What Constitutes "Intervention" in Birth?

I had a really interesting conversation with a friend recently. She and I each had babies at home this last year. I was attended by a midwife, she gave birth unassisted (without a midwife). We were talking about why I chose to have a midwife, and discussing some of the things that happened during Eagle's birth. I mentioned when he became stuck, and my midwife reached out to work him loose. I (and my midwife I think) thought it was shoulder distocia, and thus felt that it was necessary for her to do something. As it turns out it was not shoulder distocia, but just a very short cord, which soon broke on its own and he came on out without assistance.
My friend said something about my midwife's putting her hands on him having been an unnecessary intervention. This raised a very interesting question for me--is having someone else catch the baby an 'intervention'? Sure, the baby doesn't have to be caught--he could slip out into the water or onto the bed (or onto the floor...it happens!) but isn't it gentler to be received into warm hands as he emerges? I suppose it is technically 'intervening' to cut the umbilical cord too, but even wild animals bite the cord to break it after the baby is born, don't they? How about using props for labor? A pool, a birth ball, a birthing stool--are those interventions? I think one could make the argument that something like a birthing stool 'intervenes' because it helps the mother maintain a position that she could probably not hold for long on her own...on the other hand, I don't think anyone would argue that it's a bad intervention. After all, being able to maintain an upright position can speed the progress of labor, and squatting shortens the birth canal which facilitates birth.

The Mother-Friendly Childbirth Initiative defines intervention as any "practices and procedures that are unsupported by scientific evidence." I don't exactly agree with that definition, as I'm more inclined to to agree with the dictionary and define intervention as "interfering with the outcome or course especially of a condition or process (as to prevent harm or improve functioning)." Intervention means interfering with the outcome or process, which obviously can be a bad thing; but sometimes something goes wrong and intervening is necessary, and not all such interventions are "unsupported by scientific evidence," but they are still interventions by definition because they change the condition or process.

So where does one draw the line? What constitutes 'help' (a good intervention) and what constitutes 'interference' (bad intervention)? I had never thought about this from this angle before, but it's a meaty topic. After all, I might see something as interference, but someone else (be it a mother or a provider) might see it as helpful. Take induction for example--I would avoid labor induction in all but the most extreme situations (and being 42weeks pregnant does not constitute an extreme situation in my book), but I know women who feel that they need medical assistance to go into labor. Obviously what I view as interference is an appreciated help in their eyes. On the other side, some women believe that having any birth professional present will interfere with their ability to birth ideally, and others practice lotus birth, and would view my cord cutting as interference. So I don't think it's easy--maybe not even possible--to draw a definitive line.

I believe that interventions--even big interventions such as epidurals or cesarean sections--definitely have a place. I had AROM (artificial rupture of membranes, aka my "water broken") when Bear was born. We discussed it and felt that it was a good idea considering the circumstances at the time. My water broke on its own minutes before Eagle's birth, which was nice, but I certainly don't think it was bad that we chose that intervention for Bear. During my first miscarriage I requested an IV painkiller and subsequently also got pitocin to move things along. I've had D&Cs for miscarriages too. One of my friends has her cervix sewn shut during pregnancy to prevent premature dilation--this is unquestionably an intervention, but it has prevented two of her children from being born dangerously early. Depending on the circumstances, I could imagine choosing any number of interventions for future situations.

In my mind, what separates 'interference' (bad intervention) from 'help' (a good intervention) or even just from the 'normal process' are two things:
First, the risks. Bad interventions have high potential for negative side effects, often outweighing any potential benefit. For example, pulling on the umbilical cord can help get the placenta out faster (though what is the need?), but it can also cause the cord to detach from the placenta, or cause the placenta to break, resulting in retained placenta, which then involves synthetic oxytocin (like pitocin) and/or the provider going in and literally scraping out the uterus. If the risks are substantial, then I view the intervention as an interference.
Second, evaluate what would happen without the intervention. Is this intervention unquestionably helping (improving the health or safety of mother or child?) or is it based on convenience, preferred timing, or lack of patience? Frequently, labor augmentation or cesarean sections are used because of "failure to progress" in labor, but since normal labors can last hours or even days, many natural birthers have begun to refer to this practice as "failure to wait" and consider those interventions unnecessary. Given some time, the vast majority of those "failure to progress" labors would result a vaginal birth (without drugs, and without surgery). On a related topic, many mothers choose induction of labor because they have reached or passed 40 weeks gestation. However I am not aware of any cases of a woman staying pregnant forever, so sooner or later labor will start! Some pregnancies just last 42 or even 43 weeks. 40 weeks is an average--an estimated delivery time--not an expiration date, (and while I appreciate that it is hard to wait, induction of labor is not warranted just because of a calendar date).

Using those two criteria, let me go back and evaluate the initial situation that started this whole thought process: my midwife's putting her hands on Eagle when he stalled in the birth canal.
Were there risks associated with her manipulating him? Possibly, though I believe they were minimal, as she was gentle and her intention was to 'unstick' him rather than to pull him out. What would have happened if she had done nothing? In this case, he still would have come on out. He likely would have broken his cord and been born into daddy's hands--which is what happened anyway. There is a small chance that he might not have broken his cord, and instead might have been born more slowly and brought the placenta with him. It would have meant he would have been underwater (and half-in/half-out) for longer, but so long as the cord is attached there is no danger in remaining underwater. Aside from the potential discomfort to me or stress to him of being wedged in the birth canal for an extended time, I think that nothing of significance would have been different.
Consider, however, if his stalling had been caused by what we thought it was caused by: shoulder distocia. In cases of shoulder distocia the baby is caught on the mother's pelvis, and will not come on out without assistance. If we had left him alone he would have remained stuck, and both he and I might have become quite distressed. At some point (later if not sooner) it would have been necessary for the midwife to reach in and work him loose.
So was she interfering or helping? Technically, her action was not necessary, or at least was not necessary in the timetable in which she acted (she could have waited and watched a bit before deciding to touch the baby). However, it was not harmful or risky. It did not really affect the overall process or outcome of the birthing. Finally, consider that she did not push Hubby aside when she reached over--he moved aside to invite her into the space. We chose and trusted her as our birth assistant, and in that moment he wanted her assistance. So I feel comfortable in designating her action as help rather than interference.

Violent Play--yay or nay?

After my recent post about how boys make everything into a weapon, I had some very good comments, and I wanted to follow up on the subject of aggressive/violent play.
Here are portions of several comments:

I was reading about how boys do seem to play with "weapons" even if they're not allowed to play with toy guns and the like. What I was reading suggested that parents allow their sons to do so without trying to make them feel shame for what seems to be a natural outlet for boys. Also: denying the play altogether has that "don't you wish you could" siren song that might just aggravate the situation, while left alone most boys grow out of the need to swashbuckle.

~

My mom learned from play therapy with [little ones adopted out of assorted troubled situations] that it's actually important to allow children that "violent" outlet. It's a safe and effective way children act out their aggression and face their fears, and parents need to just act along...
The kids have fun and are able to act out any bad feelings they have, with [mom or dad] being the bad guy and them being victorious heroes in the end. There's something about it that is quite empowering to them. Play therapy is very interesting stuff...

~

I've always found that no matter how much you try to "shelter" kids from violence, they still like to act it out and make believe such things. Of course, how you talk about violence and portray it in your own life will be shadowed by your children. It's your example that makes the difference.

These comments address three different aspects of violent play: it's just play, acting out feelings, and imitating example. So here are my thoughts on it all.

I certainly get that a certain amount of aggressive (even violent) play is normal and natural and even a healthy release...but even in play, I hope to guide my children in healthy directions, so that as they get older those healthy contexts are implanted in their brains. ☺

The first thing that matters is safety. One commenter mentioned taking a foam swim noodle and cutting it in half to make soft 'swords' for her kids to use. We have done something similar. We also have a good supply of soft beanbags (I fill mine with rice or wheat or lentils so they are softer than beans, I know moms who fill them with fabric scraps or batting!) We try to have safe spaces (no breakable stuff) for rough-and-tumble play. Of course we intervene if anyone is actually getting hurt or scared by the play.
We also teach gun safety. We do keep a hunting rifle in the house (it is kept unloaded, out of reach, has a trigger lock, and the ammo is kept elsewhere...but it's a gun). Even if you don't keep any guns in your home, you should teach your children these simple rules because you never know when they might encounter one.
The second thing that matters is diversity in play. Yes, I'll accept that it's natural to enact violent or aggressive things, however it's also good to play at peaceful things. So we have baby dolls (yep, even for boys--they'll be daddies one day!). We have play food. We have legos and lincoln logs and building blocks and a wooden train set. I teach them knitting and sewing and cooking as they get old enough to do those things too. So sure, they play at being warriors or hunters, but they also play at being parents, builders, and creators.
We also encourage athletic and outdoor activities so that they have plenty of non-violent outlets for their energy. I personally feel that martial arts classes are great (better than wrestling or boxing) because they focus on self control, safety, and a defensive mindset, while still being very cool "fighting" classes.

The final--and in my opinion biggest--thing that matters is the thoughts behind the behavior. Contrary to the old saying, I believe that good intentions DO matter when dealing with children.
We've adopted a household policy of following the "law of the jungle" (which is that it is ok to kill to eat, or in self-defense). We try to follow this both in real life and in play. We also talk about scripture warriors like Gideon, David, and Moroni. We discuss how they followed God's word about defending their family/home/freedom, but how if they took the offensive then they lost His help. Sometimes we talk about samauri or knights and the codes of honor that traditionally went along with being a warrior.
So, according to the law of the jungle, hunting is ok--so long as you intend to respect the animal by killing cleanly and using all the parts. Fishing is the same (though that doesn't surface as often in their play!). When we hunt/fish or otherwise slaughter our own meat we involve our children in this process. (I admit that I am thoroughly squeamish about doing my own butchering, but I believe I would be hypocritical to eat meat if I were not willing to be part of the whole process, and since we have chosen to be omnivores, this is what we do.)
War games are ok in play (such as legos, army men, fencing, wrestling, beanbag wars, balloon fights, foam swords, etc). When they are playing that way, we revisit the scripture warriors. We don't allow video/computer games that involve hurting or shooting people (animal shooting would be ok as per the hunting thing, and target practice is fine). We don't allow any games with blood (realistic or fake-looking) or that otherwise glorify death. We do not watch or allow violent movies for young children (as they get into their teens we intend to allow a few specific films with realistic historical depictions for the educational value).

So there you have it.
What are your thoughts?

Five Things They Left Out of Health Class

There are a few things that seem to get left out of anatomy, health, or sex ed classes. Things that I learned much later, and wished I had known much earlier. So I'm just going to put them out there...

1) The Fertility Awareness Method (FAM) is not just for avoiding/achieving pregnancy. If you have irregular periods (or even regular ones) it can help you track exactly what is going on with your body from one day to the next, and help you predict--usually with very high accuracy--what day your next menstruation will begin. You don't have to be caught off guard. Ever.

2) A woman is only fertile a few days per cycle. It's also possible to track which days those are by using FAM. With that said, your body wants to get pregnant, even if you don't. It's wired for procreation. During the few days that you are fertile your body does multiple things to encourage pregnancy, including creating natural lubricants, opening the cervix, and having higher libido. So let me repeat, you are only fertile a few days per cycle, but typically your body is trying to beat the odds anyway.

3) Breastmilk doesn't come out of just one little hole--there are several tiny holes (5-10 in fact) on each breast. So if you go to shoot milk across the room (which often happens accidentally!) it may well look something like this ------>

4) Most girls are not symmetrical in their girlie parts. Since most of us don't look at anybody elses parts we don't know this, but yes it's normal. Most girls' breasts are not a 'matched pair' either.

5) At least one in four pregnancies ends in miscarriage. It is almost certain that you or someone you love will miscarry. Be educated. Be sympathetic. Don't pretend it isn't there.

Things My Mother Taught Me

My mother taught me a multitude of skills: sewing, needlepoint, cooking, childcare, housekeeping, gardening, food preservation, the list goes on and on. But this post is not about skills, it's about the things my mother taught me about life and how to live it. So, in no particular order, things my mother taught me:

(me, age 2, with my mommy)

Ask questions. Never assume that the status quo is the only way to do something.

Learn things for yourself. Make your own decisions.

Choose your own life. Be your own person. Don't feel obligated to go to a certain college or study a certain subject or give birth in a certain way just because somebody else did.

Whatever you choose to do (from a chore to a career), do it right and do it well.

Never stop learning. There is always something new to learn.

Trust your feelings. If someone tells you something that feels wrong, you don't have to believe them.

"A change is as good as a rest." If you can't stop, at least do something different for a while, and the change is as rejuvenating as a break.

It is worth whatever it takes to marry in the temple.

Each season in our lives has a different purpose and focus. In our youth we have a season to focus on ourselves, and we should live it up because as we grow older we will need to be focused on others.

With that said, take care of yourself. If you don't take care of yourself, you won't have anything left to be able to give.

What you think of yourself matters more than what anyone else thinks of you.

You can't kiss a baby just once.

Fast games are good--you can play several of them in an afternoon and still be able to change the baby and do dishes and make brownies in between.

If you can't find what you want, make it.

Breastfeeding is a good time to read books.

If it doesn't matter in the eternal picture, then it doesn't matter much at all. Don't bother getting into a huff over something that doesn't really matter.

People are more important than things, and family are the most important people of all.

There is no such thing as too many cuddles, too many children, too much laughter, or too many books.

Friday Feel Up

Self Breast Exam time.
☺

April FOs

Finished Objects for April:

For self/family

• altered a pair of pants I've been meaning to alter since I bought them *ahem* 9 years ago
• finally frogged out the too-tightly stranded part of Wolf's sweater and have started re-doing it
• knit a 'ski mask' type hat for Wolf (I need to rework it, as I started the decreases too early)
  

For sale (photos linked)

• Sea Turtle Diaper
• Strawberry Fields Forever diaper
• 2 custom solarveil hats (yay for custom orders!)
  
• 1 more solarveil hat for the shop (I've also set up several custom listings for these, since customs seem to sell faster than the ready-made ones!)
  

I miss my brain

I would like to call them blond moments...but I'm not blond. It might be easier if I could blame this month on my hair color... Or call them "senior moments" and blame them on my age. But at 28 I don't think I can get away with that. Post-baby mommy brain-melt? I don't know what to call it. But suffice it to say that this last month I have had more than the expected number of extraordinarily brainless moments.

It started with the pan. You remember the pan? Nice, steel pan and I melted the thing.

Then I had run out of shampoo, so I bought more. Actually I needed conditioner too. So I went to the appropriate part of the store and was opening and sniffing bottle after bottle (3/4 of synthetic scents give me headaches, so I have to be very picky with my shampoo). I found two citrus somethings and brought them home. It was not until the 3rd or 4th time that I used my new products that I noticed something...
They were both shampoo. Well, one was clear and one was opaque, it looked like a shampoo and a conditioner! But it wasn't. No wonder my hair had been so unhappy. I had blamed it on the post-baby fall-out, but obviously that was only a part of the problem, and most of the blame belonged to my lack of brain.

So then Wolf had a big overnight field trip across the bay with his 4th grade class. They went to a marine biology field center to study tide pools and other groovy ocean stuff. When he got home he--and all his stuff--smelled like old seaweed. Of course I had expected that, and put everything straight into the washing machine. What I hadn't noticed was the red hat... so for the first time in my life, I turned white socks pink in the wash. I never did it in college, never when I was new to laundry...but now I did. They were new socks too, and of course they belong to my son rather than to me. I could wear pink socks, but a 9 year old boy will get teased unmercifully if he shows up to school in pink socks. And they are very pink. (Fingers crossed that oxy-clean will save them!!)


I know everybody has moments, but three in three weeks, well, it leaves me feeling a bit dense.

Femininity vs. Feminism

Once upon a time women in this country were repressed. They were not just "the gentle sex" or "the fair sex" but also "the lesser sex." They were beaten and abused and in most cultures had few if any rights. Once upon a time suffragettes marched for the right to vote. Had I been alive, I would have been there right beside Cady Stanton, Susan B Anthony, and Amelia Bloomer, demanding that women be allowed to dress as they pleased and vote in elections.Once those rights were secured, women began pushing into other things that had previously been male-only domain. They demanded easier access to education, and the right to work. They instigated legislation to punish perpetrators of domestic violence, abuse, and sexual harassment. Were these fights still being fought I would be standing there beside the fighters.

With equal rights established however, the movement called 'feminism' began to push for other things. It began to focus on cultural acceptance and approval for crudeness in language and behavior. It fought for--and won--the right to abort babies without medical reason (where are the rights of the unborn women?!) It fought to teach women that they cannot be complete or fulfilled unless they have a career outside the home, and to preach the notion that keeping a home and raising children is inferior to having a career. In other words, the feminist movement began to undermine all the things that made women unique. In the quest for 'equality' feminism has pushed so far and so fast that it has gone far beyond the mark, so that now women are fighting, not for the right to be women, but for the right to be men; or, more accurately, to be more than men. By demanding sameness across the genders, women are forfeiting the things that make us special and unique. In order for masculinity to be valuable, it must be balanced by femininity! As the movement of feminism gains strength in the world, femininity is losing the ability to be a moderating force in the world, or to create balance between masculine and feminine. This is not empowering anyone; it is stifling everyone.

I am staunchly feminine, staunchly pro-woman. Therefore, I can only conclude that in this country, and at this stage in history, I must be anti-feminism.

There are fights worth fighting, even still. Women are being held down in places like Afghanistan and what support we can give is worth the fight. Women are victims of domestic abuse in our own country, and what we can do to support and help them here is of course worth our while. However the larger 'feminism' movement in this country has lost the nobility of purpose that once guided them. They have turned toward anger and vulgarity to accomplish their goals, and their goals are no longer positive or even things worth fighting for.
If you dare, you might check out the post "I HATED The Vagina Monologues and So Should You" (disclaimer: the play--and therefore the post--have sexual content including pedophilia, rape, lesbianism and prostitution).

I conclude with a link to two inspirational blog posts:

• The truth about Women that Feminists Don't Want You to Know, posted at Ladies Against Feminism: Promoting Beautiful Womanhood. I don't agree with everything written at that site, but I find that I agree with them more often than not. Their post talks about powerful historical women, and how they did not need feminism to be who they were and accomplish what they did. I found it inspiring to review examples of powerful women who gloried in womanhood, motherhood, and homemaking.
• Returning to Motherhood: One Solution for the Economic Crisis, posted by my friend at MotherLoverGoddess. I don't agree with everything she writes either, but I think this post makes excellent points about women in the home verses women in the workplace.

Beltane Bonfire

A local group put on a bonfire at the beach last night. Their intent was to raise awareness because April was "domestic violence and sexual assault awareness month." They spent a little while on that, but then much of the evening turned to drumming and roasting marshmallows and playing on the beach. I certainly support the group's cause (you can see in the photos some people with candles), but we also thought it was nice to spend a seasonally significant evening in nature with a bonfire. (The flames were not big for long, but it was putting out a lot of heat!)

Bear tossed a football with daddy,

and Hubby (and Wolf) got in touch with their Scottish heritage by throwing around some logs.

Medieval Meal

We've talked about doing this since before we were married, but somehow never actually did it until this year...

No electric lights, no forks, no spoons. Just a 'dagger' (steak knife) per person, some meat and veggies boiled in a pot, and a big blob of bread.

Corned beef, potatoes, carrots, all baked in a cast iron dutch oven (which I confess I put in the oven because I didn't feel like building a fire)

Honey Oatmeal bread, also baked in cast iron. We ripped off hunks rather than cutting it, and used it to sop up the juice from our meat. Mmmm, so yummy!