Birth Contingency Plans

I think that one of the healthiest things a woman can do as she prepares for labor and birthing is to go ahead and think about the what-ifs, including the ugly ones. The majority of births happen relatively smoothly, but, for the few that don’t, I believe in being prepared. What if this or that goes wrong and this intervention or that change has to happen? What will she do in that moment when her ideal birth plan is blown out of the water? I know there are several birthing methods (most notably hypnosis-based ones) which insist on thinking only happy thoughts. They don’t want mommy-to-be to even THINK a word like ‘pain’ or to contemplate what she would do if she suddenly had to have an emergency c-section, let alone to consider what her preferences would be if (heaven forbid) her infant died. Honestly I think that’s sadly naive and can do a great disservice to the women involved. While I agree that thinking happy thoughts is good, and avoiding negative influences is also good, there is still something to be said for making thoughtful contingency plans. For those who write up birth plans, I think it’s wise to include a short version of these contingency plans at the end.

When I was expecting Bear, he spent the majority of the pregnancy in a head-up position. The earliest kicks I felt were low and led me to wonder about his positioning, the ultrasound verified that he was breech, and the location of his kicks in subsequent weeks (all in my pelvis) indicated that he seemed inclined to stay that way. As the pregnancy progressed and he got bigger (with less extra room to change position) I started to think a lot about what would happen if he remained breech on his birth day. I researched vaginal breech deliveries, including talking with my provider about whether he was comfortable or experienced with them (he was). That was of some comfort, but I was still troubled at the possibility of needing a c-section.
In my childbirth education class we spent some time visualizing our greatest birth worries—with the intent that we could work through them in class so that they would not haunt us in labor. When I was honest with myself I had to admit that my greatest fear was for things to go wrong, for the baby’s life to be in danger, and to culminate in needing a c-section. Perhaps that sounds quaint to someone who has had one, but I had lost 3 babies in the prior 2 years and was terrified of losing another baby. Having to have a c-section was, for me, a variation of the complete loss of control that I had felt during my miscarriages, and so it terrified me. In class we worked through the emotional side of our fears: visualizing ourselves in the situation, then accepting the facts, trusting my OB to provide appropriate and competent care, and focusing on the good things in the situation rather than on the negative ones. It was a hard day of class to say the least, but I came out of it feeling stronger and more prepared to deal with whatever may come.
In the subsequent weeks I did some studying on c-sections and made decisions about which kind of anesthesia I would prefer and who I wanted present if that was the path we had to follow. At the end of my 2-page birth plan I wrote the following:

If the baby is breech

• I would like to try to deliver vaginally, regardless of presentation
• Even if a cesarean seems necessary, I wish to go into labor on my own, rather than scheduling the surgery in advance.

If a Cesarean become necessary

• I prefer to have a spinal rather than a general anesthesia
• Give the baby immediate skin-to-skin contact—with me or with dad.
• Please ensure that [dad] is able to remain with baby while I am recovering, and let me be with my baby again as soon as is practical.
• Stitch the layers of my uterus separately. [Believe it or not this is an issue, as some OBs prefer to do it in one step, which can increase the risk of uterine rupture for future deliveries.]
• Please adhere as closely as possible to our other ‘after the birth’ wishes.

Thankfully, around 34 weeks Bear decided to flip over into the standard vertex (head-down) position, and I was able to remove the “if the baby is breech” portion from my birth plan before giving it to the hospital staff. I left the cesarean part though. It was not an issue for that birth, but I felt better knowing that it was there, and I have written something similar for this time around.

Of course I hope that my contingency plans never have to be realized, but in case they do, I feel better knowing that I have educated myself about the options. More even than that, I am glad that I have dared to think about the possibilities. I think that one of the most traumatic aspects of a traumatic birth is the shock of it all, but if the mother (and hopefully father too) have emotionally prepared for variations from the ideal plan, then the element of shock is lessened, and thus the trauma can be too.

38 Weeks -- "Full Term" and the henna

Estimated due dates are just that--estimates. For years a baby has still been considered "on time" if it was born anywhere between 38-42 weeks. The formulas uses to estimate due dates are not always reliable, and some babies just seem to need a little longer in the oven than others. ☺ In more recent years, some providers have begun to consider 37 weeks as full term, or at least close enough to full-term that the baby will not likely have complications as a result of prematurity, however 38 weeks is still pretty standard, at least in my book.
So, today makes me full term.

And just as a note, the third trimester (particularly this last month) is the one time in my life when I don't feel like a large-busted lady...somehow the belly manages to overwhelm even my generous endowment for a few weeks. Of course, as soon as the kiddo arrives my belly will shrink and my milk will come in and I will be more top-heavy than ever. Ahh the irony!

It’s the calm before the storm. Changes in your baby's weight have leveled off with only a few ounces of fat added this week. At this point your baby should weigh in at around 7 lbs and 20 inches (with boys somewhat heavier and longer than girls). Happily, as far as internal organs go, they are now developed enough to function in the outside world although the oh-so-important immune system is still developing and will continue to do so after birth. With a large boost of antibodies provided by breast milk when nursing begins. Fighting infection and staying healthy should be well within their physical capacity when your little fighter is born.

Your health care provider will assess the likelihood of where you are relative to your upcoming birthing process—seeing as you’ve now arrived at that waiting phase that could turn into labor at any time. Various charming indicators such as loose stools, expelling your mucus plus (along with the bloody show), a dilated cervix and increased Braxton-Hicks contractions are all signs that labor is only a few days away. The infamous water breaking may or may not be your first true indicator that labor has commenced. However, water breaks for only 15% of mothers and despite what Hollywood would have us believe, is more frequently just a slow leak rather than a large gush.
(But I have a plastic sheet on my bed under the sheet just in case, so that I don't ruin our new mattress!! ☺)

Yesterday I saw my midwife and asked her if she'd do an internal check (she doesn't do them until ~39 weeks unless the mother asks). The baby's head is at a -2 station (2 cm above the pelvic bone) and I'm 1 cm dilated but very very soft. That means that once he comes down enough to engage (put pressure on my cervix) things will probably move right along, but for the moment nothing much is going on. I've had a few pretty good contractions (Sunday night I had several strong ones quite close together and started to wonder if labor was starting) but they have never continued more than half an hour. So I know we're getting close, but 'close' could mean two days or two weeks. It's normal to dilate a cm or two (or four) in the weeks preceding labor, and it doesn't mean that labor is imminent.

Be patient: if labor doesn’t start this week, or even next, keep in mind that only 4-5% of women actual deliver on their predicted due date. What’s more if this is your first pregnancy, you can expect to be anywhere from two days to two weeks late. You can distract yourself by keeping track of fetal movements, mostly to reassure yourself that all is well with your little miracle. In the off chance that movements do start to decrease substantially, try not to freak out and instead, call your doctor of midwife and discuss it with them.
If you're having trouble sleeping (which about 100% of women in this phase of pregnancy are), try to take little catnaps during the day, get one of those neato full-body pregnancy pillows, or at least lots of pillows that you can shove between your legs and under your belly to support your awkward shape more comfortably. Also, if you're feeling weird electrical tingles in your legs and inside your vagina, this would be none other than your not-so-little baby hitting various nerves as they settle into the pelvic area.

~♥~♥~♥~♥~♥~♥~♥~♥~♥~♥~

Last weekend I gathered some women in my home and we put henna on my belly. Some of you may remember that I did this last time I was pregnant, but I am much happier with the results this time--I like the design better, and the stain is much darker and should last better as well.
(Yes, I have managed to acquire a few new stretch marks this time--they didn't start coming out until these last couple of weeks, but all along the top there is a new little row...yet another reason for me to think that Eagle is bigger than his brother Bear was...)

(with the paste on--including the glitter dust)

Here's a short breakdown of the reasons behind the design:
The spiral is a symbol of eternity (significant in that this baby is being born into an eternal family)
The sunburst is a symbol of birth or new beginnings
Each of the little symbols within the spiral were either drawn by my friends/family who attended, or represent those that could not attend.
♥Dragon (lower left) is Hubby
♥Car (center) drawn by Bear (he made some little circles then told me it was a car and asked me to "fix it better" so I did)
♥Mountains (lower right) drawn by Wolf. He said they weren't very good (applying henna takes a little practice) but I can see mountains, can't you?
♥Flower (bottom center), pink butterfly (just above flower), and baby with aura (upper left) were drawn by my friends who attended.
♥Forget-Me-Not (blue flower--upper right) is for my mother. Horseshoe, (purple) celtic knot, and the heart are for my sisters.
♥The leaf (for new life), the concentric circles (for birthing), and star (for light) round out the design, with a few little artistic dot trios to fill in the empty spaces.

(after the paste was off--the actual stain of the henna)

I love this picture...we used glitter dust on parts of the wet henna, and the boys were blowing off the excess so we could take the photos...

On Birth Plans

Some people love them, some people hate them, and some doctors even post notices in their offices that they won’t allow them; but one way or the other most pregnant women have probably heard of writing a birth plan.
What is a birth plan? Most simply put, it is a way for the mother/parents to make her/their preferences known to the birth providers. The typical care provider has many patients at any given time, and can’t really be expected to remember every little thing that you want for your labor and delivery. Some attendants (such as hospital nurses) don’t usually meet the mother until she is already in labor, and have no way of differentiating her from any other laboring woman. Particularly if you want something that breaks from the routine of your chosen provider or location, it’s good to have it written down so that everyone knows.
I have heard some mothers say “oh, well, I’ve had babies with this provider before and everything was great last time” or “but I’m having a homebirth” and they assume that this means they don’t need to write anything down. As I said before though, I think it’s always worth writing things down. YOU may remember your last birth with clarity, but I suspect that Dr Fantastic has attended a few hundred deliveries since then, and he may or may not remember yours very well. Likewise, your adored midwife may have to send her partner if you go into labor at the same time as another mother, and she can’t very well be aware of your contingency plan preferences if you never tell her about them!

Every birth plan is a little different, but here are some basic suggestions for what might be included on one:

• Your name (and—in a hospital—your provider’s name) should be right at the top. You don’t want your plan getting mixed up with someone elses!
• Vital medical information such as allergies, high-risk status, or special concerns about yourself or the baby.
• Who you want present for the birth (or if there are certain people that you want kept out).
• Your preferences for labor—lighting, noise/music, privacy, eating, IVs, internal/external/intermittent fetal monitoring, movement, medication, attendants, etc.
• Your preferences for birth—episiotomy, birthing positions and locations, watching with a mirror, touching the baby’s head during crowning, who will catch the baby, etc
• Your preferences for immediately after the birth—cutting the cord, announcing the sex of the baby, skin-to-skin contact with the newborn, breastfeeding, and standard newborn routines (such as bathing, medications, tests, and shots).
• Your preferences from birth until discharge—rooming with the baby vs the nursery, visitors, binkie-usage, circumcision, or early discharge.
• Your contingency plans/preferences (more on that in a coming post)

Here are a few tips about writing birth plans:

• Keep it simple & short ~ I used bullet points. The version I gave to my doula and doctor was 2 pages, and I went over the items with them each at prenatal appointments. I made a 1 page version for the hospital staff because a nurse had told me that they don’t ever have time to look at multiple pages, and rarely even finish the first one!
• Keep it positive & polite ~ Try to word things with “I prefer____” rather than “Don’t do ____” because the last thing you need is for your attendants to feel defensive. I used phrases like “If possible” “I would prefer” and “Please.”
• Keep it practical ~ Realize that your choice of provider and location is going to dictate a few things, so if you’re birthing at a hospital try saying “I prefer minimal vaginal exams” rather than “Don’t do internal exams unless I ask for them”
• Bold or underline the vital things ~ Remember how they won’t have time to read the whole thing? If you have any drug allergies, put them top, center, and underlined. If you can sum up your other desires in one sentence, put that top, center, underlined, and boldfaced! (Mine was “Please discuss with us the benefits, risks, and alternatives of any procedure before doing it to me or the baby.”)

Forming Opinions of Birth

I remember one morning, when I was three and a half, sitting on the end of my mom’s bed with my two-year-old sister. I had a flashlight, and every so often I would turn it on and use the light to peer at the little tunnel from which Daddy said that our baby brother was about to be born. I confess that I don’t actually remember watching his birth (although I know I did), but I remember the excitement of being there.
For various reasons I missed the next two siblings’ births, but at ten and a half I was wakened early one morning by my brother (the one I’d seen born) bursting into my room with the words “mom’s dilated to a six!” I remember that birth much more clearly, as well as the ones that followed two and five years later.

Birth is part of life, and I find it sad that in our culture it is so often hushed up or hidden. There is nothing dirty or shameful about birth. There should not be anything scary about it…and yet most women go into their first labor with little but screaming media renditions and horror stories to guide their expectations. How much more confident would we women be if we had been present for several births prior to doing it ourselves? How much more quickly would older siblings connect with the new addition if they witnessed the birth and even got to participate in things like cutting the cord or announcing the sex? (Wolf cut Bear's cord, and has requested to do so for this baby too.)
I know a number of women who invite their teen or pre-teen daughters to attend the birth of a younger sibling, presumably with the rationale that said daughter is nearing her own childbearing, but I wouldn't dream of limiting attendance to just daughters or only those over a certain age. In my experience it is the smaller children who actually show the most interest, and why not take advantage of their impressionable age to let them form their first opinions of what birth is? Imagine the impact we might have on our culture's concept of birth if little children of both sexes grew up comfortable with birthing! Imagine if not only the future mothers, but also the future fathers, and the future doctors, midwives, and nurses all had witnessed a birth (or several) prior to adulthood.

Some women have told me that they think their children would be upset at the sight of mommy in pain, or would be distressed by “all the blood.” I suppose every child is different, and perhaps some would not do so well at a birth…but my tenderhearted Wolf showed nothing but excitement when he watched Bear’s birth, and both boys have informed me in no uncertain terms that they want to see this baby be born.
Obviously I would not force a child to be present if they didn’t want to be...but I hope to always keep the option open for my children. I do take the time to explain the physical process of birth (the baby is in mommy's uterus, the uterus will start squeezing to get the baby out, the baby will come down and out through a tunnel called the birth canal). Depending on the age of the child, we might look at diagrams or photos in books to enhance their understanding.
I also try to help them understand some of what will happen (mommy will be working hard, so she might make weird noises or be loud because she's working. She might be tired and sore and won't be able to hold you or play with you while the baby is coming. There might be some blood but it's ok because nobody is hurt it just goes with the placenta...)
I also show them some birth videos--yes, graphic show-it-all videos. I preview them first of course, but I think it's healthy for them to see that one woman might just hummmm and another might scream and holler and it's ok either way. I think if they see it on film first it helps them be comfortable with whatever may happen in real life.
Finally, I arrange for a "kids' doula" or babysitter...It's not truly a babysitter, because I'm not sending the kids away to be babysat. It is someone that they feel comfortable with and that I feel comfortable with, who can attend to their needs (food, sleep, play, etc) during my labor, answer their questions, take them out if they feel uncomfortable, and make sure they able to see as much as they want to see.


So, I'm curious what you think. Did you ever get to witness a birth before you were there as the parent? Would you invite your children to witness their sibling(s) birth(s)? What sorts of preparatory measures would you utilize?




Incidentally, lest anyone think that this sibling-attendance thing is limited to homebirths, or birth center births, it's not. Bear was born in a hospital. Being in a hospital or other such facility makes it all the more important that there is someone specifically designated to supervise the siblings, but they can still attend the birth.

The BRAN Principle

Anytime one needs to make a medical decision nope, scratch that, most any decision, I believe it is important to consider all the sides of the issue. Unfortunately I find that very often people read one article or hear one story or one recommendation from someone they trust and then they just go with it without asking any more questions. I have a humanist perspective in that I don't think that anybody out there is deliberately trying to spread medical misinformation, but since there is so much conflicting information then it seems pretty obvious that the issues are more complicated than any one party is willing to admit. Thus my belief in studying it out for myself and then utilizing the BRAN principle.

In my childbirth class we were introduced to the "BRAN principle" which is to consider each potential course of action in light of the Benefits, Risks, Alternatives, and what would happen if we did Nothing (for the present). For example, while laboring with Bear I stalled out for several hours. I was having regular contractions, but was not dilating because the baby had floated up and there was no pressure on my cervix. The doctor said he could break my water, but if I didn't want that then I should go home because I wasn't progressing. He knew I was wary of interventions, so he gave me the choice. Well, the benefits of breaking my water were that the baby's head would re-engage and labor would almost certainly get moving. The risks were that without the water cushion labor was likely to get much more intense (which might affect my hopes for an unmedicated labor), and if labor did not progress as anticipated then broken water means an increased risk of infection, and thus a timeline for delivery (which could lead to needing pitocin or theoretically even a c-section). The alternative was to go home and try to rest and/or get things moving with the water sack intact. If we did nothing for the time being, well, that would mean going home. I knew that labor had to get more intense before the baby could come, and that because of the regular (if ineffective) contractions I wasn't going to be able to sleep anyway, so we opted to break my water. Was it interfereing with nature? Sure. Was it a good choice? I definitely think so. But most importantly, it was an informed choice.

Here in Alaska the public health department conducts regular screenings for Tuberculosis. It's an ugly disease, and one that has apparently held on here more strongly than in the rest of the country. I have never hesitated a moment in giving my permission for my children to be screened. If a screening comes back positive, that indicates that the person has been exposed to TB, so then they do another screen (a chest x-ray) to look for signs of actual infection (past or current). If the person has signs of infection, they put them on a medication. So far so good--I'm entirely comfortable with all of that. However, if the person does not have any signs of infection, the health department still wants to put them on 9 months of medication as a preventative/suppressive measure, in spite of the fact that the original screening has a certain rate of false positives (only some doctors will recommend re-screening before medicating). The downside of the suppressive medication is that it carries a risk of giving the person Hepatitis (aka liver failure). So they also prescribe vitamin B in an effort to prevent that possibility, and most doctors will do a blood test a month into the regimen to ensure that the liver is, in fact, not failing.
So wait, if the screening (which is safe, but may or may not give a false positive) comes back positive, then they will do an x-ray (which is more or less safe), and then regardless of the outcome of that x-ray they will prescribe a medication which is clearly only sortof safe?! Whoa, stop the train here, I think I needed to get off a couple of stops ago. Yes, I understand the desire to keep TB in check--I'm not arguing that point--but for someone with a clear x-ray, doesn't it make sense to require a second screening just to make sure before starting someone on a 9-month regimen of a medication that might kill them?!

Most medical actions (be they medications, procedures, or vaccinations) have some fairly clear intended benefits. Some have varying efficacy rates, so actual results may vary a bit, but the intended benefits are obvious. In many cases, the risks are not hard to determine either--some are decidedly larger than others, but pretty much any kind of action has some degree of risk. I think that most people are at least somewhat aware of these two sides of a choice. The parts that seem often overlooked are the alternatives (opting-out of the choice altogether, doing something else) and the always available option of doing nothing--at least for now.

Is that so very odd?



As my readers may have noticed, I have not shared my thoughts on swine flu nor the vaccination for it, nor do I intend to do so. I genuinely believe that it's best for each person to do their own study and make their own choice. However, the BRAN principle came to mind for me recently during a discussion on facebook, so I thought I would share it as something that is one of my guides in making these kinds of decisions.

You Might Be 37 Weeks Pregnant...

...if you desperately have to go to the potty, and when you get there it hits you that you did this just 20 minutes ago.
...and you can't make much of anything.
...and even after emptying your bladder it doesn't feel much different.
...if you've definitely got that waddle goin' on.
...if you can't get comfortable on any couch or chair in your house, and have taken to carrying around an exercise ball (aka "birth ball") to sit on instead.
...if all the baby everything in the house is washed, the crib is set up, and you've made up your bed with an old shower curtain under the sheet (in case your water breaks in the middle of the night) because you don't want to ruin your new mattress.
...if your hips feel sortof loose and sore, like you just spent 20 minutes in a deep yoga squat...except you didn't. (That's the relaxin kicking in--getting everything nice and loose so the kiddo can slide through!)
...if you can feel that head nestled in your pelvis, and that foot pushing on your rib, and see one half of your belly sticking out further than the other half because that's the side where the kiddo's back is.
...and you can see precisely where his little bottom is, so sometimes you pat it because you know it's cute even though you can't see it yet.
...if you need to pee at least once and often twice every night.
...if getting out of bed is a production, especially if it involves rolling over, and you know that if you were so short-sighted as to lay down on the floor you might never ever get up again.
...if you feel a renewed commitment to taking your red raspberry leaf, cod liver oil, probiotics, and drinking lots and lots of water.
...if your dinner appetite is about the same as the two-year-old's (because your stomach is also about the same size).
...if you feel tired pretty much from the time you wake up, and yet you have these weird bursts of energy wherein you deep clean the bathroom or wash all the towels and sheets in the whole house.
...if you got three times the normal number of braxton hicks yesterday (including a couple strong enough to count as honest-to-goodness contractions) because your body seemed to know that 37 weeks is officially "full term" and therefore in the clear for labor to start.
...if you have to go to the potty again.


So, how has your week been?!

If My Blog had a Bumper...

I don't put many bumper stickers on my car because, while I like reading bumper stickers, I also don't want people tailgating me in an effort to read mine... (I don't really wear logo t-shirts or I might share these thoughts in that way.) However, I still like the little "this is me" vibe that is put out by bumper stickers, and since I presume you are not driving while reading my blog (you had better not be!!) here is a collection of bumper stickers for my blog...



Honestly though, if I could just have one sticker actually on my car, it would probably be this one:

Facebook Friday

Monday 10/5
Jenni's toddler ate plain peanut butter out of the jar for breakfast. Hey, it's what he wanted, and protein + some fat = good breakfast, right?
Wednesday 10/7
...just got kicked in the ribs. She doesn't remember the last kiddo ever kicking quite so high, OR so hard. [This was also the day I got my first contraction that was actually uncomfortable...must be in the home stretch now eh?]
Thursday 10/8
...is making plans for pie night next weekend, and a henna party (to paint my big belly) the weekend after.

Monday 10/12
...dropped of hubby at work this morning, and when I got home I found two moose in the neighbor's front yard. By the time I'd gotten the kiddo into the house we looked out the window and saw a third moose--a big bull--walking along the street ...within a few feet of our van! The dog went nuts, and the kiddo and I went back outside and took pictures!

Tuesday 10/13
...is hitting that point of not sure if I want the baby to hurry up already or please please please stay in for a couple more weeks so I can get stuff done.

Wednesday 10/14
...is debating which kinds of pie to make for pie night on friday...I'm thinking a chocolate velvet and a lemon cream cheese...

Thursday 10/15
...feels energetic this morning! What's up with that?!

...Today is Pregnancy & Infant Loss Remembrance Day across the world. Consider taking part in the global 'Wave of Light'. Light a candle at 7pm to join us in remembering all babies that have died during pregnancy, at, during or after birth. Post this as your status to show your support

Time Out & Time In

I think I have written about this before, but I don't know where it was, so I'm guessing it wasn't here on my blog...therefore I'm going to write about it again.

When I read Unconditional Parenting I was introduced to the notion that time out is not really a gentle method of discipline, because even though it spares them physical pain, it involves emotional withdrawal--or the withdrawal of love. For some children this is intensely painful (thus effective...and yet cruel), and for other children this is no big deal. I think most of it has to do with the child's personality--whether they are introverted or extroverted, craving privacy or interaction...but all of that still doesn't give an answer to the underlying question: if time out isn't working for you (either because it is too much for your child, or because it is too little) then what alternatives are there?
When I get to the "what now?" part of parenting, I always try to step back and ask myself the big question: What is my real goal in raising these kids? What do I want them to learn? What kind of people do I want to influance them to become? As I've stated before, my goal is to help them become thoughtful, conscientious adults. So how do I help them do that? I have transitioned away from using "time out" and now I typically try to use "time in."

Time out typically means setting the child on a chair or stool, usually in a corner or other out of the way place. They are ignored and they are not allowed to play or talk as they serve out a sentence of minutes. The goal with time out is that the child will calm down in this setting, and also that they will feel bad about what they have done and therefore not want to do it again.

Time in is only vaguely similar to time out. The way I do it does usually involve a chair, but depending on the situation, location, or age of the child, it may just be sitting on my lap, or sitting next to each other on the floor or couch. It does involve physical stillness--I find it more effective than time out ever was in helping a child calm down when he has been out of control. The big difference is that I am with the child, rather than ignoring him. With a small child I take him in my lap, hold him, may play with his hand or rub his feet, and I talk with him. With an older child we may sit side by side, or (if I'm in the middle of something) I may pull up a chair near where I am working and he will sit on the chair while I continue to work. With the physical stillness established, we discuss what happened, and why it was a problem. Depending on the situation (and age of the child) we may discuss what would be better choices to make if/when such a situation comes up again. We often talk about other things--things that are unrelated to the situation at hand. I try to use the time-in to reaffirm our relationship and my love for the child. Often hugs or other playful interactions are involved. I don't set a specific time frame for a time-in, but I try to continue it until the child seems to be feeling better and appears likely to be able to deal better with the world around him.
With an older child (preschool age onwards), sometimes I address what needs to be addressed and I can see that he just needs a little quiet time to process things or work through his feelings before he'll really be ready to be on his way. In those cases I typically say something along the lines of "Well Wolf, we've talked about the things that were concerning me, and the things that were concerning you. However it doesn't look like you're quite ready to be gentle with your little brother yet," [usually a glare at me will confirm this]. "Let's have you stay on the chair a little longer until you are ready to get along with him...I'll stop bugging you, but when you think you're ready to go just let me know." He is welcome to be silent, or to chatter to me on any topic, meanwhile he remains in my (hopefully calming) presence...and when he thinks he's ready to go then I'll tell him to go ahead. It's true that an emotional child isn't always the best judge of when he is calm enough to play nicely, but it's good practice for him to try, and if he says he's ready, and I send him on his way, and 2 minutes later he needs to come back for some more time-in, well, then he can come back for some more time-in. ☺


ETA
I'm not sure how clear I made this, so I'm going to try to restate it...
Yes I can see that giving a child love and attention after they misbehave may seem counter-productive. After all, we've been culturally trained to believe that a misbehaving child needs to be punished, and showing love isn't a punishment! However, think about it this way: the real goal with disciplining children is to teach them to behave--so we should do what works, rather than worry about what is 'normal' or even what seems 'logical' according to our social training. According to scientific studies, punishment is actually one of the less effective teaching methods (at least for humans). Therefore, why punish individual infractions (and then punish them again and again) if it's possible to just solve the problem that raised them in the first place?
My experience has been that time and space to calm down are important, but that showing love is never out of place, and that traditional 'punishments' often are.

35 weeks, or, OHMYGOSH I HAVE SO MUCH TO DO!

No, I don't really have that much left to do...but when that nesting instinct kicks in, it really kicks in!
I think I mentioned a lot of these before (because they've been done for a while) but all the blankets are washed and in the drawer. All the small cloth diapers are out (though I am thinking I'll give them a prewash, even though of course I washed them all before putting them in the box!). All the babywearing stuff is washed and in the drawer. I've been watching birthy movies and reading birthy books and getting my head into labor mode (as much as I can!). I'm working on a list of things I want to remember (or have someone else remember for me) during labor. (Last time I had a whole birth plan written up and given to my OB by 28wks, but conversations with my midwife have shown me that I don't need to be nearly so formal, and that her 'standard procedure' is much closer to what I want so I don't need to lay things out so specifically for her.)
Labor and birth are feeling very close now. Bear was born at 39 weeks, and I have a gut feeling that Eagle has a good chance of coming on the earlier side as well. I don't believe in doing anything to try to affect the timing of when baby chooses to come, but I just kindof have that feeling... I'm not nervous about labor or birthing, and I'm not terribly anxious either (in that I'm glad I still have a few weeks because I don't feel like I have everything ready!) but I do know that it's coming, and probably sooner rather than later, so I'm starting to think about labor as fairly imminent. (The frequent braxton-hicks are a good reminder of that too--and they've just continued to get more frequent in the last few weeks.)
I have not washed the little jammies and hats, so I do need to do that. I need to gather up the birth day stuff and get it into one place so that I'm not running around when labor actually starts. I need to assemble the crib (which, with one side off and scooted next to our bed, will be a co-sleeper). Otherwise, I'm basically just trying to savor the time I have now with my older kids, because I know that once the baby comes things will get busier.
Oh, and we need to find a middle name for the little guy. That's starting to feel really urgent to me.

Congratulations! You’re now carrying nearly 6 lbs of baby not counting their amniotic fluid, the umbilical cord, or the placenta itself. We’re impressed because that’s a LOT of work non-stop. Are you feeling proud of yourself yet? Well, get to it—you’ve done an amazing job! At this point, your little grower is almost busting out of the womb size-wise, which make their restricted attempts to move much challenging. Of course, your stubborn little sucker is still trying to move around as if he weren’t in a cramped space. And the accumulating baby fat deposits are starting to level off so your little butter ball will be padded and warm when he heads out of his super snug little home.

The baby is definitely filling up all the space in there. I'm feeling big and somewhat worn out. I'm looking forward to the little things like being able to see my feet, bend over to pick something up, or just roll over in bed without it being a major production. Of course I know very well that it's easier to care for a baby who's on the inside than for one that's on the outside, so I'm not about to rush him...but I will be thoroughly ready to welcome him out (and my normal little body back) when the time comes.