blog, City to Country, The Chaos

How risky is home birth?

How risky is it to have your baby at home?
How risky is it to have your baby at home?

The morning news had a segment on the latest home birth study.  Unlike most studies that I have read about home birth having very similar risks levels to hospital births and improved outcomes for mothers, this study states that being at home puts your baby at much higher risk of low apgar scores and neonatal seizures or serious neurologic dysfunction.   Their medical health expert, Dr. Shapiro, synopsized the findings, stating very clearly that she felt the study had accounted for other factors and that it was clearly the location of the birth that elevated the risk levels.  It all sounded very official.

As someone who has had a successful home birth and is a proponent for more women returning to the home to have their babies, these findings concerned me greatly.  Being a non-medical professional, I read a few more reviews of the study before taking a look at the original document.  I thought that those with medical knowledge would have a more critical eye regarding these new findings.  But it was just the usual hospital birth supporters who are all too willing to demonize home birth.  The study was, to them, clearly without flaw and being at home is akin to dooming your baby to neurological impairment or even death.

I cannot say de facto that the study is wrong or absolutely flawed.  Perhaps there is some truth to the findings; however, I do have one serious issue with their data and I think it deserves attention or clarification before we all swallow the conclusions wholeheartedly.

My issue with this study is that its entire sample, though large, are all from the U.S.  You might be wondering what is wrong with an all American population being studied.  At first glance this may seem to be quite appropriate as it provides consistency across the study; however, in my opinion it actually does the opposite.  American healthcare both inside and outside of the hospital setting is very erratic.  Even state to state there are broad differences in care.

Here are the categories of care this study included: hospital physician, hospital midwife, freestanding birth center midwife and home midwife.  Other than the hospital physician, there is no stated standard for what they consider to be a midwife and yet many types of midwives practice in the US.

I am going to assume that a hospital or freestanding birth center would expect the midwives allowed to practice there to be certified by the American College of Nurse Midwives (so a CNM or a CM.)  Though I have no proof to back up that assumption as I do not know exactly how these institutions work in the States, but let us move forward as it’s the home births that they are saying are so risky.

The study lists a “home midwife” as the attendant at these “dangerous” home births; however, there is no description of what that actually means.  It is really only saying that it is not an unattended birth.  That “someone” who calls themselves a midwife was present.  In the case of a Lay Midwife this can be someone who’s read a bunch of books at home and has decided they can help a woman give birth.  In my opinion this is virtually an unattended birth and, yes, I do think this is a more risky situation.  You cannot compare a hospital physician with a person who has “read some books” and claim that these are equals.  This makes the “home” setting just a backdrop for the ensuing disaster, and not the reason for the poor outcome.

This study does not adequately state what credentials they are comparing in order that the focus can be solely on the environment.  Where you give birth may be a factor due to a lack of hi-tech medical equipment for necessary intervention; however, unless you have the same human standard of care it is impossible to say that the location truly plays such a large factor.  In many cases a properly trained midwife (in a country that has a national standard of education) can identify potential issues and a need for transfer of care early on, either in pregnancy or labour.

Basically, I just don’t buy what this study is selling.  I think what would bolster these findings is a study of the different medical professionals attending home births and what their outcomes were.  If all had the same rates of low apgar and other issues, then it would be clear that the attendant wasn’t a factor in changing the outcomes.  But then that would be asking the OBs to leave their secure little hospitals and actually attend a whole birth rather than pawning it off to the nurses or families to manage the majority of labour.  They couldn’t race to slice a woman open and “deliver her” of her offspring.  I digress.

So if you’re thinking of a home birth and this study has scared you off a bit, I hope this argument has helped you reconsider these findings and given you new hope and the courage to try birthing at home.  It is an amazing experience- when you have the right, well-educated, care 🙂

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Taking Responsibility

Eva Ravikovich- victim of daycare negligence
Eva Ravikovich- victim of daycare negligence

The other night on the news I heard the latest about the Eva Ravikovich case, that her parents have launched a 3.5 million dollar lawsuit.  They are blaming the daycare & the government for their child’s death.  Blame and money.
Let me first start off by saying that this post is absolutely not about blame.  It is about personal responsibility.  It is about how parents, myself included, have to take responsibility for our children and their safety.  Daycare in Ontario strains this burden to the absolute limit.
This case is not new, not even two years ago a similar event occurred at another over-populated unlicensed home daycare.  14 month old Duy-An Nguyen died after only being in care for 2 days.  She was to start going to work with her mother the very next day, but that day didn’t come for this little girl.
So what exactly is going wrong?  Is the government to blame, as these parents allege?  In my opinion, no this is not the government’s fault.  People want more regulations put into place on unlicensed care.  They want everyone simply to be forced to have a licence.  They want more funding to subsidize care.  All of this would be amazing, but it simply is not going to happen.  Ever.  There is not enough staff or money to make this all happen.  Period.
The catch, at least in Ontario, is that daycare is exorbitantly expensive.  Licensed centres can be $90 per day or more for an infant.  If you’re trying to do some quick math in your head, let me help you, that’s $2000+ per month.  For most people, and I am most people, that is NOT an option and so one must look to other possibilities.  That’s where licensed and unlicensed home care options come into play.
And this is also where you as a parent need to realize that it is now your job to investigate if your child care complies with the regulations that the government forces licensed centres to follow.  We can lay blame all over the place after negligence occurs, but in reality that neglect began much earlier.
Since we are talking about children, the people we we care about most dearly and devotedly, the question becomes why would you put your son/daughter in such a seemingly awful place?  I think there are several factors in play on this:
– Number one reason is definitely FINANCES!  Bargain basement care not going to be top quality care, but some parents simply have no other options.  Subsidies in Ontario are difficult to obtain, can only be used at licensed centres and you also need to have a space at a centre reserved before you can get your subsidy…. oh, and did I mention every centre has a HUGE wait list?  My child was on 4 lists from the time I was 5 months pregnant and she is now over a year old.  I have never been called by a single centre to say they have a space.
– Availability.  As mentioned above, there are just not enough childcare options in our province.  Several licensed places have opened in my area this past year and all have filled every infant/toddler space plus a long wait list months prior to even opening.
– After those top two there are other various items.  Those being location (is it close enough to home/work), language (immigrants can have a hard time finding many options due to an inability to speak English), knowledge (a lack of understanding of child/caregiver ratios and other standards that a daycare should meet)
– Lastly there is the fact that some caregivers understand that getting care can be so difficult, and they sadly use this to their advantage.  Basically, you need me more than I need you, so it’s my rules.  Desperate parents who need to get care during work hours may be bullied into just accepting whatever care they can find ASAP.

From the facts presented thus far it seems neither of these children should have died, and that too many children per care worker may have played a factor.  In Eva’s case, yes the Ministry should have followed up on complaints, but even so I can’t believe there were no signs and that the parents sending their kids to this centre had no idea of what was going on there.
Here is my advice to parents looking for unlicensed care:
Know the Ministry standards for licensed centres and ask potential providers about their planned ratios.  Do not leave your child with anyone who does not know these ratios or does not plan on following them.  They are in place for a reason- that reason being safety!  (Licensed child-care providers can care for no more than two children under 2 years, and three under 3 years. Unlike with private operators, this includes their own children.)   The rational behind these numbers is that if an emergency occurred a single caregiver could carry the 2 children under age two and the other three would be capable of walking/listening to instructions on their own to follow them.
– This may sound obvious, but visit the location.  Even if the operator says they won’t be spending much time at the home/daycare area, you should still see it.  And ask to see it when it’s open, not just after hours when it’s empty of children.  This will give you an idea of how the space is used by the kids and if it is safe (if you see kids climbing the bookcases you will know there are no rules.)
Do transition days with your child.  This may be hard if it’s a last minute find and you have an inflexible office, but I’d fight for at least a few half days to attend the place with your child.  It is very hard to hide 20 extra children for 3 half days, or other major infractions.
Drop in unexpectedly.  This is regularly done to licensed centres and it’s a great idea.  I’d drop in within a week of starting care, and again within 3 weeks.  If you can’t get away to do this then get a relative, babysitter, or close friend pick up your child early one day or bring your child late one morning.  The pick-up can also be a good test to see if they will release your son/daughter to someone they haven’t met before.  Do they call to check with you?  Do they check the person’s ID?  They should!
References and credentials.  Preferably a reference someone who has a child that has been in the care for over a year and is old enough to speak in sentences.  The length of time shows that they trust the caregiver, and the child can talk about their day to day schedule there.  It may seem a bit on the stalker side, but if you happen upon a neighbour to the daycare ask them what they’ve seen.  I could tell you a heck of a lot about my neighbours!  Credentials that you will want are an up to date, yes these do expire, criminal reference check (done through your local police department) and infant/child CPR.  An Early Childhood Education certification would also be a “nice to have” but not a necessity.
All of the above is even more important when your child is too young to talk.  They cannot communicate to you directly.  For this age group I would advise that you get to know other parents with children in the home daycare so you can trade information and experiences.  Once your child can talk~ LISTEN!!!  Children talk about friends and their caregiver- is there a name in there that you don’t recognize?  You should know and have met every care worker so if they are telling you that someone else is taking care of them then that’s a serious breach of trust between you and the provider.  Again, it’s hard to hide a lot of major issues: too many kids, other workers who you don’t know (child talks about new people every day), inappropriate foods (the yogurt was warm and tasted funny), going to other people’s houses or locations you were not informed of, abuse of any kind (this is something you should be on the alert for no matter what care your child has).  Please keep in mind that when it comes to abuse, many victims say that they tried to tell someone in a subtle way but were not heard so really listen and follow up with questions to any comments about not wanting certain people to care for them.  Question (do not interrogate) care workers about injuries and then later speak to your child to make sure the stories match.

Even with due diligence and putting your child in a place that makes them happy and you feeling secure, accidents can still happen.  As my midwife told me, “life is risk.”  But at least if something happens I’m not going to look back and feel like I sat on the sidelines when it comes to being a responsible parent.  We all build a file of regrets during our lifetime, selecting the care of your child should not be one of them.

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Unnamed victims continue the shame of violence

One news story from a few years ago has always stayed with me. It was about a man who was tortured and held captive by his wife and her lover.
Beyond the obvious horror of the story, what also bothered me was the hiding of the victim’s name (and because of that, his wife’s name also.) This man should be shouting his name from the roof tops. He is a survivor and should be wearing that badge with honour.
This system of withholding names of victims of violent crime just serves to uphold this idea that they are the ones who should be ashamed, rather than the perpetrator of the crime.
The argument seems to be that by not releasing names, we are protecting those who were violated. That they are not being violated twice, but isn’t what’s truly being communicated is that you should hide? That nobody should know that YOU were the one who had THESE THINGS done to you. Hide your face, hide your name, never speak of it again.
Shouldn’t the rapist/murderer/violent offender be the one who is ashamed of their actions?
I feel we should be encouraging victims to embrace being survivors instead. To come forward and put their name to these events, and say proudly that they are unashamed of what another, evil, person has done. I understand that this needs to be each individuals’ choice. The person who has lived through a violent crime needs to choose if they want to be the face of that crime; however, even in offering that choice we are saying “do you really want people to KNOW you were RAPED?”
There is no stigma attached to these crimes if society starts being open about them. We need to talk about rape, molestation, & violence, not in hushed tones, but brazenly and loudly, and without anonymity.

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Why should I make a birth plan?

So you’re considering making a birth plan but everyone tells you not to bother.  They say it’s a waste of time.  They say you can’t plan birth so why bother making a plan at all.  They say that they wrote one but nobody at the hospital paid attention to it. They say so many negative things about birth plans that you’re thinking you won’t create one after all.
Well I disagree entirely.  A properly written plan can be invaluable in many ways:
– it enables you to think about and gather information on decisions ahead of time.  Decisions that you might need to make quickly and during a time where you are not thinking very clearly.  Having your wishes ready in advance means you can simply refer to your plan.
– it can allow you to feel in control of the process thus more relaxed and comfortable.  
– it can help you come away from a difficult birth with a more positive outlook on what took place.

If birth plans are as worthwhile as I claim them to be, why do so many people hold them in such distain?
Well, I think there are a few reasons.
Firstly, and most often, women do not understand the purpose of a birth plan.  At face value, it sounds like you would write down how you would like your birth to play out; however, what it really should be is an opportunity to highlight aspects of your birth that are important to you, and to make decisions about all possible outcomes. When you do not know a lot about birth, it is useful to find a template.  Many women don’t even know what decisions they have to make (do you want the baby washed by a nurse, by you , or left with the vernix on because it’s good for their skin?) Or, for example, you may want a natural birth but you would also think about decisions related to a c-section such as the possibility of delayed cord cutting and immediate skin to skin.  Your birth plan is not a closed plan, but one where you accommodate all possibilities and make your wishes known in case of those eventualities.  And also keep in mind, this does not mean your plan has to be 20 pages long.  Perhaps there are only a few items that are of urgent importance to you. This is your plan, make it what you want it to be.
The next issue is that women make plans that are unrealistic for the situation and are then devastated that their birth and birth plan do not match in any way.  For example, your birth plan states that you want no unnecessary interventions, but you have selected an OB who often uses interventions and has a high rate of c-sections amongst his patients.  He does not let women go more than 2 days past their due date, and prefers to induce labour rather than letting women go into labour naturally.  The likelihood of your intervention-less birth happening is pretty low and you either need to have a frank talk with your OB, switch doctors, or adjust your expectations and your plan.
The third issue is also very common, a plan that only covers the most ideal birth.  While I do advocate that women think positively about their upcoming birth, I do not agree with living in denial about what may happen.  Believe in yourself, believe in your body’s inherent abilities to give birth, but also plan for what you’d like to occur if life takes a different course.  Knowing you’ve made these hard decisions ahead of time will take a weight off of your shoulders, and may prove valuable later.  If all goes smoothly then hurray for you and if not then you can still take joy in the aspects you were able to adhere to such as having immediate skin-to-skin or your partner getting to cut the cord.  Those small victories do mean something, and it’s worth thinking about them and recording your wishes.
After you’ve had your baby, take a look at your plan again.  What were you able to follow through on?  Find the positives.  Too many women see that events didn’t go as they had planned and simply decide the whole plan was a failure, but this is rarely true.
Yet another misconception is that birth plans are only for women who want a natural birth.  Wrong.  If you want an epidural and an episiotomy then that is still a decision about your birth and you have the right to make those choices.  There are so many ways to have a baby.  This is your chance to determine how you’d like to have yours.
Lastly, women who’ve had a traumatic first birth often assume all future ones will be the same.  A previous c-section does not mean you will always have c-sections.  Find out from your doctor or midwife why your first birth went in the direction it did, and what you can expect to be able to accomplish in future labour and deliveries. Going into a subsequent birth with a defeatist attitude is only going to make your chances for failure higher.  Plan for a more positive version of birth, even if your options are limited.  There are always ways you can take ownership over your birth.

To sum it all up- Write a Birth Plan!  Find a template, go through the options, make note of those that pertain to you, and make sure you give a copy to your OB (midwife), as well as keeping one in your hospital bag.  Making decisions while you have the time and wherewithal to make them is never a bad idea 😉
Best of luck to all of you with an upcoming birth!

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How to get others to do your parenting

Some days there are a few news stories that just make me so frustrated at the world. Today there were two:
Ontario’s Junk Food Rules
Dad sues Rogers over son’s roaming billAs to the Ontario junk food recommendations, I do agree that we have a growing epidemic of obesity in Canada and something does need to be done.
And for the second article, I agree that Canadian cell service providers are robbing us blind. We have some of the worst cellular prices in the world.
However, overall both stories bother me because they are about parenting. More importantly, who should be parenting our children. Clearly these stories imply that the government and corportations should be doing our parenting.
Let’s look at the story about Rogers first. The roaming charges are outlandish, yes, agreed; however, you are given a very clear, very long winded contract that explains that roaming charges suck. My own phone alerts me when I’ve changed networks. I’m sure his did also, but this father didn’t see that alert because he’d handed his son the cell phone and walked away.
At no point does it say that this man imposed limitations on his child~ just feel free to spend your vacation playing on a phone. Isn’t vacation time, the time you spend outside DOING things? Maybe spending time with your family, being active and seeing another country. Why pay to travel at all if it’s going to be spent sitting in a hotel room playing on a phone?
And not to be a huge jerk, but who does not practice sun safety with their child? I know sunburns happen, but seriously he was so burned he couldn’t leave the hotel room? Yikes. Enough said.
Now as to the junk food recommendations, what could be so bad about that? How could these not be a positive? Well they are yet another possible government imposed safety net for parents… are we such poor role models and care givers that we cannot raise our children to be sensible adults?
Here are some of the recommendations:
No candy displays at retailers cash areas- because parents can’t simply say no. And when they do our children are so poorly behaved that they will have a tantrum. Hiding cigarettes at the cash has clearly led to a decrease in smoking… has it?
Enforcing physical activity regulations are met in our schools- yes! Finally schools are pulling their weight in this battle. I mean after, sure, kids get home they spend 5 hours sitting in front of the tv/video game/computer/ipad, but it really should be the schools who deal with the physical activity aspect of this equasion.
Fast food menus should include calorie infomation- it’s a fast food restaurant. Everything is high in calories. Everyone knows this. Why would seeing a number change anyone’s mind? And that aside, whether it’s 1000 empty calories or 10, they are still EMPTY. Devoid of nutrional value, high in fat, and leaving you hungry and craving more in a short time. Parents no longer understand what healthy eating is- and it certainly is not calorie counting.
Banning companies from advertising junk food to children- what about Barbie? Maybe I don’t want all those ads about toys enticing my children to ask me a hundred time for things I cannot afford. Do they get banned next? Can we not be clear with our children about what we will and will not buy, and the reasons why we are making those choices?
Over the course of the past year, I’ve learned of other bans and rules in Canada that overstep my role as a parent. On the truly safety oriented end- helmets and seat belts, but still why does that have to be a rule? Parents should be able to make that sensible choice for their children…. it’s sad that we cannot.
Then there are more questionable ones, like the baby walker. Parents were not watching their children or putting up safety gates and so some rolled down stairs. So nobody can have one now. No making decisions about your childrens’ safety- just plain no, you may not buy one.
The Bumbo has famously been recalled lately- it now needs a 5-point harness. Why? Oh, because parents were putting their children in it on top of tables and counters. Did you guess what happened? Yes, they fell. But, don’t worry, that 5-point harness will make sure that next time you stupidly put them on a table that the Bumbo will fall with them.
What is next? My forecast is the bath seat. They are already almost impossible to find in Canada. Never leave a child unattended in water, ever. Not even in a bath seat. But people do- surprise! So we better get that bath seat banned because that will stop stupid parenting decisions.
People will always make ridiculous decisions. Dangerous decisions. Legislation and law suits will never eliminate them. In fact, it makes us all worse parents. We hand over our common sence to others when we allow these kind of rules to raise our children. Time for Canadian parents to step up to the challenge of teaching our own children healthy eating, good manners, proper cell phone use, and everything else in between. Yes, those around us, including the government can support that, but they cannot do it on our behalf.