Dinner on the Farm

With the U.S. economy in a tailspin, I’m going to focus tonight on something local and pleasant: our weekend plans to attend a “Dinner on the Farm” this Saturday. Local farmers and Slow Food Atlanta members Chris and Jenny Jackson were among 15 Georgia delegates selected to go to the Terre Madre conference in Turin, Italy, where more than 6,000 food producers, chefs and educators from 120 countries will convene. To help them cover expenses they’re hosting a benefit dinner, featuring local and traditional foods -- including heritage hog and seasonal produce grown straight off the farm and prepared by Chef Eric Arceneaux of The Big Eddy Club and Shannon Klein of Food Blossoms Catering.

Kids are welcome (and if they’re under 12, admission’s free for them) and the event will feature storyteller Pam Avery and cooking demos by Chef Arceneaux well as a tour of the farm. It’s $40 per person but kids under 12 are free, so the money you save on babysitting can help cover the difference for a pricier than average meal. Chris and Jenny sell their produce at the downtown market in Columbus on Saturdays (although they’ll be skipping this Saturday to prepare for the big event). I’m looking forward to the chance to explore their farm with Will and Owen and to talk with Will about where exactly the food we eat comes from (when we manage to get it locally, anyway). Not to mention the opportunity to savor what I expect will be an exceptionally tasty meal.

The reservation deadline has been extended to Thursday (Oct. 2) so there’s still time to make plans to attend:

Time: 4-8 p.m. Saturday Oct. 4
Location: Jenny-Jack Farm Pine Mountain
707 White Cemetery Road
Pine Mountain, GA 31822
Price: $40 per person; kids under 12 are free

For reservation information contact: dinneronthefarm@yahoo.com

Document and demolish

We’ve had a couple stay-at-home days while Will’s been fighting off a mild stomach bug. He’s played peacefully with Owen, due in part to our demolition-man strategy for dealing with 4-year-old build-and-preserve-it instincts set beside 14-month-old snatch-it-and-knock-it-to-the-ground instincts.

This is our policy for brotherly peace: Much of the time Will and Owen choose to play together or in near proximity – but if Will wants to build something temporarily off limits to Owen he goes to work in our office, with the doors closing Owen out. When he’s finished, he calls in Rob and I to view his work and ask him questions about it. If Rob’s at work, Will takes a digital picture of his masterpiece, carefully framing the photo to include as much of the structure as possible so that he can document it while it’s still standing.

And then we bring in demolition man Owen to knock the structure to smithereens. Will never protests – he seems to welcome the ritual. Meanwhile we’re acquiring quite a stockpile of digital photos by architect/photographer Will that look something like this:

Reactions to the Caesarean series

The publication of our series on the rising Caesarean rates in Columbus and across the nation has launched an interesting conversation.

First, I learned from Elaine Mills, chapter leader for the International Cesarean Awareness Network of Atlanta, that on the same day the story about VBACs ran, another Columbus mother had a successful VBAC birth with Dr. Jospeh Tate in Atlanta. She wrote: “One of the Columbus moms who was pregnant at the time of your article gave birth today with Dr Tate in Atlanta - a successful VBAC after THREE cesareans, 10 lb 2 oz baby!!”

I’ve enjoyed reading about the insights and experiences on this subject of everyone from doctors and mothers to husbands and fathers – both in comments left on the Ledger-Enquirer Web site and in e-mails I’ve received. I’m going to share excerpts from a few of those e-mails that haven’t yet been posted online. And I hope more of you will join the conversation – either with a comment here or after one of the online stories, or by posting your own birth story under “forums” on the mom2mom site.

First, though I have an important clarification to make. Val Staples, the Opelika doula interviewed for one of the Sunday stories, has not only attended hospital births as the story suggested (due to my miscommunication with Val). All of the VBACs she attended were hospital births, but she said 8 to 10 of the 85 total births she has attended were home births – and she herself birthed her last three children at home. It’s an important clarification to make, since Val found herself disagreeing with Dr. Joseph Eikelberry and Dr. Joseph Tate, who both mentioned their opposition to home birth in the story.

In an e-mail Val offered this rebuttal:

I believe that home birth is a safe choice for a majority of expectant mothers. It has only been within the last centuries that birth has become a hospitalized event. And maybe if the United States could boast superior health statistics as a result of our highly technologically-influenced interventions, I would agree that everyone should birth in the hospital, but we just can’t. There are women who have educated themselves and have come to the conclusion that home birth is the choice for them, and I think that we should be able to do so legally.

Val also sent me a copy of a letter she wrote to Dr. Phil, who is soliciting home birth “regret” stories on his website for a future show. Here are a few excerpts from her letter:

Dear Dr. Phil,

I know you are soliciting home birth horror stories, but I REALLY hope that you are planning to present a balanced view…

Terrible things can happen at ANY birth -- regardless of the location. But the majority of home births are wonderful experiences for the mother and her baby.
I birthed in the hospital, and after the abuse I received at the hands of hospital staff, I decided to birth my last three children at home. I had no complications, and I am very happy with my experience.

Home birth is not a choice for everyone for many reasons. Midwives are trained to carefully screen their patients and refer them to a specialist if there are reasons that home birth is not a safe choice for them.

If you want drama, maybe you should investigate how certain states are refusing to allow couples to have a safe home birth with a midwife if that is their choice. People are crossing state lines to be able to have the kind of birth environment they want because these states are trying to stop home birth….

Another interesting e-mail came from Terri Allen, who told her story of having a VBAC some 25 years ago with Dr. Thomas Malone (a doctor featured in the story because he continues to offer VBAC in Columbus). She wrote:

I read your article today in the Ledger-Enquirer regarding VBAC with great interest as I was in the position of making a decision regarding that option in l983. My first delivery in 1981 was a C-Section. It was necessary due to placenta previa and breech positioning of my baby. My OB recommended I consider VBAC for any future deliveries.

In 1983 I found myself once again expecting a baby. We had relocated to Columbus, Georgia, and I began the process of not just locating a new OB, but trying for one who would consider VBAC. I opened the phone book yellow pages and began calling and asking right off the bat whether the doctor would consider VBAC. The response was "absolutely not" and pretty much communicated incredulity that I would even ask. I finally landed on Dr. Thomas Malone. Thank God! Dr. Malone reviewed my medical history, my previous pregnancy and delivery records and agreed that I was a good candidate for VBAC. He furnished my husband and I with medical journal articles and other information that related to the pros and cons of VBAC. He did not try to push one way or the other and made sure we knew of the potential risks.

There was no question to my husband and I that we would attempt this "controversial" delivery option. I am happy to say it was a good decision. I went into labor (all back labor) shortly after midnight and delivered a beautiful baby girl at 8:30 a.m. I used no anesthesia, went home in 2 days and recovered quickly.

I appreciate so much that this doctor was willing to step out on a limb for us. We had no medical insurance at the time so he also took the risk of us having to pay him in installments should the need for a C-Section have occurred. Obviously, he and his son are still leading edge OB's and I applaud their continued concern for the best interest of the mothers in their care.

Finally, Dr. Frank Saucier wrote in to offer his personal experience with VBAC and some insights into the state of maternity care through a doctor’s lens:

I am a local FP trained physician who formerly delivered babies including doing C-sections. Our first child had significant failure to progress (including failed forceps & vacuum) due to his hard-headedness--he would not mold. We then had 3 other very healthy children via VBAC at TMC by Dr David Roberts (who is no longer in Columbus). It was years ago when malpractice was common but still much less common than now. Plus, we knew David personally, he knew us well, and we all knew that he would do his best, and that whatever the outcome, we would not sue.We lived in China for 7 years, and I delivered several expat children there because I was the only doctor they trusted. Since China has a "one child policy", their C-section rate was about 55%--obviously only first deliveries since no second child means no VBAC. They did this because "parents only get one child, and if something goes wrong during delivery, we are responsible for that child's infirmity". (This is their thinking, not a direct quote.)

This point leads into a letter to the editor I wrote today which might be published:

Regarding the explosion of C-sections in the US, it is quite simple to understand why, and the reasons are the same as those which raise the overall cost of healthcare.

1. Expectations. The US population now has an expectation that healthcare is a right; that we should have perfect health with no pain at all times; that medicine is an exact science with definite, objective, clear-cut solutions & cures; that “I can do whatever I want to my body”, and the doctor has to fix it. In reality, of course, medicine is an art based on science and statistics, and the best doctors know how to best play the statistics based on their experience and skill. Even the best doctors make mistakes, and even in the best circumstances without mistakes, bad outcomes occur unexpectedly.

When healthcare, including a laboring mother, does not clearly go “perfectly”, the patient often loses all sense of reality and risk and wants the most secure/lowest risk plan followed. While doctors often know that patient fears are not sound, perhaps even downright unreasonable, if something goes wrong, it leads to problem #2.

2. Legal liability. We have far too many lawyers in this country needing to make a living, and they, with good reason, want to find work to feed their family. Some will find any way they can, even by immoral means, to file a lawsuit they know is not malpractice but that will likely generate income. This happens every day and creates realistic fear among doctors, especially obstetricians whose patients can have life-long infirmities from a bad outcome. Should a patient with a bad outcome be even slightly upset with the doctor, a lawsuit is much more likely; this greatly influences a doctor’s decisions, thus increasing the level of care and cost of medicine.

He adds more in his e-mail to me:

I now work in the emergency department at The Medical Center, and we take care of everything that comes in--we have to as law tells us we must care for people without regard for payment. …

Everyday I see the attitudes: You must take care of me and do what I want because I am the patient and the patient is always right…. We see the above expectation that they are owed everything to get healthy, even if they smoke, drink too much, eat too much, don't take their medicines or follow doctor's orders--it is their right!

We will only get out of this mess--high healthcare costs and everything else--when we get common sense back in play, when folks realize that we live in an imperfect world, and that pain and disease happen; when we get real legal reform and a loser-pays system. When folks have realistic choices of health insurance options---everyone doesn't need a Ferrari of health insurance--most do fine with a Ford or Chevy...

And that’s just a few perspectives among many. Go here and here to read many more comments about the stories that ran Sunday and Monday – and join the conversation if you like.

VBACs on the decline

Today’s Ledger-Enquirer includes the third story in the series I wrote examining the rising Caesarean section rates here and across the country. Many experts agree that one of the biggest factors in the recent spike in Caesarean rates is the increasing reluctance of doctors to allow women to attempt VBAC – or vaginal birth after Caesarean. Today’s story looks at what’s driving that trend and how some determined women are managing to buck it.

Please consider sharing your own birth story on the mom2mom forum. To launch the discussion, Elaine Mills, chapter leader for the International Cesarean Awareness Network of Atlanta, shares her story of the “cascading interventions” that led to a Caesarean in her first pregnancy, along with the story of her most recent VBAC (or vaginal birth after Caesarean) with her third child after two prior Caesareans.

Here’s a list of the risks and benefits associated with VBAC, according to the American College of Obstetricians and Gynecologists July 2004 Practice Bulletin:

Benefits of VBAC over repeat Caesarean

Generally, successful VBAC is associated with:
Shorter maternal hospitalizations
Less blood loss and fewer transfusions
Fewer infections
Fewer thromboembolic events
Can avoid risks of multiple Caesarean deliveries including an increased risk of placenta previa and accreta

Risks of VBAC
A failed trial of labor may be associated with major maternal complications such as:
Uterine rupture
Hysterectomy
Operative injury
Increased maternal infection and the need for transfusion
Neonatal morbidity also is increased with a trial of labor
Although the incidence of perinatal death is low (generally less than 1 percent), it is more likely to occur during a trial of labor than an elective Caesarean

ACOG also says that more research is needed to help assess the risks and benefits of VBAC: The bulletin says “Despite thousands of citations in the world’s literature, there are currently no randomized trials comparing maternal or neonatal outcomes for both repeat cesarean delivery and VBAC. Intead, VBAC recommendations have been based on data from large clinical series suggesting the benefits of VBAC outweigh the risks in most women with a previous low-transverse cesarean delivery. Most have been conducted in university or tertiary-level centers with full-time in-house obstetric and anesthesia coverage. Only a few studies have documented the relative safety of VBAC in smaller community hospitals or facilities where resources may be more limited.”

Any opinions on ACOG’s assessment of VBAC safety? Weigh in with a comment.

Examining our rising C-section rates

Today marks the launch of a 3-part story I wrote for the Ledger-Enquirer about the rising Caesarean rates in Columbus – and across the nation. Two of the three stories are in today’s paper. The first story is an overarching look at the many factors that have driven C-section rates way up over the past decade (nationally the Caesarean rate has climbed 50 percent over the past ten years). The second story is a look at what expectant mothers can do to decrease their odds of having a C-section. Local experts agree that women do have power to reduce their chances of needing a C-section, partly by being informed and prepared to meet the various challenges and complications of childbirth.

Several of the experts cited in the article offered their suggestions for mothers-to-be regarding good pregnancy and childbirth books and videos. Their suggestions follow. In addition, Columbus mother Katy McRae, who is expecting her second child any day now, shares her story of how she was pushed toward a Caesarean she now believes was probably unnecessary. This is an online feature only, so be sure to take a look. And then, if you have the time or inspiration, consider sharing your own birth story on the mom2mom forum. To launch the discussion, Elaine Mills, chapter leader for the International Cesarean Awareness Network of Atlanta, shares her story of the “cascading interventions” that led to a Caesarean in her first pregnancy, along with the story of her most recent VBAC (or vaginal birth after Caesarean) with her third child after two prior Caesareans. Go to the Ledger's mom2mom site, click on forums and scroll WAY down to "Labor and Delivery: birth stories" to read Elaine's story.

Then coming tomorrow, we’ll have a final story that looks specifically at the reasons VBAC is becoming a rare option in Columbus.

But first, four sets of reading suggestions (preceded by the person recommending them). Feel free to comment on these suggestions or offer some of your own.:

Melissa Terry Flynn, a certified nurse-midwife with Obstetric and Gynecologic Associates of Columbus:

“My favorite books are ‘Gentle Birth Choices’ by Barbara Harper and ‘Ina May’s Guide to Childbirth’ by Ina May Gaskin.
‘Gentle Birth’ has a DVD of the same name, and ‘The Business of Being Born’ ” is great.

Val Staples:
“I usually recommend ‘The Thinking Woman’s Guide to a Better Birth’ by Henci Goer and ‘Active Birth: The New Approach to Giving Birth Naturally’ by Janet Balaskas. I’m currently reading ‘Pushed: The Painful Truth About Childbirth and Modern Maternity Care’ by Jennifer Block and ‘Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First’ by Marsden Wagner. As far as movies, I love ‘Gentle Birth Choices’ by Barbara Harper and the new Ricki Lake movie (The Business of Being Born) is really good too. Paulina Perez’s ‘Special Women’ is good for someone interested in doulas.”
Dr. Joseph Eikelberry, vice chief of staff at The Medical Center and an obstetrician and gynecologist with Obstetric and Gynecologic Associates of Columbus:
“The classic textbook for pregnant women is ‘What to Expect When You’re Expecting’ but I really like ‘The Girlfriends’ Guide to Pregnancy.’ It has much of the same information as the more formal ‘What to Expect…’ but it presents the information in a more humorous way, from the perspective of someone who has gone through pregnancy rather than presenting information in a more factual and medical manner.”

Dr. Joseph Tate, a clinical assistant professor of gynecology and obstetrics at Emory University School of Medicine and an obstetrician and gynecologist in private practice in Norcross, Ga.:
“In general, ‘What to Expect When You’re Expecting’ seems to be the standard.”

And here is the story of one Columbus woman’s regret over a Caesarean that might have been avoided:

Columbus mother Katy McRae says she learned the hard way that it’s important to investigate a provider’s track record when it comes to performing Caesareans vs. vaginal births.
Before the birth of their now 2-and-a-half-year-old son, Peyton, McRae and her husband, Michael, had taken The Bradley Method childbirth classes, had written a birth plan and were hoping for a natural birth. But at 36 weeks McRae’s doctor told her that her baby was too large –and that a Caesarean was the safest option.
When McRae initially resisted, her doctor asked her to have her husband come into the office. There, McRae said, the doctor delivered a verdict that scared them into compliance: “I cannot guarantee the lives of your wife and your unborn child without a C-section.”
So at 38 weeks, McRae went to the hospital for a scheduled Caesarean and delivered a healthy baby, Peyton, who weighed in at 8 pounds, 2 ounces.
“My son was a normal healthy weight and size,” McRae said. “In fact, family members and friends who work in the medical field were kind of like, ‘That's it? That's the ‘big baby?’ "
McRae believes now she may have been pushed toward Caesarean by a doctor who was either afraid of a lawsuit (since large babies can pose risks to a laboring mother) or perhaps drawn to the efficiency and convenience of a scheduled Caesarean – as opposed to a long-drawn out and unpredictable natural labor and birth.
For McRae the experience of Caesarean felt grueling and dehumanizing. She said her doctor never talked to her during the procedure. And Peyton was rushed off to an incubator after they had difficulty getting his temperature, so McRae didn’t get to see her newborn son for an hour and a half after his birth.
It would later take Peyton 8 weeks to learn to latch on while breastfeeding, and McRae wonders if the Caesarean birth, the epidural she was given before it, or the lack of instant bonding between her and Peyton had a role to play in his difficulties.
As the epidural wore off, and McRae– her skin itching all over and her body shaking and cold – began the long process of recovering from the surgery, she told her husband she never wanted to go through a Caesarean again. She said they contemplated having just one child.
When McRae did get pregnant for the second time she knew she wanted to attempt a VBAC. She went through the phone book for three days calling doctors in town to see if they would offer her a trial of labor.
She said, beyond her personal emotional and physical aversion to Caesarean, the reading she did convinced her that she faced more risks of a complication with a repeat Caesarean than with a VBAC attempt.
In the end she found only one practice in Columbus that would allow her to attempt VBAC – Thomas Nathan Malone and his son Thomas Michael Malone, in practice together -- said they would offer McRae a trial of labor provided her medical history suggested she would be a good VBAC candidate and provided she went into labor naturally.
Now she is set to deliver a daughter with them – via VBAC if all goes as planned – in late September. Her due date is Sept. 28.
McRae said the experience of working with doctors who “are on the same page” as her has been renewing. Now she says, even if she needs a Caesarean, she will feel confident it’s the right decision.
And she encourages other women to shop around for a doctor that truly fits their vision for birth. She thinks if she had asked more questions of other women in the community, she would have realized she was working with a doctor who was quick to opt for Caesarean.
“I wish I had asked more questions – not necessarily from doctors,” she said. “I wish I had taken the time to have gotten other women’s experiences with different doctors.”

*** One last note: The e-mail address listed by my byline in today's paper is no longer accurate. If you would like to e-mail me directly, please contact me at aaddington@hotmail.com. Of course you can also leave comments here for others to read as well.

I'll buy from your attic

With our economy on the brink of collapse, I figure it’s a good week to give up all plans to buy things new and fancy this year and start buying stuff second-hand. Of course that’s kind of a life philosophy for me, regardless of Wall Street’s moods. Why not save money and recycle at the same time, especially when you’re buying for kids who will outgrow their clothes in a matter of months?

Last week I bought most of Will’s fall and winter wardrobe plus a bunch of books to use with my preschool kids at the Just4Kidz consignment sale , and this Saturday I’ll descend for a bit on the Junior League of Columbus Attic Sale, which runs from 8 a.m. to noon and 1 to 2 p.m. in the Columbus Civic Center. Admission is $1. Proceeds go to charity.

Weekend sound bytes

Scene one:
I stand fully clothed preparing to hand Owen off for a shower with Daddy and Will takes one look at my stomach and says, “Mommy, I think you have a baby in there. Your tummy’s really big.”

Groan.

While it’s true that I was arching my back and sticking the tummy forward a little to support Owen it is also true that I’ve never quite lost the last of my pregnancy pooch.

Time to fianlly start doing some crunches, 14 months after my midwife first prescribed them.

Scene two:
Luckily, Owen can’t make observations about my little pooch of a belly. But he is learning to name more and more people in his life. Still he is generally not quite willing to relinquish ownership of these names that don’t belong to him. Once upon a time he would point at Dad and say “dada” – now he’s decided to keep these names for himself.

Here's a little exercise we did at the dinner table tonight after Rob and I had made this observation about Owen to each other.

“Where’s mama?” I ask.

“Mama,” Owen says with a grin and points to himself.

“Where’s Dada?”

“Dada” Owen says and points to himself.

“Can you say Ms. Brooke?” I ask, naming one of his teachers at school, both of whom told me last week that Owen’s calling them by name.

“Ba,” he says and points to himself.

“Can you say Ms. Jenny?”

“Jjjjjuh,” he says and points to himself.

“Can you say brother?” I said, pointing to Will.

“Baba,” he says, and miracle of miracles, points out from his little egocentric 14-month-old self at Will.

(It probably helped that I pointed first.)