DIY delivery

ADRIANA BARTON

From Tuesday's Globe and Mail

May 15, 2007 at 8:41 AM EDT

BURNABY, B.C. — When Nicole Becker felt the pangs of late labour in January, she lit candles in the bathroom of her two-bedroom flat in Burnaby, B.C., and filled the tub. Only her husband and the couple's four-year-old son looked on as baby George slid into the water. "It was my dream birth," Ms. Becker says.

Ms. Becker planned throughout her pregnancy to give birth without a midwife, doctor or other birth attendant. After using a doula for her first child's home birth, Ms. Becker decided that the job of a good midwife is to "let the process happen," she says. So with George she decided to go solo.

Choosing to deliver without skilled help remains a controversial and uncommon choice. But now, spurred by the Internet, unassisted childbirth is reaching a broader range of women than ever before.

On sites such as Birthjunkie.com, Mothering.com and Trustbirth.com, women trade tips on such topics as how to measure the uterus to calculate the due date and how to figure out if the baby is breech. One of the most popular sites, Unassistedchildbirth.com, now has 30,000 to 40,000 visitors each month.

Jodie Boychuk gave birth unassisted at home to her second child, Eloise, in 2005, after a difficult recovery from the cesarean birth of her first child. (Charla Jones/The Globe and Mail)

Many women join one of nearly 100 Yahoo groups that list unassisted childbirth in their subject lines, including UCbirthnews, an online newsletter with over 1,110 members. They also browse online for books, videos and do-it-yourself resources such as Unhindered Childbirth - The Online Childbirth Class (at Unhinderedliving.com) as well as inflatable birthing pools.

"People who wouldn't have considered this years ago are considering it now," says Laura Shanley of Boulder, Colo., who wrote the influential book Unassisted Childbirth in 1994 and runs the website Unassistedchildbirth.com.

Until recently, "I was hearing more from hippie types, people more on the fringe," says Ms. Shanley, who gave birth to five children without medical attention - including one breech presentation. "I do think it's getting more into the mainstream."

But most doctors and registered midwives strongly oppose the practice. Skilled attendants play a crucial role in identifying problems such as hemorrhages and fetal distress before they become emergencies, they say.

In a few cases, child welfare authorities in Canada and the United States have investigated parents who planned unassisted births.

Although there are no large or recent studies on the outcomes of planned unassisted childbirth, the evidence stacked against the practice is "overwhelming," according to Vyta Senikas, associate executive vice-president for the Society of Obstetricians and Gynecologists of Canada.

Dr. Senikas questions the rationale for choosing unassisted childbirth. "By all means, choose the home," she says, "but have a skilled attendant there."

Childbirth is a natural process, she adds, "but you can die and you can end up having problems."

Advocates of unassisted birth say that any medical interference, no matter how well-meaning, can disrupt the instinctive and hormonal processes of labour, triggering a stress response that halts the birth's progress. They believe that widespread use of interventions that slow labour can contribute to higher rates of C-section.

Adherents base their beliefs on the writings of authors such as French obstetrician Michel Odent, who wrote Birth Reborn in 1984. Although he does not specifically advocate unassisted childbirth, Dr. Odent says that in his practice, women who weren't observed in their labour had faster and easier births.

There is no way of knowing for sure how many Canadians are choosing to give birth unattended, since neither the federal nor provincial governments collect statistics on planned unassisted childbirth. But the rate is probably much lower than home births attended by registered midwives, which accounted for just 1.5 per cent of all deliveries in British Columbia and Ontario in 2005 and 2006.

Jodie Boychuk of Dunnville, Ont., says she chose an unassisted birth for her second child because of the difficult recovery following the cesarean delivery of her first daughter. In September, 2005, her second daughter was born at home into the hands of her husband, Richard. The labour was smooth and the 8½-pound baby was healthy, Ms. Boychuk says.

But the practice remains controversial enough to impel some midwives and authorities to intervene. When Ms. Boychuk declined the services of a registered midwife during her second pregnancy, the midwife - who questioned the safety of even an attended home birth after a cesarean - promptly called the Children's Aid Society.

A two-week investigation ensued, but it was dropped because unassisted childbirth is not illegal.

Even the staunchest advocates of the practice acknowledge that it's not for everyone.

Sarah Buckley, an Australian physician trained in obstetrics and author of the book Gentle Birth, Gentle Mothering, says a woman must be healthy and educated about birth to deliver unassisted.

As well, she says, the woman should be relaxed enough to avoid triggering the fight-or-flight response that can delay the birth, and should have a backup plan such as transferring to a hospital.

Registered midwives agree that too much medical intervention can impede labour - but they "cannot support the concept of unassisted, unattended births" due to the risks, says Elana Johnson, president of the board of directors of the Association of Ontario Midwives.

For Ms. Becker of Burnaby, the birth of her baby in January is still fresh in her mind. It was a joyful occasion to share with her husband and her son Max, she explains, and most of all, "it was just us."

How to Green Your Baby

by Team Treehugger, Worldwide on 05.14.07
TH Exclusives (how to green your life)

What’s the Big Deal?

A new baby entering your life can create an enormous number of unexpected changes. Along with the little one comes a whole new category of things to purchase—not only the obvious large items like furniture and diapers, but also all the unforeseen extras that seem to accumulate. While having a baby is consumer heaven, the key is to not be gulled into an unnecessary buying frenzy. In truth, a baby has very minimal needs. On the flip side, there is more to a sustainable life with your baby than cloth diapers, organic baby food, and fair-trade clothing…read on for more.

Top 10 Tips

1. Diapers (aka Nappies)

Studies are divided on the subject of environmental impact of disposables vs. cloth. But knowing that your baby will use approx 6,000 diapers before toilet training, and that disposable diapers take 200-500 years to decompose, this is certainly a key issue to ponder. Washing cloth diapers takes water, energy, and chemicals (not to mention time), but you might want to consider the benefits of a laundering service. One study has found that home-washing cloth diapers has only 53% of the ecological footprint of disposables, and if you use a diaper laundering service that impact is halved again.

Cloth: Reusable diapers aren’t what they used to be and the days of diaper pins are all but bygone. Go for fitted cloth diapers with Velcro or snap closures for convenience, made from an eco-friendly material such as hemp, bamboo, or organic cotton. Use an organic wool cover that is both warm and breathable, minimizing diaper rash and cold bottoms at night. Use either removable or flushable liners and when washing either use a laundering service or wash at home at lower temperatures. With a new baby around you’ll probably notice a lot more laundry piling up, so make sure you’ve optimized your setup with an efficient machine and non-toxic detergent. If you can line-dry, that is ideal, but don’t bother ironing.

Biodegradable diapers: Made with plant-based plastics (also known as bioplastics), these diapers non-petroleum based and are compostable. While these have been found not to break down under landfill conditions, there are other options to compost them such as using a composting toilet, an earthworm system, or a highly active and properly conditioned composting area. Hybrid diapers, like gDiapers, have removable inserts that can safely biodegrade when flushed.

2. Breast or bottle

This one’s a no-brainer: breastfeeding is best. It's free, has health benefits for mother and baby, has no environmental impact, and is a precious bonding experience. However, in our commerce-driven society there are products for everything, and breastfeeding is no exception. For breast pads, ditch disposables and try re-usable organic cotton or wool felt pads. While there are many great, organic nipple creams available, some locally produced olive oil or organic lanolin does a great job.

If bottle feeding becomes a necessity, pumping your own is the first choice. Beyond that, using a fair-trade organic infant formula is preferable. If this is neither affordable nor accessible, then the next best thing is to ensure the brand of formula you buy is from a company not profiteering from marketing their product to developing countries. These companies disregard or try to get around the marketing code set by The World Health Assembly.

3. Solid foods

At about six months, babies starts to eat real food. Rice cereal and mushy veggies turn to combinations of fish, meat, eggs, legumes, and vegetables—yep, a regular person’s diet. Buying jars of food is sure convenient, but as an adult you don't live out of jars, so why should your baby? For those occasional situations, purchase organic or fresh frozen baby foods. Otherwise, make your own. Cook up veggies, casseroles, or tofu and lentils, whatever is your thing, and freeze it in tiny containers or ice cube trays ready to take out and defrost when needed. (Be sure you discuss any concerns over dietary requirements with your health professional)

4. Clothing

All those designer baby clothes are cute and oh so hard to resist in their fruity colors. But be careful. Not only does a baby grow out of clothes amazingly fast, they are constantly sending bodily fluids flying onto those precious outfits. The baby couture might be better replaced with convenient one-piece suits in practical white terry cloth. Choosing organic hemp or cotton, bamboo or wool fabrics made without toxic chemicals are best against a baby's sensitive skin and last longer with the constant washing. Second-hand clothing is the cheapest and most sustainable option. Get hand-me-downs from friends and family or look in thrift shops, Craigslist, or Freecycle.

5. Body care and bath time

It’s very easy to get sucked into the constant advertising of baby powders, creams, and lotions. But the best baby lotion is plain old olive oil—cheap, natural, and un-perfumed. As for other products, keep it as natural, organic, and fragrance-free as possible. For more on this, take a look at How to Green Women’s Personal Care.

6. Laundry and washing

It’s quite possible that our war on germs is actually making things worse. Studies have shown that children brought up in over-cleaned houses are more likely to develop allergies, asthma, or eczema. The best thing you can do for sensitive baby skin is not to cover it with synthetic chemicals. Wash nappies with pure soap and warm water. Make your own non-toxic cleansers with simple ingredients such as baking soda and vinegar. For more, see How to Green Your Cleaning.

7. Toys

Get back to basics and try old fashioned wooden toys and organic cotton or homemade teddies. Because babies put most things in their mouths, go as natural as possible, then when baby is a little older, get hold of second-hand toys. Also aim for toys that helps build a child’s bond with nature and the natural world. The sad truth is that the average American kindergartener can identify several hundred logos only a few leaves from plants and trees.

8. Furniture and accessories

Babies don't need much—a secure place to sleep, a car seat, a high chair, and a way to be trundled around. Go for second-hand furniture, everything except cot mattresses (some research suggests a link between second-hand cot mattresses and sudden infant death syndrome) and car seats, (which can have invisible accident damage). If you buy new furniture, purchase high quality, durable pieces made of sustainable, low-toxicity materials. Think about some alternatives to the regular old wooden baby bed; try using an organic cotton baby hammock or a cot that extends into a bed and lasts 6-7 years. The most ethical option for stroller (pram) is recycled. For more on furniture, see our guide.

9. Household environment

It goes without saying that alcohol consumption and cigarette smoking while pregnant are bad for a baby. But it is also very important to avoid exposure to the synthetic chemicals contained in everyday products such as paints, carpet, furniture, bedding, and pesticides. When decorating the nursery, use natural and low-VOC paints and don't lay new carpet before the baby is born. Suspicious new items should at least be left outside to off-gas for a few days before bringing inside.

10. Wipes and liners

Diaper wipes and liners commonly include propylene glycol (a binder also found in antifreeze), parabens (a family of compounds commonly used as preservatives) and perfume, which can be made from up to 600 different chemicals. Try using good natural organic cotton wool and water and avoid disposable changing mats and perfumed diaper bags.

So You Wanna Do More?

1. To have babies at all?

With the world population estimated to pass the nine billion mark by mid-century, the sheer number of people on the planet is one of our biggest risks. While the biggest population booms are happening in the less wealthy developing countries, North Americans and Western Europeans have a per-person environmental footprint that is far above world average. It’s a big decision and a touchy subject, but the number of children you have, if any at all, is an enormous factor in your impact on the Earth. Adopting kids is also a profound contribution to a sustainable world.

2. Try attachment parenting

Sleeping with and wearing your baby, while not for everyone, is said to promote a strong bond leading to a sensitive, emotionally aware child.

3. Avoid using diapers altogether

Elimination communication is a technique of timing, signals, cues, and intuition to help baby/infant express his or her poo-related needs. This is best begun before six months of age, and while it is most commonly used in third-world countries where parents are in constant contact with their children, it has been used in the West with some success.

4. Shower with your baby

Save water and enjoy precious bonding time by holding your baby while in the shower.

5. Get crafty

Make your own diapers, breast pads, toys, and baby clothes. There are plenty of Web sites offering free patterns and advice on DIY baby goods (see below for more). Also, don’t forget about your local craft shop or group for advice and materials.

6. Avoid unnecessary gadgets

Monitors, motorized rockers, musical mobiles and the like are tempting, and can be useful or educational, but keeping the baby-related consumerism in check is a wise move. Ask yourself if you really need them? If so, try for secondhand items first.

7. Swapping

So many baby things only get used for a few months, it seems mad to buy them new, (e.g. strollers, beds, playpens, highchairs, etc). Buy secondhand, beg, borrow , or swap with friends and family to find what you need. Also remember community fairs, garage sales, and online swap sites.

By The Numbers

1. The average baby uses approx 6,000 diapers before potty training.

2. Petroleum-based disposable diapers take between 200 and 500 years to decompose.

3. Disposables used per day: Australia uses 2.2 million, Japan 6.7 million, the UK 9 million, and the USA 49 million.

4. A home-washed cloth diaper has only 53% of the ecological footprint of disposables, and a nappy laundry service has a mere 37% of that footprint.

5. Americans spend an estimated $1.4 billion on complicated births due to smoking while pregnant.

6. Disposable diapers contain chemicals that were banned in the 1980s in women's tampons, but continue to be used today to improve absorbency in children's diapers.

Treehugger Resources

Diapers are one of the biggest issues when thinking about having an eco-friendly baby. Check out our explorations on diaper alternatives like The Nature Nappy, The Cradle to Cradle-certified gDiaper, Wam Bamboo Nappies, and Eenee eco-diapers.

Here, readers offer comments on finding a stroller without the toxins.

Lovely eco friendly furniture options include Stokke Tripp Trapp chair, and the eco crib from Mothercare.

For baby food, check out Liz Hurley's line of organic natural foods and organic baby food from Ulula.

Find more on eco friendly baby creams, lotions, and powders from sources like Sage Baby, Avalon Organics, Erbaviva, and Munchskins.

And if you were intrigued about the no-diaper solution, read our story on potty whispering and this earlier story on diaper-free babies.

For clothes and cloths, go organic and get back to basics. Check out hemp towels from Transylvania and organic baby gear from Nui Organics.

If you want to buy just one perfect soft organic teddy, check out our top five organic soft toys.

Baby furniture from Nurseryworks is handmade and highly morphable.

E Magazine takes a hard look at raising a healthy child in a toxic world.

More Resources

Vegetarian Baby is a site for parents of vegetarian and vegan children under three, with topics on pregnancy, nutrition, and products.

The Guardian has a charming article entitled “How to stop your baby wreaking eco havoc.”

Organic Baby is a New Zealand site offering guides on safe, natural parenting.

Kids Health provides doctor-approved health information about children from before birth through adolescence.

Baby Center is an Australian site with information on shopping for your eco baby.

Information on formula marketing around the world can be found from the International Baby Food Action Network.

Baby Milk Action and The Australian Breastfeeding Association have more in depth information on feeding your baby.

The Real Diaper Association has hard facts on the impacts of disposable diapers and the benefits of cloth.

Colorado department of public health and the environment has facts about smoking while pregnant.

Alabama Mothers Deserve Midwives

North Carolina mothers say Amen!!!

Going it alone

Why would anyone choose to give birth without a doctor, midwife or even her partner in attendance? Viv Groskop reports on the growing trend for freebirth

Wednesday May 9, 2007
The Guardian

To me, giving birth is as personal as having sex," says Sarah, 24, from Essex. "You don't want someone else sitting there watching you." Sarah chose to "freebirth" her first child, now two, at home. Freebirthing involves giving birth alone, without a midwife and often even a partner or friend in attendance - Sarah delivered while her husband was in the next room. "I didn't have any experience of pain," she says, "there was just this really strong sensation that muscles were working. Then the baby's head appeared."

To prepare for the three-hour labour, Sarah had read everything she could on the subject, and says she "would have known instinctively if anything was wrong. As his head started to come out, I thought, I know the cord is around his neck." She flipped the cord over his head and, "He just flew out." As he was born, she says, she was laughing with joy.

Although rare in the UK, there is a growing online community of freebirthers or "UC-ers" (unassisted childbirthers) in the US who are celebrating "the primacy of autonomous birth". Laura Shanley, 49, from Boulder, Colorado, author of Unassisted Childbirth (Greenwood Press, £14.95) and veteran of five unassisted births, believes that "women are the true experts of birth. Birth is sexual and spiritual, magical and miraculous", she says, "but not when it's managed, controlled and manipulated by the medical establishment." Her website motto? "If you want the job done right, do it yourself."

"People think it's pretty crazy," admits Laura Field, 31, from Atlanta, Georgia, whose second child, Grace, nine months, was born at home, unassisted, after four hours. "Some people think you must be superwoman. Others think it's reckless. You get every reaction from awe to horror. I just feel like it was the most normal thing. It felt somehow life-changing and extremely ordinary at the same time." She is a member of a local group of 15 women who have had unassisted births. "There are a few extremists who are really anti-medicine but they are in the minority," she says, "To me it wasn't 'unassisted or else'. If you have good back-up plans - you know the warning signs to watch for and you are really in touch with what is going on - it is safe. I had back-up midwives and knew which hospital I would go to if necessary."

Mary Siever, 36, from Alberta, Canada, has free-birthed three children at home. "I think hospitals and doctors have their place, I just don't think they have their place in birth," she says. "I've noticed a lot more people are getting interested in it now. People are trusting themselves more or maybe they are trusting the doctors in hospitals less. I wanted personal control and responsibility. For others, it may be that they had a horrible experience in hospital and don't want that again."

Bornfree, the biggest internet forum for freebirthers, has more than 1,000 members worldwide, mostly in the US, Canada, Australia and New Zealand. In the past 10 years Laura Shanley has heard from "a couple of dozen" British mothers who want to go it alone and Sarah knows of two others who chose to give birth without assistance.

Although it is never going to be a majority movement, the issue of the over-medicalisation of birth is pushing freebirth on to the mainstream agenda in the US. A slogan war has broken out, with natural birth websites selling T-shirts which read "Pizza boys deliver. Women birth", while the American College of Obstetricians and Gynaecologists gave out bumper stickers at a meeting last year, bearing the opposite message: "Home delivery is for pizza."

Home birth per se is not illegal in North America, but in 13 states there are legal issues for midwives attending home births. Denied the chance of an attended home birth, some women would simply rather do it on their own than go into hospital. "Women who feel they are being shoehorned into hospitals, and who don't like what happens to them when they get there, see freebirth as a viable option," says Tina Cassidy, author of Birth: A History (Chatto & Windus, £12.99), who is based in Boston. "It's a fringe thing but it's a signifier of something bigger: women now feel they have no control in the birth process."

What is telling, says Cassidy, is that there is virtually no historical precedent for this movement: "Since the beginning of time women have turned to other women for help in childbirth. There are one or two very small tribes where giving birth alone is a means of status - but even within those cultures people rush to the woman's side afterwards to make sure she and the baby are OK." That women are considering going it alone is a wake-up call for the medical profession in the US, she says, where one in three births now ends in a caesarean section. "I'm not an advocate for or against freebirth. But you can understand why people would go underground. They think, I'm just having a baby. What is the big deal?"

Because freebirth is such a fringe movement there have been no studies on it. However, a report in the magazine New Scientist recently quoted a survey undertaken in a religious community in the state of Indiana, where there were more than 300 unattended births in the 1980s. The neonatal death rate was calculated as 19 per 1,000 live births, compared with seven per 1,000 for the rest of Indiana.

There is some concern that the number of freebirthers in Britian may rise, because so many women feel their choices over how they give birth are limited, says Beverley Beech, chairwoman of the Association for Improvement in Maternity Services. While the health secretary, Patricia Hewitt, has promised that every woman will be able to choose an attended home birth by 2009, the service is currently a postcode lottery. Plus, the government is planning to introduce new - and prohibitively expensive - insurance requirements for independent midwives who currently provide private backup to women who have found it difficult to arrange an attended home birth on the NHS. "If this law comes in, either [independent] midwives will practise illegally or we will have a lot more women who will choose to give birth alone," says Beech. "We have been having discussions about providing a support group for these women so we can provide somebody to be with them."

Freebirth fans contend that it can be better to be alone anyway. On one blog a woman writes of "the thrill of the catch" - what it feels like to seize your baby emerging from your body. Self-delivery is not necessarily something women should strive for, she adds, but something they should know they are capable of. There is much online discussion about "lotus birth" - when the umbilical cord is not cut but left to disintegrate naturally, usually within three days of birth.

One pioneer of the freebirth movement is Dr Sarah Buckley, a respected Australian GP who lectures on home birth and is described by the French natural birth guru, Michel Odent, as "driving the history of childbirth towards a radical and inspiring new direction". Buckley had her fourth child unassisted at home near Brisbane and writes: "It was a great gift for me, with my medical training, to liberate myself ... from expert thinking."

The movement's unofficial leading light, Laura Shanley, explains: "I look at birth as a sexual creative act and you have to be free to birth in your own time and your own way. Even if you are with a midwife, she has to follow certain rules and your body can't do what it needs to do within its own time."

During her five pregnancies, Shanley shunned all monitoring, including scans. The first indication she had that her second child, Willie, was in the breech position was when she was giving birth at home alone and reached down to feel his feet coming out first. Her fourth child, Nicholas, was born prematurely unassisted at home and died almost instantly from a congenital heart condition. Shanley later sought reassurance that the outcome would have been the same in hospital (she was told that medical intervention would have made no difference).

The controversial NHS doctor who writes an award-winning blog under the pseudonym "Dr Crippen" has proposed that at some future point women will be sued by their (damaged) offspring for having had a home birth (let alone an unattended one). Freebirth advocates argue that a woman's choice of how she gives birth is a human rights issue. They say that most births proceed normally and going to hospital only increases the chances of intervention and complications. Even during a home birth, a midwife can intervene in a way the mother doesn't agree with. Is this a selfish attitude? Not necessarily, says Cassidy: "I don't buy that 'selfish' thing. I've heard horrible stories of women haemorrhaging to death in hospital and babies' faces being cut with scalpels during C-sections.

"Women have been giving birth since the beginning of time and birth is very rarely complicated. So is it selfish to stay at home? Or is it selfish to go to hospital?"

My story: 'I shed the placenta and had a bath with my son'

I always planned to have children but I could never imagine giving birth in a hospital, or with any kind of official in attendance. The only way I had ever been able to picture myself giving birth was alone, or with an old crone in silent attendance. At night in the woods by a stream was my preference, but my own front room and bath was, when my time came, the best available option.

As the day approached and pressure from the NHS to "plug-in" mounted, my partner became increasingly fearful and I increasingly resolute. Talk of stillbirth - designed to drive me to hospital - only heightened my distrust of those who saw fit to try and worry me at such a vulnerable time. I had, by this time, had my fill of the local midwives, all but one of whom had treated me with a complete lack of empathy, and the idea of inviting a random team of two of these frankly cold women into my small home seemed laughable.

The evening before I went into labour I had my spirits boosted by the book Spiritual Midwifery, not because I felt in any way connected to the free-loving, be-necklaced and hairy-partnered women pictured within, but because the pages and pages of homebirth statistics in the back made for optimistic reading. I read the book in the bath before going to bed and went to sleep thoroughly optimistic, When I got up in the night I found a trace of blood, which convinced me my labour had begun. I got up and while I was running a bath, I spread all the lovely white sheets the midwives had provided over the floor in the front room. My contractions were minutes apart within the hour and as the pain quickly intensified I woke my partner, who went straight back to bed on the basis that it would be a "busy day tomorrow". I was soon oscillating between agony and ecstasy, with only time to stagger the five yards between bath and white sheets, at which time I started to panic that I didn't know where my much-read-about cervix was.

I woke my partner, who went out looking for a newly qualified midwife who happened to be staying with a neighbour, and he returned with a drunk woman who reeked of cigarettes, which put me right off my contractions. I sent her away after agreeing with the general consensus that I was unlikely to give birth until the following day. As soon as she left I felt the baby's head emerging, and after much screaming but less than four hours of labour I gave birth to a very skinny boy on some very bloody sheets. I painfully shed the placenta and had a bath with my son before going back to bed. He is now four, and fine, and very wonderful, by the way.

In my second pregnancy I avoided all contact with the NHS and had no antenatal care whatsoever. After 10 hours of extremely painful labour at home, alone throughout, I gave up and called an ambulance. Less than an hour later, on my back in hospital, I gave birth, vaginally, to premature twins. In terms of the amount of medical intervention I had to have, it was the opposite of my hopes and dreams, but I had never imagined having twins - and what a lovely surprise that was. Besides, dialling 999 was always my back-up plan, being only 10 minutes from the nearest hospital. The twins are now big and bonny.
Name withheld

Jeannie Babb Taylor: May 2052

05/09/07
Jeannie Babb Taylor

“You’re fortunate to be living in this era,” says Nonna, brown eyes twinkling above the dimples in her wrinkled cheeks.

Rachel sips at the red raspberry leaf tea, the cup clinking against the saucer as she sets it down to respond. Her grandmother is already talking again.

“When I gave birth to your mother,” she goes on, “I was not allowed to eat or drink.”

Rachel’s eyebrows shoot up. “The whole time?”

“That’s right. Back in those days, all babies were born in hospitals — even healthy babies. Laboring mothers weren’t allowed a single sip of water.

“I was so thirsty my tongue was swollen and sticking to the roof of my mouth. After many hours, I was given ice chips, but even that was taken away when I was caught swallowing some of the ice to stave off the gnawing hunger.”

“That’s horrible,” Todd interjects, dropping down to perch on the Victorian loveseat beside his wife. “Having a baby is like . . . running a marathon. What athlete would attempt such a feat dehydrated on an empty stomach?”

Nonna chuckles at his analogy. “You’re right, of course. But you see, laboring women were not treated like athletes. We were treated like sick patients, like there was something wrong with us. According to the doctors, our ‘condition’ was best treated with narcotics, opioids, and surgical intervention.

“By 2005, the c-section rate went through the roof, with nearly one out of three mothers sliced open for delivery. From the doctors’ point of view, laboring women were all potential targets for expensive surgery. That’s why they starved us.”

Rachel scowls, rubbing puffy hands over the swollen full-moon belly.

“But labor can go on for hours — or even days,” she notes.

“Especially when you’re lying down with feet in stirrups, pushing uphill,” the old woman acknowledges.

“That’s absurd,” Todd murmurs. “Why not let gravity work?”

Rachel shakes her head. “That position was designed to benefit doctors, not women.”

“You’re right,” Nonna answers. “It placed us at a great psychological disadvantage, too. It allowed medical staff to treat us as objects, paying attention only to the ‘business end,’ as if we had no face, no heart, and no mind.”

“I’m so glad no caregiver would think of using stirrups today,” Rachel sighs, rubbing her belly again. “It’s a wonder women were able to push at all.”

“The doctors had ways of speeding up labor artificially,” Nonna answers. “But the drugs sometimes caused uterine rupture, killing the baby or causing permanent brain damage.

"One drug, Cytotec, was not even FDA-approved for obstetrical use. Eventually they had to stop using it.”

Rachel smiles, her face transformed. “So they went back to the natural ways?” she guesses.

“Not at first,” her grandmother answers. “At first they skipped the contraction drugs and resorted to the knife much sooner.”

Rachel looks down, distracted for a moment by the contracting of her own womb.

“I’ll go heat the rice bag,” Todd offers, trotting to Nonna’s kitchen with the handmade cloth pouch. Nonna watches him round the corner, thinking how glad she is for Rachel.

At last Rachel’s attention comes back to her grandmother’s wizened face. “Why did the women allow it?” she asks.

Nonna sighs, holding out empty hands. “We just didn’t know better. Our own mothers were knocked out for birth. We thought we were making progress just by being awake. Some women realized things should be different, but it was a constant fight.

“I chose a hospital that was supposed to be supportive of natural birth. They still pulled the ice chip stunt. Before I registered, they said they allowed ‘rooming in’ so I would not be separated from my baby girl.

“But right after birth, they whisked her away! I begged for her, but they kept her ‘under observation’ for four hours. They also gave her sugar water against my wishes, and pushed to inject her with vaccines just hours after birth.”

“That’s horrid,” Rachel clucks. “Why didn’t women just stay away from hospitals? Have their babies at home?”

“Well, in Georgia it was illegal.”

Rachel laughs. “How can birthing a child break a law?”

“Oh, it was not homebirth that was prohibited, so long as we did it alone! It was homebirth midwives they outlawed.”

“So women could birth at home — but only without help?”

Nonna nods. “Things were different back in 2007 when your mother was born,” she says. “For one thing, eight out of 10 lawmakers were men. There had never even been a woman President. Women only earned 70 cents on the dollar.

“We didn’t have the kind of power you gals have!”

She beams at her granddaughter, so young and confident. “My next child — your Uncle Tim — was born at home with an ‘illegal’ midwife.”

“Wow,” Rachel whispers, throwing a glance at Todd as he tucks the warm rice bag into the small of her back, “There was a black market for midwifery?”

“Certainly. There were always women who refused to be mistreated, and there were always midwives willing to skirt the law to give excellent care. The legal risks were high for those midwives. Once in a while, a baby dies during birth. It happens sometimes, no matter where women give birth.

“In a hospital, these deaths were considered a statistical eventuality. In the early 2000s, no one was charged for hospital deaths, even when the damage was clearly caused by uterine-rupturing drugs or overuse of painkillers.

“It was extremely rare for a baby to die in a homebirth setting — but when it did happen the midwives were charged with manslaughter. In other cases, overdue women were jailed for refusing to have a c-section.

“It was actually against the law to disobey a doctor’s orders! Eventually it was the women who turned the tide.”

“Through lawsuits?” Todd guesses.

“That was part of it.” Nonna nods thoughtfully. “The studies showed clearly that it was doctors’ drugs and fasting that caused most of the ‘danger signals’ (like blood pressure drops and changes in babies’ heart rates) that led to the c-sections. But that went unreported for 20 years!

“It was not until women stood up for themselves that things changed. Women reporters talked about the studies on the six-o’clock news. Women journalists wrote about the prohibition of home midwifery and the barriers to natural childbirth. Women doctors watched the signs instead of the clock. Businesswomen opened natural birthing centers. Women were elected to office and they legalized home-birth midwifery in Georgia, and later nationwide.

“Most of all, laboring women refused to let their needs be sacrificed to hospital protocols and doctors’ schedules. We had to insist on change!”

Nonna sets down her teacup. “We insisted on dignity. We did not let doctors push us into inductions or surgeries just to accommodate their schedules. Women who still used hospitals refused the wheelchair and the gown that were presented at check-in.

“Women refused to be starved, or to have their veins punctured with unnecessary IVs. Mothers refused to let doctors break their waters or insert electronic monitors in the baby’s scalp.

“When we pushed our babies into the world with our own fierce power, then we refused to let them out of our sight.”

Nonna smiles. “Eventually even the medical community came to recognize that birth is an act of motherhood, not an act of medical science. Today a laboring woman is not regarded as a body on a table, as if she and the baby needed some doctor to ‘deliver’ them from each other. Today women are honored as life-bringers.”

Jeannie Babb Taylor is a local business leader and author. She also teaches Sunday school, educates her children at home, and engages in Georgia politics. To contact Jeannie, E-mail jeannie@babb.com.

Midwives and doctors get along just fine

As a certified nurse-midwife, I am grateful for the attention given to midwifery by your article regarding midwives and upcoming legislation (Midwives fighting for legitimacy..., April 29). I beg to differ -- legitimacy cannot be legislated. Legitimacy grows with a reputation built on education, accountability and safe practice.

The article suggested an adversarial relationship between midwives and doctors. As certified nurse-midwives we work closely with supportive OB/GYN doctors, and the women we care for benefit from collaborative practice.

Our goal is safe and satisfying care. Most of us attend births in hospitals or birth centers, although some CNM's do homebirths.

Certified nurse-midwives are more than "...licensed nurses with additional training in midwifery." We enter our midwifery education programs with a bachelor's degree in nursing, and enter midwifery practice after extensive clinical experience and a master's degree. Our programs provide us with the pharmacology background to safely provide medications and write prescriptions.

Certified nurse-midwives are mid-level healthcare providers. We function independently at the same level as nurse practitioners and physician assistants. We care for women across their entire lifespan -- not just during pregnancy, but also for gynecological and menopausal care. CNM's are able to bill health insurance companies for the cost of care in the same way as doctors or other health professionals. Homebirth midwives are unable to bill insurance companies.

It's important that women understand the difference between certified nurse-midwives (CNM) and homebirth midwives (LM, CPM) regardless of the initials involved.

Erma Evans

Oakland

jeevans5@adelphia.net

Mom of 16 takes life ‘one day at a time’

Submitted by Shawn Hogendorf on May 10, 2007 - 2:52pm.
Filed under: Entertainment

By Shawn Hogendorf

Staff Writer



Bea Melville of Prior Lake grew up with 15 siblings, so she was used to having a big family.

As a child, she joked that she was going to beat her mother and have more than 15 children.

“It didn’t turn out to be a joke,” she said, laughing.

In 1949, Melville gave birth to her first child. Twenty years later, she had her 16th.

Today, Melville is a proud mother of 16 children, 27 grandchildren and nine great-grandchildren.

Having 16 children didn’t shock Melville the way it would somebody else, since she came from a large family.

Bea married her husband Bernard in 1948. They had 12 children before they moved from Bloomington to Prior Lake in 1963.

Bernard worked for Honeywell as an electrical maintenance worker for 35 years.

Bea waited tables and cooked at Prior Place for five years, where she babysat women’s children while they bowled. She cooked at Freddy’s on the Lake, now Captain Jack’s, for five years and T.J. Hooligan’s for 15 years before retiring.

When the Melvilles first moved to Prior Lake, Bea worked three nights a week while Bernard babysat the children.

Being a mother of 16 came naturally. “I never minded having a lot of work to do,” she said.

In addition to working in restaurants three nights a week, Melville did all of the cooking for her children. Bernard was a big help with everything, she said, but he didn’t like keeping house. So, Melville always delegated jobs for her children around the house.

Melville cooked a lot of casseroles, soups and chili. The dinner table would overflow into the family room most of the time, she said. She made one meal, and if her children didn’t like what she cooked, they had to learn how to eat it.

“When I would give them something to eat and they didn’t like it, I would say, ‘I wouldn’t give you something I wouldn’t eat myself,’” Melville said. I would tell them, ‘I had 16 kids and I still have 16 kids, so, I wasn’t trying to kill you.’”

Melville has 10 daughters and six sons. All of her daughter’s names begin with the letter “P.” All of her son’s names begin with the letter “L.”

After the Melvilles moved to Prior Lake, neighbors and friends would say they named their children after the town, she said. “But we had 12 of them before we moved here, so we didn’t name them after Prior Lake,” Melville said.

Coming up with first names was never difficult. Finding middle names that didn’t begin with the same letter was the tricky part.

Melville can still keep all of her children’s birth dates straight, but she doesn’t know all of her grandchildren’s birthdays.

The only month Melville doesn’t celebrate a child’s birthday is March.

‘A lot of love’

Melville said her favorite part of being a mother was giving birth.

She loved watching her children grow up, but her favorite ages for children were before they became teenagers, she said.

“I loved being a mother to the little kids,” Melville said. “Once they became teenagers, they became trouble.”

Melville said she kept her children in line by watching every child, every day and getting to know who they were hanging out with.

“I was one with all my kids,” she said. “There was a lot of love to go around.”

In addition to her 16 children, there were at least three neighborhood children who always called her Mom, as well as a family dog, a horse, a donkey and a calf.

“It is amazing to see all the grandchildren and great grandchildren,” Melville said. “I never know when there is going to be another one. When my grandkids started having kids, I started to feel old.”

The novelty of birth never wears off, Melville said.

“It’s new every time a baby is born,” she said. “After my kids would have two children, they would say, ‘Mom, how did you ever do this?’”

One of Melville’s neighbors asked her the same question. Melville’s response was, “The same way you do it.”

“It’s something that comes on one by one,” Melville said. “They don’t all come at the same time, so you take it one day at a time.”

For most of Melville’s motherhood, she had four children in diapers. In addition to cooking for the other children, she made her own baby formulas, food and cleaned the cloth diapers.

Melville’s family has their own double-sided, nine-page directory to keep birthdays and anniversaries straight. Melville has been to hundreds of weddings, baptisms and confirmations.

For Mother’s Day, Melville’s children usually send her flowers or candy or pop in for the annual Mother’s Day open house.

She will spend Sunday sitting at her house waiting for phone calls from her children, who are spread out across the country, and visiting with those who stop by.

Melville had her first child on a Thursday. The following Sunday was Mother’s Day.

“That first Mother’s Day, they brought my daughter wrapped in a blanket and handed her to me,” Melville said. “She had a little corsage made of apple blossoms on her that read, ‘To Mom, from Peg.’”

Melville said she always wanted twin girls but never had them.

“I never got my twin girls, but my daughter Paula had twin girls,” she said.

Melville has another grandchild on the way, as well as her 10th great-grandchild.

One of her grandchildren, Amber McFadden, is currently serving in Iraq, Melville said with a proud look on her face as she held the American flag in her hands.

“She sent this flag to me that was flown in Iraq for nine minutes and 11 seconds,” Melville said.

Shawn Hogendorf can be reached at (952) 345-6374 or shogendorf@swpub.com.

Aims: Government must provide more resources

11 May 2007

Aims: Government must provide more resources
The government must put more resources into funding for midwifery if it was truly to offer free choice for how a woman gives birth, according to the Association for Improvements in the Maternity Services (Aims).

Chairperson of Aims Beverley Beech said that while maternity services continued to be underfunded and overworked there was no real possibility of being able to offer every mother-to-be the option of having her baby at home.

"Until this government puts some resources in, it's going to continue to be difficult. There is a very serious shortage of midwives. And it means that women, in the meantime, are getting very substandard care as a result of this shortage," Ms Beech stressed.

She also said that any expectant mums who wanted a homebirth should be determined to make her wishes known to her health practitioners and to remain persistent if she was advised to have her baby elsewhere.

""[Home births] are an option for every woman. And it's the woman who makes the decision," she said.

Expectant Moms Eagerly Look Toward to Due Dates

By Bailey Clark
Contributor

It is that time of year again. The time of year when on one singular day, we gather together to celebrate and pay homage to the most important women in our lives: our mothers.

For many parents, Mother's Day is a time to reflect on the children they've raised, the memories they've shared, and the joys they've experienced. Yet, for a rare group of young women, this Mother's Day means something entirely different as they await the birth of their new babies.

For these mothers, this occasion is one of anticipation, fear and excitement as they anxiously prepare for the arrival of the newest member of the family.

This holiday not only marks a moment of reverence for the women who have healed, helped and held us throughout our lives, but a time to recognize those who will soon be stepping into the role of mother once again. For three area women, this day is not only in celebration of their current role as parent, but also for everything that lies ahead.
Kristin Thomas

Due Date: Late August

"Expecting just one baby has been so exciting," says 31-year-old Kristin Thomas.

This is a rare statement from an expectant mother who intends to welcome her child into the world using natural homebirth methods. A rare statement, that is, until her 2-year-old twins come charging into view.

"Feeling the baby move this time around has been amazing," she said. "I didn't think it would be that big of a deal to me, but because it's just one, I can feel the baby move a lot more."

Thomas is a stay-at-home mom to fraternal twins, Isaac and Grace, and wife to her arborist husband, Matt Thomas. The family is ecstatic about the soon-to-be arrival of a little boy, whom they have decided to name Daniel.

Although homebirth may seem frightening to many expectant mothers, to Thomas it is a breeze compared to laboring at home with the twins.

"Sometimes I worry about finding enough one-to-one time with each individual child," Thomas admits, adding that "making sure there is enough time" is surely her largest fear.

However, Thomas's first singular pregnancy is not without its own joys.

"We were amazed at how much this baby is moving," she says, "I can see my belly hop around already."

Fruit and ice cream top the list of pregnancy cravings, and as Thomas approaches this latest Mother's Day, she has one goal in mind for her attributes as a parent: "patience."

"Love is the most important thing," the she adds. And if there is any value she hopes her future baby could understand, Thomas can sum it up in one sentence: "To grow up knowing the importance of a personal relationship with God."
Christy Miller

Due Date: Aug. 15

"Surprised and excited," was how Christy Miller, 26, said she felt when recently finding out she and her husband, Ben, were expecting their first child together. As a mother to a young son, Jordan, 8, Miller feels a completely new set of emotions with this pregnancy because she is expecting a baby girl.

"It's exciting how active she is," Miller said. "Jordan was a very calm baby, but with her I can sit on the couch and physically see her moving!"

As a busy insurance career sales agent with American General Insurance, Miller barely can find time between her hectic schedule to put her feet up. "I have to take naps in the evening, or I won't be worth anything later in the day!"

Then again, these days her biggest dilemma seems to be deciding upon a name for the baby girl.

"I keep telling Ben we have to pick one already," she explains, "but we just can't decide."

Names aside, Christy's biggest challenge with the impending birth of her child is certainly one of balance. "Trying to balance when I go back to work when I have a new baby," is the largest concern to date.

She is quick to add though, "With this pregnancy, I'm happy as long as the baby's healthy."

With the celebration of Mother's Day and her happy pregnancy, Miller has two wishes she hopes to give her child: "love and commitment."

Whether she is busy or not, Miller believes in one thing as the key to being a good mother. "Optimism," she says. "Children get enough negative opinions in their lives, and I feel it's our job as parents to make them feel that they can do anything."
Danielle Miller

Due Date: Sept. 7

If you wanted to know how Danielle Miller, 28, is spending this Mother's Day, chances are you will find her cleaning the house.

"I'm fanatical about organizing with this pregnancy," she says, "I'm driving my husband crazy." As stay-at-home mother to daughter, Ivy, 20 months, and wife to painting contractor, Adam, many differences stand out between the arrival of this baby and that of her last.

"I have been sick this entire pregnancy," Danielle admits, "whereas it only lasted a few months with Ivy." In addition, Danielle plans to give birth at home, instead of the hospital setting that welcomed her previously.

Danielle and her husband are choosing not to learn their new child's gender until birth, and the same goes for their choice of names.

"We don't have any names picked out," she says, "when we see the baby, that's when we'll decide."

Despite the excitement of her pregnancy, Danielle still has her own fears as the due date approaches. "I am concerned about the state of the world," she explains, "and bringing an infant into it."

Yet, if she has her way, Danielle is determined to do her best to protect through the job of motherhood.

"I want to home-school my children, raise them with good Christian values, and teach them to have good relationships with people," Daniellesays, with "trust" topping the list of most important value to her as a parent.

This holiday, Danielle had threewishes for her children, as she anticipates the arrival of baby,

"I want them to be my very best friend, to trust me, and to tell me everything," she said.

Teachers joined in birth, death

Two new mothers taught together, died days apart.

By Marie McCullough
Inquirer Staff Writer

In March, the staff, students and parents of Avon Elementary School threw a surprise baby shower for teachers Valerie Scythes and Melissa Farah.

Mere weeks later, both young women were dead.

They died, 15 days apart, after delivering by cesarean section at Underwood Memorial Hospital in Woodbury, Gloucester County. They left behind healthy infants - Isabella Rose Scythes and Grace Melissa Farah.

A combination of the unthinkable and the incredible, the deaths have turned two first-time fathers into widowers, shaken the tiny school and its close-knit borough of Barrington, and left myriad questions about what went wrong.

"It's just unbelievable," said Barrington Mayor John Rink, whose son Nolan was in Scythes' class last year.

Scythes, 35, died March 28. The cause is unclear, and final autopsy results are pending, said John Baldante, a Philadelphia lawyer representing the family.

Farah, 28, died April 12 of "shock, due to bleeding and anemia," according to her death certificate. The family's attorney, Todd Miller of Allentown, said he was awaiting an autopsy report.

Underwood Hospital spokesman Richard Bellamente said the women were "treated and transferred" to Hahnemann University Hospital and Cooper University Hospital - although he did not know which woman went where.

According to people who knew the women, Scythes was airlifted to Hahnemann University Hospital, while Farah was rushed to Cooper University Medical Center in Camden.

The New Jersey Department of Health and Senior Services, which investigates deadly medical errors, has not received reports or complaints regarding the care of the two women, department spokesman Nathan Rudy said.

Death during or around the time of childbirth, a common occurrence a century ago, is now extraordinarily rare in this country. In 2000, 396 women in this country died of obstetric complications of pregnancy or treatment of those complications - including incorrect treatment, federal statistics show. That's fewer than eight women per 100,000 births.

"It's like winning the lottery - a bad one," said Louis Weinstein, chair of obstetrics at Jefferson University Hospital.

The most common causes of such deaths are blood clots, a blood-pressure disorder called eclampsia, and a coagulation disorder triggered by, among other things, hemorrhage, said Robert Debbs, a high-risk obstetrician at Pennsylvania Hospital who also practices at Underwood and is familiar with the cases.

In Debbs' opinion, "the Underwood cases were both catastrophic complications that could have occurred anywhere in the country and were unpreventable," he wrote in an e-mail.

By all accounts, the poignancy of death so closely linked to birth has been compounded by the coincidence that Scythes and Farah were friends and colleagues in a small suburb. They were known to just about everyone with children in the two elementary schools that serve the 1.2-square-mile Camden County borough of 7,000.

Although Scythes came to the district four years before Farah, both were alumnae of Rowan University and loved working with special-education students.

Avon principal Anthony Arcodia, a 25-year veteran of the district, said he interviewed both and recommended they be hired. "They had a level of passion and enthusiasm. The last day I saw them, they still had it."

Scythes was known for giving her pupils individual, handmade Christmas ornaments. Both women were known for their love of all things Disney.

Daniel Farah, 29, a computer-information specialist who met his wife-to-be at Collingswood High School, recalled: "I proposed to her in front of the castle in Disney World after dinner at Cinderella's Castle. They had cleared everyone from in front of the castle for the fireworks show, and we were the only ones there."

The couple married in July 2005 and built a house in nearby Oaklyn.

"We started trying to have a baby on our first anniversary," he said. "I was a planner. She was a planner."

James Scythes, a college history professor who lived with his wife in Woodbury, declined to be interviewed. Baldante said his client wanted time to deal with the emotional trauma and questions surrounding his wife's death.

Underwood Hospital has about 1,100 deliveries a year, hospital billing records show. It is one of two hospitals with maternity units in Gloucester County.

Underwood has "never" had a maternal death, Bellamente said. He declined to discuss the cases, citing privacy rules. "Hospital policy and practice is to refrain from disclosing protected health information."

An Inquirer analysis of Underwood billing records shows that between 2001 and 2005, seven obstetric patients were transferred to other medical facilities.

In the Barrington school district, news of Scythes' death was shared by a letter sent home to parents. At the Avon school, which serves children in kindergarten through fifth grade, Melissa Farah was beyond grief-stricken.

"She said: 'Oh my God. Is this going to happen to me?,' " recalled parent-teacher association president Beth Cavallaro. "We tried to reassure her and said: 'No, no. It was just a freak thing.' "

On the Sunday night after Farah's death, the district's automated recording service called each Avon parent to alert them that an unspecified "tragedy" had occurred and that counselors would be available at the school to talk to the children.

Proposals for memorials to the teachers - and funds for their babies - are coming from all quarters, Arcodia said.

Already, the parent-teacher association has ordered plaques that will be unveiled at back-to-school night in September, Cavallaro said. The organization also plans to install a tree, a bench, and specially inscribed bricks in the new playground, to be built in August with $52,000 raised from Barrington parents and businesses.

Still, for most of those who knew the women, the double tragedy remains incomprehensible.

"Even if it was an act of God," said Daniel Farah, "the odds of two new mothers dying, then that those two people did the same thing for a living, that they worked together, that they went to one another's baby showers - the odds are astronomical."

For photos, obituaries and tributes to Valerie Scythes and Melissa Farah, go to http://go.philly.com/health

To Contribute

Funds have been set up for both of the babies.

For Melissa Farah's daughter:

Checks should be made to "Grace Melissa Farah UGMA Fund"

Pinnacle Food Group Inc.

6 Executive Campus

Suite 100

Cherry Hill, N.J. 08002

For Valerie Scythes' daughter:

Checks should be made to "Isabella Rose Scythes Trust Fund"

409 Mantua Ave.

Woodbury, N.J. 08096

Staff writers Josh Goldstein and John Sullivan contributed to this report.

Reach Sullivan at johnsullivan@phillynews.com or 215-854-2473.

Hail Caesarean: Such births rising in East Asia

This is scary! - AmyMc

BANGKOK: When the time came, the doctor stood over Suthasinee Santikanavin's bulging belly and said: "It's almost 9:19. We are going to pull the baby out."

The birth of Suthasinee's daughter was written in the stars, at least according to a Thai astrologer who helped pick the precise day, hour and minute that the infant should be extracted from her mother's womb by Caesarean section.

Suthasinee's husband, Mahakanasnan, an intelligence officer for the Thai Navy, stood anxiously beside the operating table and made sure the auspicious timing was respected. He programmed the alarms in both of his cellphones, one in each pocket, to vibrate silently at 9:19 a.m.

"The alarms went off," Mahakanasnan said, a tone of satisfaction in his voice. "And I heard the baby crying."

That baby's birth at a private hospital here on March 22 was part of a wider trend of what medical researchers are calling an epidemic of Caesareans across East Asia.

Once considered a procedure reserved for emergencies or high-risk pregnancies, Caesareans are now commonly planned for a variety of non-medical reasons, including fear of labor pain, convenience for the doctor and the patient, and astrology.

In a region that lives by time-is-money production schedules at footwear and computer chip factories, the elective Caesarean brings clockwork and clinical tidiness to one of humankind's most stubbornly unpredictable processes.

Meanwhile, medical advances that have made the procedure safer and more routine have also, paradoxically, helped reinforce age-old superstitions. Couples in Chinese-influenced cultures have long tried to time births for auspicious years. Now, many can refine their choice to the day and minute.

The World Health Organization estimates that under normal circumstances a country should not have a rate of Caesareans higher than 10 to 15 percent. That widely quoted benchmark was established two decades ago and was loosely based on the experiences of developed countries with the lowest infant and maternal mortality rates.

But while Caesareans have become increasingly commonplace in almost all countries outside Africa - they make up around 30 percent of all births in the United States, a quarter of births in Germany but less than 2 percent in Mali, Niger and Nigeria - rates have skyrocketed over the past 15 years in East Asia as the region has prospered.

In Bangkok's private hospitals, which typically cater to wealthier patients, Caesareans now make up about 65 percent of births, up from 40 percent in 1990, hospital administrators said. In Hong Kong, where the notion of scheduling a birth dovetails with the city's palpable ethos of efficiency, 59 percent of all babies born in private hospitals came into the world under the knife in 2005, compared with 31 percent two decades ago, according to the Department of Health.

Cesareans involve slicing through layers of skin and fat and stretching apart abdominal muscles to reach in and pull out the baby. They take about an hour to perform and are safer than ever; in the West, the rate of maternal or infant mortality from the procedure is well below one percent for both mother and child.

Yet the growing use of elective Caesareans is controversial. Because it entails major surgery, there is always the potential for complications, even as the technology improves.

Still, the procedure's popularity is growing and is having a sociological impact. Increasingly, birthdays occur by appointment.

Whether astrologers or doctors decide, there is often haggling over the appropriate day and time.

Bumrungrad Hospital in Bangkok, a large private facility that caters to wealthy Thais and foreigners, bars parents from scheduling Caesareans during the inconvenient hours of 9 p.m. to 7 a.m. The hospital delivers about 180 babies a month, 65 percent by Caesarean.

At St. Paul's hospital in Hong Kong, where the Caesarean rate is about 70 percent, couples are charged extra if they select a time of birth between midnight and 7:30 a.m.

Noppadol Saropala, an obstetrician at Bumrungrad, says about one third to half of all his Thai patients who choose Caesareans want to set their own date and time. But there are limits: A patient must be close to the average gestation period of 40 weeks.

"I will not do a Caesarean if they're less than 38 weeks," Noppadol said.

If labor drags into a Friday evening, doctors may be tempted to speed things along, said Monir Islam, director of the WHO's Making Pregnancy Safer program. "They will go for a Caesarean section so that they don't have to be called over the weekend," Islam said.

Caesarean rates have been known to spike on the eve of major holidays. One recent example was April 12, the day before the start of Thailand's Songkran festival, a time of family gatherings, which this year amounted to five days off. At Phayathai 3, a private hospital in Bangkok, the number of Caesareans rose to eight, compared with the usual rate of three or four a day, said Supakorn Phawanna, a hospital spokesman. Supakorn said patients chose Caesareans because they wanted to "have relatives and friends visit their baby during the long holiday."

Doctors and hospitals alike have a financial incentive to perform Caesareans, especially at private hospitals. At Phayathai 3, a "Caesarean package" - four days and three nights in a private hospital room - costs 41,900 baht, or about $1,200. That is 40 percent more expensive than the typical vaginal birth.

Elective Caesareans are not covered by Thailand's universal health care system, reinforcing the notion that this is a procedure for the rich. In Thailand's government-run hospitals, which serve the country's have-nots, only 20 percent of births are Caesarean.

One of the women who chose April 12 to give birth was influenced less by the holiday schedule than astrology.

Apinya Jirupansawat, a 34-year-old employee of a stock brokerage, was told by a Chinese astrologer that she had three choices: April 12, 18 or 24.

After cross-checking with Thai and Western astrology books, Apinya settled on the first day. As she explained, according to Chinese astrology, a child born then "would support his parents and be easy to raise."

Some days of the week are luckier than others, said Pinyo Pongcharoen, the astrologer who helped time Suthasinee's daughter's birth.

This year, according to Thai beliefs, Sunday and Monday are generally auspicious, he said, while Saturday and Wednesday are not.

Doctors sometimes have trouble timing Caesarean operations so that the baby is extracted at the astrologically correct hour, Pinyo said, but ideally the birth should take place within 10 or 20 minutes of the time he selects as most compatible with stellar and planetary alignments.

"Sometimes we give them many dates," Pinyo said in the classroom at a Buddhist temple where he lectures fellow astrologers. "It's up to the doctors and the parents to choose which one is most convenient."

Pinyo's colleague, Sompong Winworanat, says the lucky time should be planned for the baby's first cry.

"It's not the time when the woman's stomach is cut," Sompong said. "It's when the baby first screams: Waaaaaa!"

While there is little public debate about soaring Caesarean rates in East Asia, there are early signs of a backlash.

Concerned by a national Caesarean rate of 40.5 percent in 2001, doctors in South Korea managed to bring it down by three percentage points by 2005, according to Joo Hyun Nam, the chairman of the Korean Society of Obstetrics and Gynecology.

In Japan, the overall Caesarean rate has risen sharply, but was well below its neighbors at 21.4 percent in 2005, up from 11.2 percent in 1990. The rate in Taiwan is 35.4 percent, according to a study published last year in the medical journal Birth.

If some see the burgeoning resort to Caesareans in Asia as a problem, it is overshadowed by more pressing issues related to the application of medical technology to engineer a culturally desirable outcome in childbirth, such as the growing use of ultrasound and abortion to determine a child's sex, said one international health official who asked not to be named because she is not authorized to speak for her institution.

When compared to such practices, she said, "I don't see such a big, big tragedy in terms of all babies being born on a Saturday."

Pornnapa Wongakanit contributed from Bangkok.

Placental problems in mums who have had a previous caesarean section

New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology shows a link between the development of placenta praevia and placental abruption during the subsequent pregnancies of women who previously had a caesarean section.

Placental praevia is defined as the implantation of the placenta over or near the internal opening of the cervix. Placenta abruption is the premature separation of the placenta from the uterus. Both result in bleeding during the pregnancy, which could spell danger for mother and baby.

This study was undertaken to examine the risk of placenta praevia and placental abruption in singleton, second pregnancies after a caesarean delivery in the first pregnancy.

Data provided by the US National Centre for Health Statistics, Centres for Disease Control and Prevention was examined by a team of Canadian researchers. A total of 5, 146 742 pregnancies were analysed over 1995 – 2000. This is the largest population-based study of its kind to date.

Researchers found that women who previously delivered by caesarean section had a 47% increased risk of developing placenta praevia and a 40% increased risk of placental abruption in the following pregnancy.

The authors believe that caesarean sections cause scarring inside the womb which may affect placental attachment in future pregnancies. The ligation of the uterine vessels during caesarean sections could also da mage the lining of the womb, resulting in the low implantation of the placenta in the next pregnancy.

Dr Qiuying Yang of the Ottawa Health Research Institute and University of Ottawa said, “Our paper, which is the largest study to date, shows an important association between caesarean sections and the subsequent pregnancy complications of placenta praevia and placental abruption.”

“More than 1% of pregnancies with a prior Caesarean section had one of these events which had a 50% increase compared to women without previous Caesarean section. This has important implications on the management of these pregnancies. It also introduces new and important evidence in the debate on the risks of caesarean sections ‘on demand’.”

Professor Philip Steer, BJOG editor-in-chief, said “The caesarean section rate in the UK is one of the highest in the world. This isn’t because, in some cases, women are ‘too posh to push’, but rather, complications occur during the pregnancy or birth which make normal delivery impossible.”

“Women need to be informed of the possible risks that can happen throughout the pregnancy and it is important to have their scheduled ultrasound scans to detect if the baby is developing safely. Should a woman encounter unusual bleeding during her pregnancy, it is best if she sees the doctor immediately.”

(Last updated on Wednesday, May 9, 2007, and first posted on Tuesday, May 8, 2007)

A few more minutes of maternal attachment may reduce anemia in children

In the past, the newborns' umbilical cord was not clamped right after birth, thus allowing the blood flow to stop naturally. This practice, known as "late clamping", was replaced by "early clamping", that is, cutting the cord immediately after the infant is expelled. However, this new practice lacks studies corroborating its benefits. In fact, recent studies on the importance of when clamping should be done have shown contradictory results.

A doctoral thesis carried out at the Department of Obstetrics and Gynecology at the University of Granada (Universidad de Granada [http://www.ugr.es]) by Catalina de Paco Matallana shows that the clamping of the umbilical cord of newborns from full-term pregnancies (that is, infants born after a nine-month pregnancy) two minutes after the infant is expelled from the womb makes no difference to hematocrit or hemoglobin levels of the umbilical cord vein compared to clamping the cord within 20 seconds. Thus, the study shows that early clamping (which is widely performed) is not justified.

Analysis of 151 umbilical cords

The doctoral thesis Repercusiones clínicas y fisicoquímicas del tiempo de ligadura del cordón umbilical en recién nacidos a término (Clinical and Physiochemical Repercussions of Clamping Time of the Umbilical Cord of Newborns from Full-Term Pregnancies) analyzed a total of 151 umbilical cords of newborns from full-term pregnancies. In 79 cases, the umbilical cord was cut within 20 seconds, and in 72 cases it was clamped two minutes after the infant was expelled.

The study found that the partial pressure of oxygen in the umbilical artery of the newborn babies who had late clamping had risen, while there was a lesser need of oxygenotherapy after birth. There were no differences in the removal time of the placenta and the mother's bleeding after birth - one of the reasons why early clamping of the umbilical cord started to be practiced.

De Paco Matallana also analyzed the melatonin concentration (one of the strongest and most currently studied antioxidants), finding differences between the melatonin concentration (aMT) in the umbilical vein and the umbilical artery, the latter being where the concentration is significantly higher. "This suggests that the fetus not only receives melatonin from the mother via the umbilical vein because it crosses the placental barrier, but also that it is produced in stressful situations such as during labor," says de Paco Matallana. Thus, high melatonin concentrations in the umbilical cord, together with the arterial and vein differences according to type of birth, suggest that the pineal gland is used by the fetus and that it can respond during birth.

Preventing anemia in children

As for the concentration of the triacylglycerols (TAG) analyzed in the umbilical vein of both groups, this study found statistically significant differences, as there is a higher concentration of TAG in the group of early clamping. The same is applied to the umbilical artery, where there are also statistically significant differences, with higher a concentration of TAG in the group of early clamping. However, there are no studies corroborating these findings, so more research is needed, although many other studies recommend late clamping "especially because of the beneficial effect on the prevention of anemia in children," says de Paco Matallana.

The author points out that the results of her thesis "show that there are no differences in the hemogram or the general biochemical profile in the umbilical vein in the cases of early and late clamping". Moreover, there were no differences in the viscosity or the melatonin in the umbilical artery and vein, which have traditionally been variables related to early clamping. From a clinical point of view, there were no differences in either group with umbilical clamping at birth.

"This study has not found any scientific evidence to suggest that the practice of early clamping is advisable or to justify the abandonment of late clamping in newborns from full-term pregnancies," says de Paco Matallana. "There are convincing findings for and against the two different types of clamping analyzed in this study, which shows not only the complexity of the problem, but also that research in this field may not be controlled enough or designed correctly."

(Last updated on Wednesday, May 9, 2007, and first posted on Wednesday, May 9, 2007)

Modern Milk

The milk we drink today may not be nature’s perfect food,” says Ganmaa Davaasambuu, a Mongolian physician who is a fellow this year at the Radcliffe Institute for Advanced Study. Even as the scientific community has become interested in the effects of the bioactive substances found in pesticides, says Ganmaa, not much attention has been paid to the naturally occurring estrogens found in food, which are both far more abundant and more biologically available than environmental estrogens. In fact, she is concerned that the high levels of hormones found in commercially produced milk may be harmful to human health. Estrogens and other growth factors have been implicated in the development of hormone-dependent cancers: those affecting the prostate, testes, ovaries, breasts, and uterus.

Skeptics note that humans have been drinking milk without apparent harm for millennia, she says. But modern milk is different. Her concern stems not from the use of bovine growth hormone (she excluded BGH-fed cows from her studies), but from the fact that milk-producing cows in commercial dairies, through use of artificial insemination and high-quality winter feed, are kept pregnant and lactating 300 days a year. “Cows are like humans,” she explains. “When they get pregnant, the estrogen levels in their blood, milk, and urine increase. [Human pregnancy tests detect similar increases.] This made me wonder—since the cows are pregnant all the time, the hormone levels in their milk should be really high.”

While earning her doctorate in environmental health in Japan, Ganmaa began investigating the prevalence and effects of these naturally occurring hormones. In her native Mongolia, traditional patterns of milking—the same as those used in Westernized countries until the 1920s—are still followed: pasture-fed cows are milked only through the first three months of a new pregnancy. Their raw milk had only one-tenth the progesterone that she and her colleagues found in commercially produced milk in Japan.

Mongolian physician Ganmaa Davaasambuu has linked increased tumor formation and growth in laboratory animals with chemically induced cancer to high levels of hormones in commercial milk. Seasonal milking practices among Mongolian nomads ensure that cows produce milk only during the first three months of a new pregnancy, when hormone levels are low. Because modern dairies, on the other hand, milk cows well into their next pregnancy, commercial milk often contains much higher levels of biologically active hormones.

In a 2002 study of cancer and diet in 42 countries, Ganmaa and colleagues found that countries with the highest consumption of dairy products suffered the highest rates of prostatic and testicular cancer. (A similar study Ganmaa did in 2005 showed much the same results for breast, ovarian, and uterine cancers.) In 2003, the group focused on the relationship between rising rates of these cancers and increased dairy consumption in Japan. Prior to World War II, the Japanese consumed very little milk, and rates of these cancers were low. But in the 1950s, a school-lunch program that included milk was instituted nationwide. Since that time, the intake of milk has increased twentyfold, and the incidence of prostrate cancer has increased twenty-five-fold.

Still, such epidemiological evidence is circumstantial. But in a 2004 study that used rats in which mammary cancer had been induced, she and her colleagues found that rats fed low-fat milk (1 percent) were more likely to develop tumors, and in greater numbers and of larger size, than rats fed water or artificial milk. In a 2006 study, also in rats, she proved that the hormones in milk are biologically active in animals. Both adult and immature milk-fed rats showed increased uterine weight—the gold standard for measuring the estrogen activity of food and other substances.

During her time at Harvard, which began with a year as a research fellow at the School of Public Health under Stare professor of epidemiology and nutrition Walter Willett, she and her colleagues have conducted two pilot studies. The first compared American milk (whole, whole organic, skim, and “shelf-stable” ultra-high temperature milk) to milk from Mongolia. Levels of hormones and growth factors were low in both American skim milk (hormones are carried in the milk fat) and Mongolian milk. In a subsequent study, Mongolian third-graders were fed U.S. commercial milk for a month. The good news was that a number of the children who had been vitamin D-deficient when the study began saw those deficiencies corrected. “Milk is a complex food that contains many good things, such as vitamin B, vitamin D, and calcium,” Ganmaa notes. But the Mongolian schoolchildren’s growth- hormone levels shot up 40 percent; and the children grew, on average, one centimeter during the month—a statistically significant increase, according to Ganmaa. “But we don’t know if it will be sustained in the long term, whether it will affect their sexual maturation or their age at puberty,” she says. “One month is too short.” She and her Harvard colleagues are now seeking funding for a two-year study.

Based on what she has found so far, Ganmaa believes that cows in late pregnancy should not be milked—or, at least, that such milk should be labeled to indicate that it comes from a pregnant cow. In the meantime, it is reassuring to know that skim milk from the United States has low levels of hormones, just like the traditional stuff from Mongolia.

~Jonathan Shaw

Ganmaa Davaasambuu e-mail address: gdavaasa@hsph.harvard.edu

Lag Ba'omer bonfires 'ecological disaster'

Reform rabbi slams ritual lighting of bonfires during holiday that causes massive air pollution each year, calls on haredi rabbis to issue clear instructions on matter

Kobi Nahshoni

Published:

05.07.07, 03:12 / Israel Jewish Scene

"This is an ecological disaster, it's virtually rabbi-sanctioned vandalism," Reform Rabbi Levi Weinman Kalman said Sunday, referring to the Lag Ba'omer bonfires that were lit across Israel Saturday night and caused massive air pollution throughout the country.

Weinman-Kalman, head of the Kol Haneshama congregation in Jerusalem, is a staunch opponent of the ritual Lag Ba'omer celebration, and claims that the "Bal tashchit" prohibition, which bans destroying anything that is of value to man, is a prominent mitzvah that applies in this case.

The rabbi, along with environmental organizations, does not expect Israelis to refrain from lighting the traditional bonfire on the holiday, but recommends to light less bonfires.

"Nowadays there is competition between yeshivas and families on who has the biggest bonfire. The rabbis should issue a clear instruction to those who celebrate that it is quality – not quantity – that matters," he stated.

Regardless of Lag Ba'omer, the rabbi believes that the concern for the environment can lead to rare cooperation between rabbis, including haredi ones, and the green organizations. For instance, he suggests to declare one Shabbat a month as a "car-free day".

"A car-free day and such cooperation certainly seem far-fetched, but creative thinking can lead to cooperation between sectors who usually don't meet," he stated.

Rabbi Aviner: Green organizations exaggerate

In response to Rabbi Weinman-Kalman's suggestion, Rabbi Shlomo Aviner, the rabbi of the Beit El settlement and head of the Ateret Kohanim yeshiva told Ynet that rabbis were aware of damages to the environment.

"Not everything we do gets media attention, and therefore I warn again of 'Bal tashchit' and of damages that may be caused to people and the environment," he said.

However, Rabbi Aviner said that as a former scientist, he knew that green organizations usually exaggerate the importance of ecological issues.

"It's true that we only have one planet Earth, and that without it there would be no Eretz Israel, Torah and mitzvot, but the damage caused

to it is minor… The money and resources that go into preserving the environment should be invested in more important things," he said.

Rabbi Aviner said that he believes that in the war for the environment, the consideration of gain versus loss should be kept in mind. "Disposable diapers are also bad for the environment, but no one thinks of returning to cloth diapers, because there are other needs as well," he explained.

According to the rabbi, although bonfires have no religious justification, if they meet the need for stress relief, entrainment or even pyromania, then they are legitimate.

The Home School option

August 20, 2001: 10:38 a.m. ET Why a growing number of parents are educating their children at home By Kamala Nair

NEW YORK (CNNfn) - Deanna Busch runs a tight ship. Classes start at 6:30 a.m. – those who are not in their seat by then receive detention. Like other teachers, Busch does not allow gum chewing. She requires homework to be finished on time and tests to be taken in silence. The only difference is: Her students call her "mom." Like most military families, the Busch's lifestyle takes them all over the world. When her husband was posted in Korea, Deanna Bush had a chance to preview schools for her six young children. Unsatisfied with the quality of education offered by the Department of Defense, she decided to take her children's education into her own hands. She began researching the home schooling concept, reading books such as "The Big Book of Home Learning," by Mary Pride, which recommends curriculum and lesson manuals. She attended home school conventions, which are held annually in every state, where she visited exhibits displaying a variety of useful books and curriculum. Within a year, she added "teacher" to her list of qualifications, and turned their home into a classroom. A growing contingent According to the ERIC Clearinghouse on Educational Management, the Busch family is not alone. The home schooling population has grown from 10,000-to-15,000 children in the late 1960s to well over 1 million today. The most common tools parents use when beginning to home educate their children are annual conventions, the Web, and correspondence programs, which test children and design curriculum for their specific needs. About 20 percent of home schoolers belong to these programs, which also keep records of academic history and issue diplomas upon graduation. While currently only about one-third of parents educate their children at home beyond the elementary level, Chris Klicka, senior council at the Home School Legal Defense Association (HSLDA), estimated that roughly 80 percent of new home schooling parents plan to educate their children through high school. In such cases, parents themselves issue their children transcripts and diplomas. Research conducted by the HSLDA indicates that since home education families are not dependent on public, tax-funded resources, they save United States taxpayers more than $7.5 million a year. However, parents who school children at home pay the same amount in property taxes as everyone else. Parents pay about $450 annually to teach one child at home, about $6,000 to send a child to public school, and anywhere from $1,000 to more than $6,000 to send a child to private school. Busch said her costs have increased as her children grow older, reaching around $800 per year for her 7th and 8th graders, because she sends their assignments to certified teachers through a correspondence course, who provide grades and transcripts. Busch emphasized that fusing the roles of parent and teacher can be a big sacrifice for parents. Because they are generally one-income households, money is often an important factor, especially for military families who don't earn a large income. "But the sacrifice and hard work pay off," asserted Busch, who will be sending her oldest son on a $1,000 scholarship to begin high school at a prestigious parochial school in Washington, D.C. Home schooling, which once was outlawed in most states, is now legal throughout the United States, and its popularity has grown steadily over the past several decades. While the Department of Education does not impose any federal restrictions on home education, each state has its own policies regarding the issue. South Carolina, for example, requires a parent to enroll with the local school district or with an accountability association. The parent must have at least a GED or a high school diploma, must teach for 180 days out of the year, and keep records and samples of their children's work. Other states, such as Arizona or Kansas, simply require parents who home educate to register with the state, but do not monitor the children's progress as closely. According to ERIC, while home schooling families come from all major ethnic and income groups, the typical family tends to be large, religious (Christian), conservative, and white. They are also generally middle-class, better educated, and more likely to be part of a two-parent family. About 10 percent of these families belong to the military as well, since many parents feel that forcing their children to migrate from one school to the next is harmful to their development. "My oldest son has been to the same grade school even though we have moved so often. Our house and our friends change continuously, but his education has stayed constant," said Busch. Brian Ray, president of the National Home Education Research Institute (NHERI), said the most commonly stated reasons that parents give for home schooling their kids include: teaching them specific philosophical and religious values; controlling their social interactions; developing close family bonds; and promoting high-level academics. At the same time, he said, many parents feel that schools today are breeding grounds for morally corrupt behavior and attitudes. "Parents do not want their kids to be exposed to all the violence in schools these days," said Gloria Ferber, of the Grace Home School Association, based in South Carolina. Academic and social implications In fact, advocates argue that educating children at home not only protects them from moral corruption, but that it also leads to increased maturity and a higher level of academic achievement. Through a nationwide study conducted by NHERI, Ray discovered home educated students to be scoring, on average, at or above the 80th percentile in all areas on standardized achievement tests. That is well above the national average, which is in the 50th percentile. According to ERIC, college admission statistics are also a measure of success. Home school graduates have reported admission to more than 1,000 different colleges and universities, at last check. While there is no conclusive research suggesting that additional time with peers is preferable to more time with individuals of varying ages, parents who choose to educate their children at home say that the increased exposure to people of all ages they receive through community activities and involvement with support groups, increases their self-confidence and maturity. "Kids should not be learning what's right and wrong from other kids – they should be learning from adults," said Busch. Although home schoolers are an ever-growing contingent, the practice still remains controversial. Organizations such as the national Parent-Teacher Association and the National Association of Elementary School Principals oppose this mode of education, and the National Education Association has called for more rigorous regulation of home schooling. Conversely, groups such as the American Civil Liberties Union believe that parents have a constitutional right to teach their own children. The majority of Americans, while they don't necessarily promote the institution, believe in a parent's right to take charge of their children's education, and many state legislatures have amended their laws to provide greater flexibility for home schooling. Klicka, of the HSLDA, acknowledged the limitations that home education poses to children, in terms of access to labs and athletics. However, he firmly believes the individual attention and disciplined learning environment it provides outweighs the cons. "Home schooling parents feel their children need to be educated based on the values this country was founded upon," he explained. "A lot of people are concerned that their kids will become an academic or social statistic. They want their kids to be literate and to be able to have the necessary skills to succeed."