lydia : an urban crunchy mama

Now that we have a garden in the yard, putting food scraps in the city compost bin seems like a real waste of resources, so I’ve been thinking about starting a compost pile in the back. After reading through a composting book Jim and Taylor gave to me for Mother’s Day, I had some preferences of my own, but I wanted to get some more input from people with composting experience. 

I attended a free composting class this Saturday and came home with a revised composting plan. I went in thinking that I might put a compost tumbler in the yard to minimize rodent problems and to make turning the pile easier. However, in talking to one of the instructors, I learned that this system is not ideal for a family who wants to add to the pile on a daily basis. Using a tumbler is better suited for adding a bunch of organic matter at once and leaving it alone for awhile.

After the instructors showed us the basics of a hot, composting pile and composting containers, I leaned toward a ready-made and widely-available container like this. But that all changed when vermicomposting became the topic of discussion. With a worm bin we can put a bunch of worms in a bin and add food scraps daily for the worms to eat. Their poop (or castings, if you prefer) becomes the nutrient-rich material we can add to our garden soil. Factor in that Taylor loves playing with worms, and I was sold.

Instead of buying a pricey worm bin, Taylor and I built our own after perusing YouTube for how-to videos. All we needed were two plastic tubs with holes drilled into them for ventilation, some worm bedding in the form of newspapers, cardboard, and coconut coir fiber, dirt from the backyard, a bag of red wiggler worms, water, and some food scraps. Voila!

  After drilling holes in the upper bin, we hydrated the brick of coconut coir fiber…

  and ripped up some cardboard.

  We then mixed in the coconut coir fiber into the moistened cardboard.

  We added some dirt from the backyard and spritzed with water.

  Jim helped Taylor dump a bag of red wigglers into their new home.

  Taylor served up some veggies.

  We topped it all off with a layer of newspaper and a final spritz of water.

If all goes well and we maintain the bin in a manner suitable to the worms, they’ll eat our garbage and we’ll have rich fertilizer for our garden. After separating out recyclables and compostables, I’m already amazed at how little we put out on the curb for the garbage men to dump into their trucks. With our worm bin, it’ll be even less.

Also on our list of borrowed books from the library is The Paper Princess series by Elisa Kleven. The books still fall into the category of picture books but consist of lengthy and detailed plots . A girl creates a princess out of paper, and the royal lass is swept up by the wind, carrying her on many adventures and into the lives of various children around the world. Taylor has requested that we renew the books so we can hold on to them a bit longer. The second book in the series, The Paper Princess Finds Her Way, is Taylor’s favorite of the three.

President Obama and the Democratic National Committee are asking the American public to share their personal stories and input as Congress prepares to reform healthcare policy this summer. In response, I have written letters to the President and to Senators Boxer and Feinstein. I am asking that midwifery be integrated into the current maternity care model to provide freedom of choice and the highest-quality, most cost-effective care for women and their families.

Dear President Obama,

Midwifery in Healthcare Reform

Please integrate midwifery in healthcare reform policy, so women may have access to the highest-quality and most cost-effective maternity care, both in and out of hospital settings.

As a woman who earned a Bachelor’s Degree and a Master’s Degree, I considered myself an educated person, an individual with the resources necessary to access information and to act upon that information. However, in hindsight, I (like millions of women in this country) walked into pregnancy quite uneducated, adopting the mindset that I would go along with whatever my doctor suggested and what “every other” woman seemed to be doing in regards to pregnancy and birth.

I remained unaware of the various maternity care options until a friend shared a list of books, websites, and birth professionals with me. For the remainder of my pregnancy, I worked tirelessly to surround myself with the appropriate people and information to ensure the safest birth possible.

I approached my obstetrician with the information I gathered and asked how the doctors in the practice might support me for the remainder of my pregnancy and in labor and birth. While the practice reassured me that my needs would be met, I felt no genuine reassurance that I, a healthy woman carrying a healthy baby, would be supported in a hospital notorious for the overuse of costly, medical intervention.

In my last trimester of pregnancy, I chose a different hospital and practice with several Certified Nurse Midwives (CNMs) on-staff. Under the midwifery model of care, these CNMs provide primary prenatal care and 24/7 labor and delivery care for all women in this practice, unless a situation requires the additional consultation of an obstetrician. This model of support seemed ideal for a woman in search of the safest, least-invasive, and most cost-effective birth.

Although this collaboration between midwives and obstetricians minimized some of the unnecessary medical interventions I wanted to avoid, the staff’s adherence to hospital protocols (as opposed to individualized care) did result in other unnecessary medical interventions that caused undue harm and injury. This model of care can be a safer and less expensive option than traditional obstetric care; however, further integration between obstetrics and midwifery is needed to ensure the best outcomes for mothers and babies. Had midwifery practices been a more integral part of hospital protocols, my daughter and I would have likely avoided much, if not all, of the physical and emotional trauma we experienced.

As my husband and I look ahead to conceiving our next child and choosing a care provider, we plan on hiring a credentialed, homebirth midwife. For us and many other families, this choice addresses all three of your goals in reforming our healthcare system (i.e. cost savings, choice of care, quality of care), yet out-of-hospital birth is not widely recognized or supported by our current healthcare system.

Cost

Whereas obstetric and hospital costs during my pregnancy and birth totaled over $16,000, homebirth midwives provide more comprehensive care for approximately $4,000. Midwifery care inherently costs less because technology and medication are employed only when necessary.

Choice of Care

Whereas obstetricians are ubiquitously recognized by the healthcare system and supported by insurance carriers, CNMs, CMs (Certified Midwives), and CPMs (Certified Professional Midwives) do not receive this same level of recognition or support. Based on their specific needs, women should have equal access to OBs, CNMs, CMs, and CPMs.

Quality of Care

Whereas most women, regardless of health risk, receive maternity care from medical doctors trained as surgeons, only a fraction actually need medical intervention during pregnancy and birth. Women would receive more individualized care if midwives routinely attended low-risk women while doctors attended high-risk women.

With childbirth as the leading reason for hospitalization and the most costly hospital procedures associated with pregnancy, birth, and newborn care (in excess of $86 billion a year), integrating all levels of credentialed midwives in healthcare reform policy simultaneously improves outcomes and significantly decreases expenditure. Please keep this in mind as you meet with your colleagues and work towards a healthier future for our nation.

In indulging Taylor’s interest in princesses, I am careful to limit her exposure to the damsel in distress model (read: Disney princesses) and, instead, fill her reading repertoire with princesses of all kinds. We both enjoy this whimsical spin on a classic.

On a recent trip to the library, I grabbed this book as we were gathering our things to leave. Although I couldn’t remember the storyline as I grabbed it, I recognized the cover from my preschool teaching days as a book I wanted read to my own kids one day.

I appreciate the richly drawn and colored illustrations, along with the moral of the story. Parents will also appreciate the underlying messages about healthcare in the plot. Taylor absolutely LOVED this book, and I envision checking it out again and again for many years to come.

Taylor is just shy of 41 months old.
Taylor : Do boys have babies?
Me :  What do you mean?
Taylor : Do boys have uteruses?
Me : No, only girls have uteruses.
Taylor : Does Daddy have a uterus?
as we were settling in for a nap.
* *

When Taylor utters new and amusing words I’ll post ‘em here.

Still struggling to keep it under the 2,000 character count limit… 

Using ultrasound technology originally developed for the US military, Electronic Fetal Monitors (EFM), machines that can continuously track and record fetal heartrates, first made their way into maternity wards in the 1970’s. Although initially reserved for only “high-risk” women and babies, EFM quickly became mandated by hospitals on nearly all laboring mothers. Despite over 30 years of routine use and upwards of 93% of women in labor wearing them, EFM has not improved outcomes – meaning rates of infant mortality, cerebral palsy, and infants requiring additional care immediately after birth in the Neonatal Intensive Care Unit have not improved. Rates of Cesarean Section have not improved either, skyrocketing from 5% in 1970 to 31% in 2006. 

And if the outcomes don’t speak loudly enough for themselves, EFM has yet to be reviewed for safety by the Food and Drug Administration. 

Routine use of EFM is just one example of how a ubiquitous yet unproven obstetric practice can decrease safety and increase expenditure. Instead of spending millions of dollars per year on machinery, women and babies would fare better in a maternity care system that practices a “low-tech, high-touch” model. In Women’s Bodies, Women’s Wisdom, Dr. Christiane Northrup explains, 

“Marshall Klaus, MD and John Kennell, MD have proved in six controlled clinical trials that the presence of a female labor support person, known as a doula, shortens first-time labor by an average of 2 hours, decreases the chance of a cesarean section by 50%, decreases the need for pain medication and epidural anesthesia, helps the father or co-parent participate with confidence, and increases the success of breastfeeding. Dr. Kennell has proved that if doula labor support were routinely used, this simple step would save the health care system at least $2 billion a year in the costs of unnecessary C-sections, epidurals, and sepsis workups for newborns.” 

Beyond financial benefits, doulas provide a continuity of care that machines, nurses, and even obstetricians currently do not provide. In preparation for their clients’ birth experiences, doulas meet with mothers to discuss common birth practices and procedures to ensure that mothers acquire the knowledge they need to make informed decisions. Doulas also learn about their clients’ individual physical and emotional needs so these needs can be addressed leading up and during birth. Doulas attend to their clients from the very beginning to the end of labor, suggesting comfort measures, supporting mothers’ labor partners, encouraging mothers to ask questions and express their preferences and concerns, helping mothers incorporate changes to plans that may arise, and enhancing communication between mothers and hospital staff. Doulas often hold additional credentials in breastfeeding, massage, yoga, newborn care, and/or childbirth education, which supplement the high level of care and support they inherently bring to new families. 

At a time when citizens and policymakers are reflecting on our current healthcare system and looking to make improvements, replacing unproven, high-tech machinery with high-touch care makes sound financial sense and human sense.

* * * * *

Previous Letters to Oprah

Maternity Care : Introduction

Well, I finally did it. I’ve been drafting a letter to Oprah in my head and on multiple scraps of paper for over a year now, and the letter has finally been sent. The two-thousand character count (including spaces) limit is a killer!  So much to say, and so little space.

Initially, I invited a mom I met in an online support group to join me in launching a more formal letter-writing campaign that involved key birth advocacy groups, but (quite understandably) she became too busy with other priorities.

This letter to Oprah has lingered on my thoughts long enough! I understand that millions of people e-mail their thoughts everyday, so I intend to share my two cents until I get a response from one of her staff members. Subsequent submissions will include details and resources that the initial letter (below) does not contain. If need be, I’ll start busting out direct quotes from Oprah herself and from guests whom she highly respects. If Oprah is true to all that she lives and encourages others to live, she can’t ignore the maternity care crisis.

As you and Dr. Oz have reiterated time and time again, information is power. Through various topics on healthcare, you have reminded us that we need to actively research our own path to wellness and to advocate for ourselves. I implore you to shed light on yet another ailing section of our healthcare system – maternity care. 

Thus far, the maternity care crisis in America has received very limited exposure in mainstream media. My hope is that you give maternity care its due attention and spark a public discussion that initiates positive change. 

“As the No. 1 cause of hospital admissions, childbirth is a huge part of the nation’s $2.4-trillion annual healthcare expenditure, accounting in hospital charges alone for more than $79 billion.” – LA Times, 5/17/09 

In addition to the staggering financial impact maternity care has on our overall healthcare system, consider the individual women who experience this care and the generations of families this sorely broken system affects. 

The US spends up to two to three times more than any other country in the world on maternity care, yet the US is ranked second-to-last for neonatal mortality in the industrialized world. As we, as a culture, have embraced technology in every facet of our lives, we sometimes extend it to situations that fare better with less of it, and maternity care is one of them.  

Technological advances have, no doubt, saved many mothers and babies over the years; however, the eagerness to utilize medical intervention on pregnant women can have life-altering consequences. Many common prenatal, labor, and birth practices run in direct opposition to evidence-based care (i.e. best outcomes for mothers and babies), and many others have yet to be proven safe. 

The most interventive and consequential practice is that of Cesarean Section (C-section). The World Health Organization states that when C-section rates rise above 10-15%, the dangers of surgery outweigh the lifesaving benefits it is supposed to provide. As of 2006, the Centers for Disease Control and Prevention revealed that 31% of women underwent surgery to birth their babies, meaning over half of the C-sections in our country are unnecessary. 

Implications of surgical birth run wide and deep, too many to list here. Having a C-section means higher rates of infertility, ectopic pregnancy, and potentially severe placental problems in future pregnancies. Although women having a repeat C-section are twice as likely to die during delivery, many care providers refuse to let women have a vaginal birth after cesarean (VBAC). 

Preventing women’s initial C-section is key in their and their family’s well-being, as well as our healthcare system’s financial future. If there is any doubt about the validity and severity of these issues, please ask your trusted friend and OB/gyn, Dr. Christiane Northup. As a seasoned physician, a mother, and an individual who understands the inseperable connection between mind and body, she has a wealth of knowledge to offer women and their families. Please ask Dr. Northrup to join you in educating women and empowering them with the information they need to have the safest, most cost-effective, and joyful births possible. 

 Left: Planting Day     Right: Earlier this week 

To celebrate our garden’s one month birthday, we scattered ladybugs under its canopy. Our indoor basil (which actually needs the ladybugs most) gotta little ladybug treat too.