MAYD to Birth: At Your Doorstep

Promoting gentle, empowering mother journies…

Camping

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we spent the entire weekend in the woods and i feel oddly recharged and exhausted, if such a thing is possible. like, a pleasant sense of exhaustion that comes from hard work i guess is how i would describe it.

friday we left after securing the dogs weekend plans and david had come home from work. we drove to southern ohio to hocking hills (a pleasant +1 hr trip). to our shock when we go to our check in we realized i had made a little boo boo and our camp site was the sort you leave your car, throw your gear on your back, and hike into the woods. needless to say it was 90 degrees and we had to take 3 trips, which was a 1 – 1 1/2 mile trek into the woods. oy vey.

david was in a sour mood, after a long, hard day at work and now this. we pretty much threw up the tent and collapsed in a sweaty pile. the night was pretty bad. i could not get myself to fall asleep and when i did, i woke up having a “serotonin surge” (uncontrolled, unprompted rise in heart rate, tingling, dizziness, which naturally then progresses to a panic attack). what a way to wake up! but i gripped davids arm until he woke up and we talked for a while until it passed. we had no way to keep track of time on our trip – i highly recommend this while on vacation – but i would guess around 2-3 AM we heard raccoons having what i can only imagine was an animal version of a beat it style knife fight over the hershey’s chocolate bars we had stuffed into our cooler. we had wedged the cooler under the picnic table but there was apparently enough space for them to stick their wee little arms in and grab the chocolate as well as eat a yogurt cup handful by handful. the scuffle woke david and i and we spent the next hour laughing and trying to scare them off before properly securing the cooler. there was no further raccoon molestation on our trip!

first full day we got up bright and early and went to the main attraction of the area, old man’s cave and it’s nearby waterfall. we skipped rocks and showed the children all kinds of rocks and sedimentary stuff. it was very cool and they were bouncing off the walls with happiness to be Actually Hiking Something. we later drove to a campground and went swimming like we owned the place. the woods was cool but i was so excited to sit poolside and feel cool and read a book. which reminds me, we brought no less than 5 adult books between david and i which we sat beside the fire with our lanterns and flashlights and read each night after the kids went to bed.

day two we again got up early, hiked to the car, and went to two caves – ash cave and rock house. rock house is a former hangout for old timey horse thieves, murderers, and robbers which made it all that cooler to the kids obviously. then we went antiquing for an hour or so before getting on a bus that took us along the river to canoe. we were overly ambitious and chose a 7 mile long trip and we ended up dead tired and starving 4 hours later. apparently half of the state had the same idea because there were hundreds of people, most of whom were wasted, on the same river. it was a bit frustrating to be surrounded by so many people who were hooting and cracking beers, getting in our way, while i’m just trying to paddle my freaking way back to civilization without dying of heat stroke in front of my children. when we landed david announced that we would not be going back to the car to drive back, to hike to our tent, to start a fire to cook on, WE WERE EATING AT ARBY’S. definitely could have made out with him right then and there i was so happy.

all in all the trip was amazing. it’s so good to get disconnected from the city/stimulation/technology and be in nature. humans NEED that sort of treatment. i didn’t even mind sleeping on the ground for three nights! the weather was hot during the day but the woods were around 5 degrees cooler and the caves cooler than that. the nights were clear and cool and eating s’mores around a fire with the three people i love most in the world? sign me up for more.

TIME – You know the one….

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Photo of woman with breast-feeding child

Yes of course, I agreed, offensive and controversial…. I went on to tell them my passion is to help mothers succeed at breastfeeding and it really wasn’t a big deal to see a mom nurture her kid, but many people think it is. My son who is embarrassed by every thing I say, didn’t think twice about any of this.So, I haven’t read the article, yet. I’ve only seen the cover.

 I went to Publix tonight ( a few weeks ago, this sat in draft mode), I thought I’d better get a copy of that TIME issue and weigh in as an early mothering expert. You guys want to know what I think, right? They didn’t have the issue. There was a May 14th issue. At check out with my 15 year old, I asked to the cashier and carry-out people, if they knew if there were any more around. They said they never saw it. They thought that the store probably wouldn’t put something out like that because it might be offensive. So I haven’t read the article. I have only seen the cover.

When I first saw the cover of TIME, I first thought, big deal, it could have been me….A photo of a mother with her kid standing next to her reaching for her breast to breastfeed.

I could have been on the cover!
Photo by Bernadette Clark

In the course of my daily work, it is not so unusual for me to see children breastfeeding. It’s not really a thing that phases me.

However, I never did a professional poised photo shoot with my three year old(s). Most of the time, when I fed a boy the same age as the one in the photo, it was in bed, on the couch, in a chair, in PJ’s or something cozy … and I was overweight …. Most often, my hair was wet, in a towel… definitely no make-up. And there was eye-to-eye contact, laughter, happiness and connection. My boys also were often in over sized T’s or some other comfy houseclothes, barefoot and suited for cuddle time. Most of the time.

But  at times, the boys stood and see if they were big enough to nurse or just because they could. If they could they were happy. By three years old  if I pulled out a camera in a propped situation they would have ran. The boy in the TIME newspaper looks a little stressed. His mouth is just there.

Breastfeeding a three year old is about so many different things. It’s hard to condense the value of nursing a three year old into one photo or one short news article and condense the years that lead to such a journey.

I want to help mother’s overcome the common obstacles society places on them that interfere with breastfeeding.

It’s OK to speak up for your birth.
It’s OK to hold your baby after birth. No one should rob you of that time.
It’s OK to co-sleep…. in the same room… in the same bed… even if you have a dog.
It’s OK to hold your baby and Babywear. It’s OK to stay at home with your baby (or get out if you prefer.)
It’s OK to be the most natural mother you can be if you desire. You are mom enough, you are doing a fantastic job. Traditional Medicine shouldn’t make you feel guilty. A cover of TIME shouldn’t make you feel guilty either.

Yet, it’s nice to see breastfeeding and Dr. Sears get some coverage in TIME.

Breastfeeding Meeting in PSL

I love seeing anything that supports the upper durations of breastfeeding.
Nursing a three year old is more common than you think. Even in Port Saint Lucie, Florida.
All the power and honor to the mom who got the opportunity to be on TIME’s cover.

As a new mom you only have to take it day-by-day and not worry about nursing your child till he can tell you he wants to join the military. The moms I see on a daily basis are doing an excellent job attending to their children’s needs.

My 15 year old finally saw the cover to TIME. He said, “That’s not natural.” He meant the pose. He knows breastfeeding is natural. He KNOWS.

Since seeing the cover my younger son has found mommy-stuffed-animals for his baby-stuff-animals. Thank you TIME for reminding my 8 year old how his little babies need their mommy’s night-nights.

 I have a copy now. I’ll let you know soon what I think of the article, itself.

Permission to Mother now available on Kindle!

Non-Specific Hormone Problems

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I refer out to compounding pharmacist often. I am willing to try cutting edge approaches to help balance non-specific hormone problems. Some people call it Anti-aging Medicine (or Bio-identicals). I find those titles too limiting to describe the full-spectrum of what I do as I help teens with issues; preconception & lactation; and weight-loss, fatigue, and libido in all ages(both genders).

I should have been an Endocrinologist?
Maybe, but I like being a primary care physician who can work with open-minded specialist. There are like-minded endocrinologist, but they are hard to find.

Patients don’t understand the relationship I have with the Pharmacist I consult with and patients often go to my nurses to ask if I will transfer the recommended prescription hormone to a different pharmacy. I wrote out a dialogue for my nurses to share with callers why I won’t transfer locally. I decided to share my reasons with you. Pardon me for talking about myself in third person.

“Dr. Punger refers you to the best resources for  your circumstances. She uses the PharmD, Doctor in Pharmacy, (the compounding pharmacist) as her clinical extender which means you are getting expert team approach care. It is not likely she will call your hormones locally if she made a referral that you agreed to. The pharmacist is a part of your medical care team. She relies on him and his team to gather information about hormones and endocrine disorders not so always readily accepted by other MD’s and drugstore pharmacists. The PharmD attends continuing education and meetings when she can not. She relies on him to make recommendations about dosage and delivery route (for example, SL, sublinguals are not available locally). The Pharmacist also is available to you for on-going opinions and adjustments in dosage often after hours. That will save you face-to-face visits. At the current time, Dr. Punger prefers to keep up with her primary care skills and she can extend you the specialized hormone balance by keeping the pharmacist on the team. It is rare to find a physician who continues primary care AND extends services to hormones to the extent she does. By using the same pharmacy team, medial errors are reduced, as compared to having different pharmacies and different protocols for her to keep up with. 
She has no disclosures. She does not receive kick-back from the pharmacy. Nor are PharmD’s employed by the practice. She simply refers you to the best resource for your circumstances at the time. In the meantime you are not paying high fees for anti-aging or weight loss clinics. Most of the consult is handled by phone call after initial face-to-face appointment with Dr. Punger. The teamwork between the PharmD and the MD is a highly specialized one and patients come from all over seeking this kind of care.
Dr. Punger won’t refer you to the Pharmacist if she doesn’t think you need that approach. If you simply need straight forward Vit D, or Synthroid, you will be directed to the locally pharmacy from the get-go. She will send you to an ENT, GYN, thyroid specialist right-off if that is what she thinks is best. 
If you don’t like the team approach Dr. Punger has with the PharmD you may seek on your own a GYN or endocrinologist (who will likely tell you that what Dr. Punger does doesn’t work) and offer you other options. Understandably not all patients will respond to Dr. Punger’s treatment and you are free to seek any opinions you want. At that point, you will be under the specialist care and Dr. Punger will no longer be responsible for your hormone balance/weight loss/bleeding etc…. 

Dr. Punger has had good results with her approach and thus she continues to use all the resources available to her.”

Permission to Mother now available on Kindle!

Times they are a’ changin

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DSC01807
2008

Trains 2012
2012

i am on the cusp of entering a new phase of my life. a life without children at home! this fall augustine will be in 2nd grade and olive will enter kindergarten. i am kind of excited to see how it shakes out. i mean, let’s be real it will be fine! i imagine getting all of my work done in a timely manner (WHAT?), errands run, meals cooked, house better cleaned, etc. obvs im going to treat myself to the occasional nap, let’s just be honest. i will however also be taking on a more active role in helping out with our church too. i know they need someone to regularly come in an help clean the office, file papers, organize this or that small thing.

i must admit i am slightly melancholy about the whole thing though in some ways too. i love raising children. i enjoy the daily routine (LOL) of figuring out how to navigate life with a little one in tow. my dad said that once olive got into school i’d be begging david for another baby. i admit i took a bit of offense to this, as if kids are some sort of diversion? meh. but if im honest i feel a little bit of that pull. not a lot, but a little more than i have ever felt about a third. however david is D-O-N-E, done with having more so whatever. it’s not such a passionate feeling that it would come between us though if he had a change of heart i’d seriously consider it.

"Find a doctor that will support you"

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This comment was left on the Facebook page last night. Congratulations, Monica, on seeking out a doctor that favors shared decision-making. Feel free to give Dr. Tsinker a hearty high-five on my behalf at your six week appointment.

Childbirth Simulators Mobilize

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Whenever an article comes out about childbirth simulator dolls, it is inevitably followed by comments that they are obviously part of a plot by Big Pharma Vagina to teach every med student that birth must occur in the lithotomy position. I’m not going to pretend that seeing all of the birth simulators displayed on their backs in the exhibit hall…

OBs, Midwives, Lies and I Have No Idea How to Title This Post

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It’s been about four years since I embarked on this here journey to figure out what the hell the problem is with maternity care in the United States. I’ve been down a few roads and back, tried on a few frameworks and took them off in favor of cruising around the interwebs naked and now have my mind set on (read: am obsessed with) a different way of tackling the problem using research that’s been around for decades.

Here are a few things I have learned, and I have learned them in a pretty unique manner, mostly in the last year or two.

mudder’s day

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mother’s day was great. in the past this (and my birthday/our anniversary) has been a huge source of division between david and i. i came from a home where every celebration was over the top and you felt especially special on those days. well david, coming from a home that was significantly more low key, naturally struggled to live up to the precedent set by my family when we got married. this year and the immediate past two mother’s days david has hit in on the head. he and augustine both have figured out my “language” i think. augustine made a coupon book for very meaningful things to be like “this coupon entitles you to sleep in more” or “helping you clean the house on sunday.” i got all choked up and snuggled into his lions man.

for the past 4-5 months now i have tried to more closely observe Sabbath on sundays. the main thing is that we watch no television and i do no cleaning. well i mean if the dog pees on the floor obviously im going to clean that up, but beyond that sort of thing, nada. this sounded like a great idea until i quickly realized how trashed the house gets even after just one day of passivity. monday we host a dinner and bible study for a dozen or so people so O M G has mondays become a source of dread for me. not only do i get back to my job but i have to clean a wrecked house and cook at least part of a meal (we potluck for dinner). oy vey so many times i’ve wanted to just chuck the idea of not cleaning on sundays but umm that is sort of the point of the exercise. so augustine expressing his understanding of that situation and offering a coupon to help clean on sundays, oh dang i cried!

david got me a nook color for mother’s day, let me sleep in on saturday, and we all went out to dinner. it was a great, relaxing weekend. obviously the children have commendered the nook already, playing games on it and watching netflix. no bigs, i still have 4-6 physical books checked out from the library so i don’t NEED digital books just yet. still, i am SO EXCITED about being able to say, go camping and take all of my books with me and not have to hermione granger it all the time. this is my own personal undetectable extension charm i guess

Let’s Talk About Homebirth

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Is home birth safe?

Most doctors in the US will say no, absolutely not. But is that really true? Here are a couple studies so that you may decide for yourself.

1. 2009 study published in the Canadian Medical Association Journal (CMAJ)
Conclusion: ”Planned homebirth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric intervention and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.”
 Details: This is a very good study because it looked at only women who were low-risk; even the women who gave birth in the hospital would have qualified for a home birth if they had desired. Therefore, the study is not biased in favor of homebirth, but is as fair as humanly possible. For a planned home birth, rates of perinatal (baby) death per 1000 births was 0.35. For the planned hospital births with a midwife, rates of perinatal death per 1000 births was 0.57. For planned hospital births with a physician, rates of perinatal death were 0.64. Notably, the study finds that women who had planned home births were significantly less likely to have bad maternal (mother) outcomes, such as severe tearing or hemorrhage.

2. 2005 study published in the British Medical Journal
Conclusion: ”Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.”
Details: This study looked at all of the planned home births in 2000, attended by Certified Professional Midwives in the US and Canada, in locations where home birth is not integrated into the healthcare system or well-accepted by most medical providers in the area.

3. The Maternal Mortality Rate in the U.S. is atrocious, for how medically advanced we think we are. 
Instead of having fewer mothers die in childbirth now as opposed to 20 years ago, the US has actually seen an increase in maternal deaths since 1990. This means that a woman in her twenties is more likely to die in childbirth than her mother was. As an industrialized country, we fall dismally behind countries such as Canada, Japan, and the Netherlands, all of which have midwives attending the majority of births. We rank 39, which means that 38 countries have better maternity survival rates than we do…and most of them are substantially better.

So what have we done wrong? Why are women more likely to die in childbirth than they were only 20 years ago? Could it be  due to the skyrocketing unnecessary medical interventions such as induction and cesareans? Could it be that maybe, with all our medical advances in case of emergency, we’re so on edge that doctors actually create the very circumstances they were trying to avoid? Could it be that most births are not medical emergencies, and that most women will give birth safely to healthy babies if left to their own timing, with a midwife who will offer support and appropriate medical care throughout this phenomenal life change?

Maybe. Maybe we’ve had it all wrong.

Let’s Talk About Homebirth

No Comments »

Is home birth safe?

Most doctors in the US will say no, absolutely not. But is that really true? Here are a couple studies so that you may decide for yourself.

1. 2009 study published in the Canadian Medical Association Journal (CMAJ)
Conclusion: ”Planned homebirth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric intervention and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.”
 Details: This is a very good study because it looked at only women who were low-risk; even the women who gave birth in the hospital would have qualified for a home birth if they had desired. Therefore, the study is not biased in favor of homebirth, but is as fair as humanly possible. For a planned home birth, rates of perinatal (baby) death per 1000 births was 0.35. For the planned hospital births with a midwife, rates of perinatal death per 1000 births was 0.57. For planned hospital births with a physician, rates of perinatal death were 0.64. Notably, the study finds that women who had planned home births were significantly less likely to have bad maternal (mother) outcomes, such as severe tearing or hemorrhage.

2. 2005 study published in the British Medical Journal
Conclusion: ”Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.”
Details: This study looked at all of the planned home births in 2000, attended by Certified Professional Midwives in the US and Canada, in locations where home birth is not integrated into the healthcare system or well-accepted by most medical providers in the area.

3. The Maternal Mortality Rate in the U.S. is atrocious, for how medically advanced we think we are. 
Instead of having fewer mothers die in childbirth now as opposed to 20 years ago, the US has actually seen an increase in maternal deaths since 1990. This means that a woman in her twenties is more likely to die in childbirth than her mother was. As an industrialized country, we fall dismally behind countries such as Canada, Japan, and the Netherlands, all of which have midwives attending the majority of births. We rank 39, which means that 38 countries have better maternity survival rates than we do…and most of them are substantially better.

So what have we done wrong? Why are women more likely to die in childbirth than they were only 20 years ago? Could it be  due to the skyrocketing unnecessary medical interventions such as induction and cesareans? Could it be that maybe, with all our medical advances in case of emergency, we’re so on edge that doctors actually create the very circumstances they were trying to avoid? Could it be that most births are not medical emergencies, and that most women will give birth safely to healthy babies if left to their own timing, with a midwife who will offer support and appropriate medical care throughout this phenomenal life change?

Maybe. Maybe we’ve had it all wrong.