk. I decided to circumvent my gauge problems by starting a Baby Surprise Jacket. Elizabeth Zimmerman is so encouraging and laid back about knitting. Her writing sooths and inspires.

Six months ago or so I picked up her Knitting Almanac so I could have the BSJ pattern. Then I found a site that translates it into a row by row accounting that I find easier to follow. I am using those directions, but keeping the Almanac close at hand for company and reassurance. I mean, look at her:



Any knitting problem is a little easier to face with her wry face and handwritten message of good will just below.

So this is the start of the jacket. In cream yarn my MIL gave me, leftover from a sweater she knit my younger son. And for contrast, some sock yarn that refuses to gauge up for my first attempt at socks.



I don't know that the wool (cream) and bamboo (varigated) will combine for a particularly harmonious final product. But what the hell.

Second, birth. I thought I'd come to peace with the whole disconnect between obstetrical calendar keeping and the rest of the world when I was going through my own pregnancies. But it has started bothering me again.

Most mothers know, or with a little prompting remember, that pregnancies -- and, therefore, fetal age -- are dated from the first day of the last menstrual period. You may also recall that ovulation typically occurs two weeks before blood flow starts.

For the average woman who ovulates mid-cycle (i.e. halfway between the start of two periods) this means [preachin' to the choir here, I know] that two weeks of "gestation" have elapsed before conception can even occur. You are "four weeks" pregnant when you notice you're late for your period.

The reason for using the last menstrual period (LMP) date as a peg for calculating the due date is because it is more certain than ovulation. Women KNOW when their period starts. Many do not know when they ovulate.

BUT, many of us KNOW when we conceived. How many times have you heard stories about "the one time we had sex that month" or "I decided to leave my diaphragm out that weekend?" And that date is not exactly two weeks after our LMP. Yet here we are pregnant.

Those of us still must conform to the LMP dating system, even though we know better than it, when our babies were conceived.

I guess I find it both an artificial construction and, often, a denial of our own knowledge of our bodies to use LMP as the pregnancy dating system. Why not work with women to see if a conception date can be approximated based on their personal reproductive and recent sexual history. Then, if not, if LMP must be used, then just subtract two weeks from the total so that two weeks after conception is week 2, not week 4.

And lest we think it's crucial to know exact gestation age, remember that plenty of pregnant women have NO idea when their last period was. Maybe they are nursing and haven't bled in two years. Or they just don't track their periods and can't remember if they last bled 3 weeks ago or eight. Those women still manage to have healthy babies and survive at least some part of their pregnancy without a firm due date. (I know, I know, now they do repeated ultrasounds to estimate fetal age in those cases.)

I don't think I'm going anywhere with this other than to say let's count pregnancy from conception and consider a baby "at term" 36-40 weeks later.

Peevish

What better word to describe how I've felt lately. About so many things.

About knitting. Cinxia is making my fingers ache the stitches are so tight i can't get gauge with anything else I touch despite swatching up and down needle sizes always the wrong weight yarn or the wrong needle sizes i just want to be making something pretty and soothing not cursing every five minutes and threatening to douse the garment with lighter fluid and burn baby burn.

About the kids. Sometimes it's okay to say out loud that much as I love you dear son i do not at this moment like you when you refuse to wear a coat tho it's 28 degrees out and windy and by the time we've walked six blocks your ears are red as apples and you keep drifting in front of me so i either have to stop in my tracks to avoid you or step on you which makes you fuss or push you out of the way which is what i want to do but refrain from because it's just rude.

About volunteering. Like I want to spend the hour and a half of free time i have today working on a project for the center that won't make a difference anyway because we lack organization and competent leadership and we're no better off now than we were three years ago when i joined the board in fact we have backslid in some areas.

About, dare I say it? Birth. Don't mess with the doula stuff anyway it's more trouble than it's worth you help less than you think and you only help people who don't really need doulas anyway you've been kidding yourself to think it's more than a hobby you're lucky enough to engage in and the family wishes you wouldn't anyway.

At first I thought it was my blood, steaming in on a hormone express, exacting retribution for writing about it a few posts ago. But that only explains the weekend. I don't know what explains today. Stay out of my way.

My latest idea for personal environmental benchmarking

In my past and in my core is a desperate environmentalist. Terrified as a child by the apocalyptic narratives (Revelations?) my father foretold of our beautiful planet's demise, I spent the first half of my life planning to do something to prevent it.

Only AFTER going to law school and working for few environmental non-profits and, later, doing 18 months of psychotherapy and having a kind-hearted doctor introduce me to anti-anxiety medication did I come to some peace with the fact that I can't save the world. I really can't. I'm a lot of things, but I'm not, as they say, "all that."

But old habits die hard. When one spends one's entire youth (and this was 30 years ago, mind you) being told that by:

• keeping the refrigerator door open 1/2 second longer than necessary,


• running the shower water while you lather instead of just for rinsing,


• driving to the high school dance rather than walking,


• throwing out clothes that were anything less than threadbare,


• setting the thermostat higher than 68,


• putting plant matter in the trash instead of the garden,


• and, generally, being born and living in the late 20th century

one was helping cause the destruction of our revered planet, one has a hard time "loosening up."

Lately I have been struggling again with food issues. Not eating issues, but food issues. What food is good to eat, not just nutritionally, but from an environmental sustainability and social justice standpoint?

My conscience surfaces when I see trucks of hogs on the way to Detroit for slaughter. And when I read about how now deep ocean fish are being depleted because we've taken care of all the shallow water fish. And when I consider the transportation and unfair trade costs of those Chilean grapes I can buy for $.99/lb. You get the picture.

My proposal is to get some smart cookies to create a website where you can determine how much of what foods you can eat sustainably in a month or year and then provide a mechanism for tracking it.

For example:

Input: Family of 4 in Michigan, two adults, two children; seeking annual quotas

Output:
20 lbs. Poultry
0.5 lb. Beef
6 dozen eggs
100 gallons milk
2 lbs. ocean fish
5 lbs. freshwater fish
unlimited vegetables and fruit if local and in-season

Who knows what it really would look like. That's my point. What if combined animal protein (meat, poultry, eggs, dairy) is only 5 lbs? FOR THE YEAR.

Still, it would be good to know that I was eating within appropriate limits.

A similar kind of survey exists for assessing one's "Ecological Footprint," i.e. the impact, especially in terms of resource use, one has on the planet.

Birth Story

Nine years ago today was the second birth I ever attended.

The mother's water broke at 10:15 p.m., just as she was finishing watching Michigan and Davidson play in the NCAA tournament (for her March Madness has forever after had a different association!).

She called her doctor, who said they like to have all women with broken water come in to the hospital right away. "But I'm not having contractions yet," the mother protested. "Well," the doctor countered, "sometimes they come on very quickly and we like to have you here."

Perhaps it was the power of suggestion, but the mother began having contractions as soon as she hung up the phone. She was excited and disbelieving with the first one: "Oh! This is one!" Her husband was grinning. You could tell they were thinking "it's really happening. Oh my."

They began moving around making plans for going to the hospital. They didn't have any living children (a prior pregnancy had been terminated at 20 weeks), so it was only a matter of getting The Bag. Another contraction happened soon after the first. The mother had to sit down and breathe through this one. "This is hard," she said when it was over. She walked toward the kitchen and had another contraction en route. The husband picked up his pace.

"I feel like I'm going to throw up," the wife said, sitting back in the living room with her eyes closed. Her husband got her a and empty large yogurt container and went out to brush off the car. He came back in for the mother and they walked out together, she leaning into him twice for contractions along the way.

By the time they got to the hospital she was contracting every 2-3 minutes and the contractions were lasting 1 1/2 - 2 minutes. In triage the nurse asked the usual questions: last menstrual period date, last meal, color of the fluid, while the mother struggled to undress. There was some confusion over the amniotic fluid color and the mother finally snapped to the nurse, "well look at the pad." The fluid was yellow (or was it? The mother later said she was using Seventh Generation pads with unbleached fiber; perhaps that was the source of the color) so it was assumed to have meconium.

The mother was 7.5 cm dilated when the nurse checked her, 100% effaced and zero station. They quickly wheeled her to a room where her doctor and a nurse were waiting. There was an awkward moment where the husband mistook the male nurse for the doctor and the female doctor for a nurse, but otherwise they quickly got settled. The mother labored on her side in the classic Bradley position with the husband guiding her through each contraction with the description of waves and floating up one side and down the other. Thankfully the doctor and nurse just sat in a corner and left the couple alone to labor.

Soon the mother said she wanted to push. The doctor checked and she was 9.5 cm. The nurse stepped in and helped the mother with some patterned breathing to keep her from pushing. Ten minutes later she was complete and pushing all out. Within a half hour she'd brought the baby down to where we could see a patch of head the size of a silver dollar. For ten more minutes she pushed without any progress. The doctor said, "I'm just going to make a little cut here," and before the mother knew it, she'd had an episiotomy.

The baby came out two pushes later. He was hurried over to the warmer for the pediatrician team to look him over, this meconium baby. All was well and he was soon brought back to the mother.

The baby was 8 lbs., 3 oz, born at 12:50 a.m. on March 14, less than 3 hours after labor started.

Happy ninth birthday, my elder son!

Just in time for winter's last blast

I give you the finished Mohican Hat:



Pattern: Morehouse Merino's Mohican Hat

Yarn: Lion Wool Ease Worsted in Ranch Red and Oxford Grey; both left over from the rescue sweater.

Needles: Brittany DPN, size 6

Notes: I followed the pattern exactly, which took some faith. It seemed like it was going to be too small until I had it half-way done. Only then could I believe it might fit a child. I added stripes to use up the yarn and for interest. It probably looks better in one color. But I needed some variety.

I don't think I'll make this again because the spikes took way too long. Each one is 7 cast-on and bound-off stitches. And I must use different tension for one than the other because my spikes consistently curved to the left. I tried loosening my loops but couldn't straighten them. Blocking might have helped but I was not going to fuss with a hat that my son is likely to lose before the snow melts.

Best part of this was using all but about 2 yards of the red yarn.

I take that back. The best part is that my son has worn it every day since I made it, and loves that it keeps his ears warm.

Catching your C-Section Baby

Here is a glimmer of hope for making surgical birth more humane:

http://www.thewest.com.au/default.aspx?MenuID=77&ContentID=22841

If a quarter of us are having them, we might as well get to deliver our babies while we're at it!

Doula Liability and Insurance

A comment in my last post asked about doulas and liability insurance. I just spent the last 15 minutes trying to find my post on this topic at the DONA discussion board. It was several years ago, however, and long gone. I've written on the topic less directly in this blog here and here. But as to a full-blown post, none yet. So here are my thoughts on doulas and liability insurance:

Get it.

One of the meta-themes in law school is how the legal system -- at least the common law legal system we use here in North America -- does not always (often?) have true justice as its aim.

Strike that. Another thing I learned in law school is the breadth of "gray areas" in the world and the narrowness of black and white ones. "True justice" depends on your ultimate goal. Making the guilty party pay? Law doesn't work so well. Bringing a sense of compensation to the wronged party? Slightly better results.

[Four paragraphs and I'm still stuck in philosophical rambling...cut to the chase already]

If you are a doula and practice long enough/active enough, you will likely be named in a lawsuit. It's that simple. Bad things happen at births. Bad things happen to newborn babies. Bereaved families or families facing lifetime expenses they can't meet have little recourse other than litigation.

In malpractice suits, anyone who might have some money or who might be responsible (though the former is more valuable than the latter) is named as a defendant. If you are in the room at the hospital when a baby dies, you may be named in a malpractice suit. If you arrive at the hospital with a couple in labor and the baby is found to have no heartbeat, you may be named in the malpractice suit. If you are providing postpartum care to a family whose baby dies of malnourishment you may be sued.

This does not mean you were guilty. It does not mean you were in any way responsible for the bad thing that happened. But until you are named as a defendant, no one knows how much money you're worth. Could be you have hundreds of thousands of dollars in personal wealth (stop laughing, doulas...some of us may be wealthy!). The way to see is to sue you.

[Note, my cynicism here -- and I fear it is coming across in my tone -- is directed at the legal system, not at the families who sue. Compensation under the present tort system in the US is difficult and I don't know what I would do if faced with a malpractice situation. Probably sue.]

Now chances are, if you were being a diligent doula and following DONA's Code of Ethics and Standards of Practice (and you don't have to be a certified doula to do this either), you will be dismissed from the lawsuit. Nothing helps your case like having followed the pre-existing behavioral guidelines of your profession. Incidentally, THIS is why doctors/hospitals won't let women do many of the things they'd like in labor. If a doctor allows a woman to try a VBA3C outside the OR and she dies from a ruptured uterus, a malpractice attorney can say, "This doctor was in clear violation of the standards of practice at X hospital (or ACOG); she put her patient at unreasonable risk and was negligent in letting the patient attempt to birth vaginally in the low risk wing of the hospital." Even if the patient insisted on laboring in the low-risk wing; even if the patient signed consent and waiver forms.

But I digress. You are likely to be dismissed from the lawsuit. No harm, no foul. Except that you will want a lawyer handling your motion to dismiss. The stakes are too high to try this on your own. And even if all the lawyer does is meet with you for a few hours and show up in court, you could easily face several thousand dollars in legal bills. And that's if it's uncomplicated.

Liability insurance through CM&F costs about $60/year. That and adherence to the DONA guidelines should provide enough protection to let you sleep easy at night.