My archives might be a little outdated especially the older blogs. My links above are all new and current.

I have only positive things to say about Permission to Mother, an autobiographical account of a thoughtful mother and clinician who courageously writes from her heart, soul, brain, and personal experience; who is open to change in her views and opinions and is not guided by the safety of rules of any group or the status quo; she is guided by love and openness to the experiences life brings her and her family. Her process benefits her and those around her and those who read her words. And to add to that, the writing style and story telling ability here make it a very enjoyable read speckled with both the humor and seriousness of life. ~Laura Keegan RN FNP, author of Breastfeeding with Comfort and Joy

Readers enjoy your feedback and Reviews (82!) on amazon. Kindle Version Available!

Please Join me on Facebook at Punger Family Medicine.

Friday, February 29, 2008

February Blog Summary

In case you missed something this month, this is a summary of my posts this month. My post and reply to ACOG's stance to homebirth got more hits than any post before and then my book announcement was just as popular.

Not sure about Cloth Diapers
What My Next Birth Plan Would Be...
My Near-Collision with Cesarean
Time to Deal with Bedwetting
Time to Deal with ACOG
Blogging about Birth and my Boys
My Pregnancy Portraits
Where to find Permission to Mother
Thank You for your Links
Life Before Motherhood
Permission to Mother Feedback
Administrative Questions about Permission to Mothe...
Nikki has Updated my Blog
Karate Promotion Night
Post Publication Analogy
Permission to Mother featured at tckidz
Meet my Cover Models!
Don't Judge the Adequacy of your Supply by Pumping...
A Day Off
Amazon Reviews of PTM
Five Months Sugar-free Detox
Blessing Over the Bread

January 2008

Last year while, I wrote and read and proofread my manuscript, a friend inquired, "What will you do with yourself when you are done and published?" I looked forward to not having to stay behind when my family goes out for fun on the weekends. Since being published, AND it's only been about two weeks, I've been swamped. With what, you want to know? I am not exactly sure. E-mails, inquiries, getting the word out, and getting the book out to the ladies that helped me....

I've sent a few copies out for review. I will share those reviews when they happen. I have been invited to a few upcoming book signings, meetings, conferences. I've been a homebody through the writing process so I am changing gears a little bit. I will share those details as I confirm them.

My Grandfather of 95 is critically ill. With that I will probably take a blog break for a few days and turn more of my attention to him and my family. My dedication page in Permission to Mother is to my stepgrandmother: Adele Deutsch, a mother to us all. I was hoping I'd be able to show him that my book honors her memory. I'm [the book is] too late. He's out of it. He'll probably never be alert enough to know about it. His mind was fully alert until just recently.

I have plenty of topics in mind to write about in a few days.

Thursday, February 28, 2008

Blessing Over the Bread

I finally broke down and bought a bread machine so I can make bread without the preservatives and sugar. It took a few times to get it right. Finally this morning it was perfect and my boys devoured it. They are so fussy and hardly like anything I make. This was truly a happy event for me.

Later on, they asked when I would make another loaf. Tomorrow wasn't soon enough! I made another loaf for dinner. Before I made the first cut. They said, "WAIT, we need to say the blessing over the bread."

This is another happy event for me. The only prayer I ever hear over food is, "Rub-a-dub, dub, thanks for the grub." I am happpy that they actually learned something in Hebrew School AND my BREAD was worthy of this ritual. Yeah.

Boruch atoh adonoy, (Hebrew)
elohaynu melech ho-olom,
hamotzi lechem min ho-oretz.
You are blessed, Lord our G-d, sovereign of the world, who brings forth bread from the earth.

This is the bread machine recipe I used.

1 1/8 cups water
2 1/2 cups White bread flour
1/2 cup wheat bread flour (I usually do 2 cups white and 1 cup wheat)
1 1/2 TBSP dry milk (I used soy milk instead and decreased the water to 1 cup)
1 1/2 TBSP Honey
1 1/2 tsp salt
2 TBSP butter
2 tsp fast rise yeast OR 3tsp active dry yeast

I glazed the whole surface in butter when removed from the bread pan.

Tuesday, February 26, 2008

Five Months Sugar-free Detox

I am still maintaining my detox. I've got a month to go. I do get asked if I will keep it up after the 6 months. Its been about two months since I posted about sugar-free and after re-reading my previous sugar-free posts made me realize that I continue to to make many positive changes to my diet.

I feel better... so what's to go back to? True, I may not need to be so restrictive as I am now. In the beginning when I thought sugar-free was total torture, but now I am glad I have had this chance to realize how bad sugar is for me. I once thought how lucky I am that I can eat anything I want. I felt sorry for people that needed to be on restrictive diets. Now I feel very empowered that I took the alcat test and know the inflammatory effects sugar has on me. Now I wish others can appreciate how bad sugar is.

I've come to the conclusion that sugar should be illegal. Its a domestic product and taxable so it would never happen. It may sound eccentric that I say sugar should be illegal. Consider...a third of our adult population has diabetes and a third is overweight. For everyone that has taken the alcat test, sugar shows up some how. Some have an anti-inflammatory reaction like I had, some have candida (yeast) sensitivity and the treatment is no sugar, some have insulin resistance by test (without overt diabetes). Many of our kids have behavioral problems. It makes no sense that sugar is so readily available. Its side effects are worse than street drugs.

To my surprise in the past two days, three men in my practice have followed my advice to read labels and cut back on sugar. All three have lost weight and feel better. The two that are diabetic are better controlled. I am pretty excited that three MEN, not a part of the birth, breastfeeding, blog community found what I say helpful.

I used to think of my husband as the diabetes doctor in our practice. He is good at juggling all the fancy pharmaceuticals (which never seems to help a person with a non-compliant diet) and managing all the complications of diabetes. It is so much more rewarding to treat a motivated patient nutritionally.

Monday, February 25, 2008

Amazon Reviews of PTM

I really appreciate the reviews that you have written for Permission to Mother on They can be read here. With self-publishing, these 5-star reviews really make a difference with the success of a book and helps the book from sinking to the bottom of the cyber heap of books. Many reviews give a book more visibility and importance on Thus, more mothers will see the book paired with other books or come up higher in searches. As a reader, it's also fun to see what other people thought of a book. As an author I will be checking and reading the reviews every now and then to see what readers are getting out of the book. Since many of my regular blog readers are the first to read and post a review, you can see what others you will recognize have said.

A few people who intended to write a review told me they couldn't. If you don't have a user name it won't allow you. If you never made a purchase with that user name it won't let you post. If you have any other problems putting up a review, please let me know. Check and make sure your post goes through. Overall its really easy. This link takes you directly there. Please post only if you read the book or my complete prepublication manuscript.

Thank you so much,

Sunday, February 24, 2008

A Day Off

A real day off with my family.
Getting ready to go fast.

" I am a big boy, too. I can go all by myself."

"I like fast motorcycles."

"OMG! He caught two fish!" That's Scott rock climbing...

There he is bungee jumping. You can tell who the dare devil in the family is.

Friday, February 22, 2008

Don't Judge the Adequacy of your Supply by Pumping

Look at the baby, not the pump--

I frequently get an inquiry like this:
"It's been a month since we last nursed :( but I still have drops of milk.... I thought by now there wouldn't be any more milk - ??? How long until I dry up. What's normal?"

I heard from another mom a similar situation. Her twist was that she couldn't produce enough milk to have a good weight gain in her newborn and used a lact-aid supplementer for the long haul. She still hasn't dried up. Her toddler happily asked to nurse after a month of weaning.

"Not drying up may be entirely normal."

I always explain to new moms that you can't tell how much milk you make by expressing. On the other extreme, I am nursing my 4 year old. He is faithfully at the breast morning and night for a lengthy cuddle and "feed." I have never had a milk supply issues; he never had weight gain issues. I haven't seen a drop of milk in years in his mouth or by expression (hand or hospital grade pump). David insists somethings coming out. I see no evidence. But he is happy. AMAZING IT IS!

You can't judge the adequacy of your milk by how much you can or can't express.

Wednesday, February 20, 2008

Meet my Cover Models!

"Mom, will I ever be in the newspaper?" asks Onika a few months ago.

A few days later, I just happen to e-mail Joan seeking consent to use their photo in(side) my book.

Joan explained to her daughter, Onika, "This is even better than being in the paper!"

I also submitted several photos for cover design. This photo of Joan and Onika, fit the format! I was biased towards this photo because my idea for title came from one of Joan's e-mails, "You've been an inspiration to us in so many ways. It's like you've given us 'permission' nurse just the way we want to, for how long we want to. " For me the cover photo and the title are associated.

I waited till I was absolutely certain that this wasn't going to fall through to share the news with Onika that she was going to be on the cover of my book.

I haven't seen her since she was a baby. It was my pleasure and a lot of fun to bring her an autographed copy of the book today. She was so sweet to be waiting for me on the driveway. Onika flipped through the book and asked me how I can write so much. She happily pointed out the interior photos of breastfed babies to her mom. The influence Onika's birth had on me is also a chapter in the book. Thank you Onika and Joan for letting me use this photo. Did you see the link in my previous blog post; your picture is in the local internet newspaper. I hope your photo will be in many newspapers. :)

Permission to Mother featured at tckidz

Wow! This made my day. Go check out Permission to Mother's first feature article at "tckidz."

"Permission to Mother"
by Denise Punger, M.D. FAAFP IBCLC
TCKidz: Your Treasure Coast Parenting Resource! - Wednesday, 20 February 2008

Tuesday, February 19, 2008

Post Publication Analogy

An analogy can be made between publishing a book and giving birth. Writing "the book" is like pregnancy: steady and long with some bumps. Then submitting the book to the printer, and going back and forth designing a layout is very hard work(labor). It seems like every round back-and-forth became more intense and longer to wait for (was it really longer or just a perception, I am not totally sure). THEN boom... you're published (birth).

You then see your book for the first time. I envisioned it would come to my house quickly and I'd have time to read it and hold it and love it. (Up to this point it was all done on computer and I never saw a hard copy.) That's not exactly how it went. Mary, my friend and the boys nanny, (and a few others) ordered a copy off of as soon as they knew it was up and got a copy right away,faster than I got my courtesy author's copy. I couldn't stand it. I went straight to Mary's when she told me she had it.

I got my first feedback(!) that night from a long distance reader:

I just devoured your book. I loved it. Made me feel so good about nursing over 2 years with no support from anyone. Even my mom wanted me to bottle feed. I also co sleep (my boys are 4 & 10.) Everyone says it is so bad, but I don't care. My kids and I enjoy this time together. This book will be my gift to any pregnant mom. -Becky

I was so happy to get that note; Ineeded that. I signed a copy at the office the next day from someone else who was speedy ordering.

When I got home that night I missed my book very much. I couldn't sleep. I felt like I peaked at it and it was taken away (nursery). I called Mary at 8 am Saturday morning and told her I couldn't stand it, I was coming over NOW to take her copy. And I did. Mary is so kind. She does anything for me.

I felt pretty anxious until my copies came on Monday night. I feel a lot better now that I have my babies in my hand. I got 10 author copies. I can share them. I just brought two copies to Bernadette Clark, who wrote the foreword and was my first doula. My other doula Regena got a copy today, also. I've designated one to Wife to the Rockstar, Mary Rainer a local doula/cbe and LLL leader., Kristen who contributed to my book and blog (her husband affectionately calls me the witch doctor). Tomorrow evening, I am bringing a copy to the mom and baby on the cover.

So far I've been invited to bring my book to three local conferences/meetings and have to get back to them on those dates. (I didn't expect any invites so quickly).

I've been asked by a few birth/midwifery groups to send a book so they can give it a review. ( I expected this and I plan to send copies to LLL for review and approval. I plan to send a copy anywhere I can think of in the birth/breastfeeding community for review.)

I've ordered my bulk order today so that I can follow through with all this activity and make the book available in the office and to give gift copies to the rest of the moms who earned a copy by contributing to my book.

I've got a lot to look forward to!

Thursday, February 14, 2008

Karate Promotion Night

Tonight William and Scott were promoted to yellow belt/green stripe. This is William just before the board break. He broke the board. I missed it. :( His instructors are the two in black. Hanshi Fabrey has been teaching martial arts for about a hundred years. The class is taught using "Japanese." I like the cultural/language part of it. They really emphasize form and technique. We have sat in on many different martial art schools. Too many of them are about promoting students too quickly for self-profits. My boys get a good mix of kicking, punching, sparring and self-defense in this class.

Here they are again. Sensai is Hanschi's son.
This is Scott's certificate.

I highly recommend United States Karate Federation for local families.
I have a photo of Willaim breaking the board (and his foot as through the broken board) from when we lived in Georgia. When I find it I am posting it here. Of course, I can't find it tonight.
I want to highly recommend Roman Martial Arts in Rome Georgia. I also liked their family-run school, the small classes. I liked the studio and their library of martial arts books with S. Korean and martial arts stories.

Nikki has Updated my Blog

Nikki, from Blogs for a Cause has updated my blog today. Besides updating the header, she upgraded the format. She can do your blogspot, also.
Nikki is a very talented blogger, writer, and Canadian college student. She is also an amazing humanatarian. Check out her personal site about her trip to Haiti. She is going back again this summer. This is what I wrote about her the first time she stylized my blog. She continues to amaze me. She ranks up there with Mother Theresa and Princess Diana. She really does. Thank you Nikki!

Administrative Questions about Permission to Mother

I am going to designate this post as a place to ask any administrative questions about the book. If its more appropriate for your questions to be handled by e-mail or phone you can leave that in your comment and it won't be publically posted.

Permission to Mother Feedback

I am reposting some of the feedback I get here. I'd like to have a back up to I also get some feedback via e-mail (from non-bloggers) that I'd like to share with consent. Fell free to post comment. It's not just for me!

Wednesday, February 13, 2008

Life Before Motherhood

Was there such a thing? Valentine's Day is a good time for reflection....

I hardly sat still. This is me and John in Key West (as if you wouldn't recognize the landmark) in 1994.

Now we are in Yellow Stone.

We got married a year after we met. We met in our residency in Augusta, Georgia. We were both in our 2nd year of Family Medicine Training. Our attendings thought it was romantic that 2 of their residents met and married.

My sister met her husband Brian about the same time I met John. We had a double wedding at my mother'shouse. Actually, my sister and Brian made all the plans. John and I were engaged. They asked us if we wanted to get married on the same day. So we did. We kind of-like hijacked their wedding. I didn't do much planning except for picking my dress and inviting a few friends.
We all lived happily ever after....

Tuesday, February 12, 2008

Thank You for your Links

Thank you to everyone who linked to my Permission to Mother publication announcement. Since, I am self-published, that also means I am the "marketing department," too. I really appreciate your help spreading the news of my books availability. I'll look forward to soon recieving book feedback. Thanks to the many birth and midwife blogs for all the referrals to my ACOG post and thanks to everyone else for links to my other posts.

ACOG would probably have a fit over my extended birth story in PTM. I'd love to know what ACOG (or any OB/GYN) would say about it... if I could ever get any of them to read it. But most importantly its for the moms who need permission.

I have edited my Top Referring sites in the upper navbar and I have also added a blogroll furthur down the navbar of other blogs and sites that I know of that have linked back to me. If I missed you, please let me know. These links are of a nice variety of sites, so go enjoy!

Now... I am far behind on reading new blog posts and I want to catch up... so no one post anything until I catch up. Okay? Thank you. :)

Sunday, February 10, 2008

Where to find Permission to Mother

Permission to Mother ships for free through and

(You can trust the free shipping option, I use it all the time.)

Check out and

Copies are ALSO available through my store here for 24.95 if you pick up. We will ship, too. Maybe I'll autograph it for you. :)

Save $5.00 off backcover price by picking up book in person. Code "pick up" before check out.

The publisher has a wholesale ordering form for bulk orders here. This is a great book for your store or classes.

Check upcoming conferences and events to see if there are other locations and opportunities to pick up the book at reduced rates in person.

Why Do You Need Permission to Mother?

The "Standard-of-Care" is a legal term, the level at which the average, prudent provider in a given community would practice. It is how similarly qualified practitioners would manage a patient's care under the same or similar circumstances.

Sadly enough, the standard-of-care legally protects only the provider (the physician or hospital) and is not necessarily in the best emotional, physical, or spiritual interest of the consumer (the patient). Dr. Punger's personal experience brought this to her attention. She has experienced a doula-attended hospital birth without intervention, working while tandem nursing, tandem nursing beyond the toddler years, and perhaps most dramatically, a footling breech birth at home.

Included are other women's experience's that go beyond the status quo. All stories have one feature in common: Dr. Punger goes beyond the medical standard-of-care that too often imposes on a women's right to mother to the fullest.

Through her warm, attachment feel stories about her own mothering journey and the inspiring women she is in close contact with, Dr. Punger gives you permission, to birth just the way you want to and to breastfeed for how long you (and your baby) want to.
Illustrated by the author (and friends) with 65 interior black & white photographs of gorgeous pregnancy photography, doula-attended labor support, mothers and breastfed babies, and home-centered parenting. This book is compliant with the World Health Organization Code for Marketing Breastmilk Substitutes. The author supports the Baby-Friendly Hospital Initiative and The Mother-Friendly Childbirth Initiative.
Click here to see the Table of Contents

Saturday, February 9, 2008

My Pregnancy Portraits

This series of photos is of my third pregnancy. I was 2o0 pounds at the beginning of my 3rd pregnancy (if I recorded my weight right and wasn't lying to myself at the time). I thought I would never be able to get attractive pregnancy photos. I thought I was fat and awkward. I put my mind to getting good photos, because I saw the value in a positive self image when it came to a successful birth outcome. E-mailing and sharing the photos was a part of my outward plan to mentally prepare for labor. If I couldn't be comfortable sharing photos with my friends, how could I ever be comfortable laboring in front of them?

This is my beautiful mother pregnant with my sister. This is the only pregnancy photo we have of her. In 1967 she said, you were to hide your secret for as long as possible under a tent.

This is my pregnancy portrait during my second pregnancy. I "learned" how to hide my pregnancy too. My sister took this photo. It's a cute photo, but I didn't really think much of my belly.

Now, in my third pregnacy, I want to free myself. I don't show much here. It is just the beginning of a series of e-mailing photos to my supportive friends and doulas. Photo taken at Berry College in N. Georgia.

Here I am about to take the Jet Ski out. We are in NE Alabama now! I am always going to wonder if the Jet Ski jolted David into a breech position ;)

Now I am in Seattle around 28 weeks. I saw the glow in the "light" and ran out with my sister so she could snap this shot. My sister is a terrific photographer. I could have had all the beautiful photos I wanted in my earlier pregnancies, if I would have only let her....

Here I am again with Scott and my niece. My sister took this photo also at 28 weeks after she casted my belly. I am making an effort to be more comfortable with my changing pregnancy shape, be comfortable with others seeing my body... and feel beautiful and special.

Now at 32 weeks, I let my sons participate in the rest of my photography. ( I really didn't have anyone else around who could oe would photograph.) William took this photo. I also felt most "comfortable" letting my boys take photos--finally unveiling my growing belly.
Scott, as goofy and as he was that morning took this photo of William. I am so amazed at all the great photos, that the boys took.
William even took this silhouette!

Another shot by Scott. the boys were 4 & 6 at the time.

Near the end of my pregnacy, William cooperated and took this.

Here is John. He had something to do with all this. We were in N. Georgia.

My baby safe and secure. He's in the safest place he could be. No pressure by anyone to induce early. I had no idea he was going to present feet first. What a difference one day in my life made. My imagery, my mental preparation, working on my inner confidence to trust and believe in my body got me past my obstacles. It took 9 months of positive preparation.
Now, look back at my mom in the first photo who represents how many women feel about their pregnancy. Can a mom-to-be that feels like her pregnancy should be hidden under a tent, labor uninhibited and successful?
How are you showing off and coping with your pregnancy? Behind the words, your photos (or lack of pregnancy photos) and icons/tickers tell alot how you feel about yourself and your growing baby!
I can't help but hope I passed on my good attitude on to my boys. We also have the memories of taking the photos. As a result, my boys are also published photographers. I love my pregnancy photos. They accomplished a lot.
Here is a recent photo of my beautiful mom.

Thursday, February 7, 2008

Blogging about Birth and my Boys

What was life like before the internet? How did we parent before the internet? One of my sons once defined the Internet as the place I go to learn how to breastfeed.

Our household purchased the first computer when my first son was about 1 1/2. I went back and forth about purchasing the computer. "What will we do with one?" One of the first sites I found was an attachment parenting article by Dr. Sears. What an eye opener. I found someone who described what I doing. I thought I found a goldmine. (the article link isn't valid anymore)

I was pregnant at that time. I also found padded ring sling sights and ordered my first sling. I was still suspicious of this gimmick as I knew absolutely no one that used a sling, but I knew the carrier I tried first with William was not functional. I found the DONA.COM site during my pregnancy in pusuit of finding a doula.

My sister came to stay with me around the time of my second birth. She set up my hotmail address that is still my primary address I use today. I did not know how to create an account or use it. At the time I told her, to just call me if you want to talk to me!

One of my first uses with my new e-mail address was to contact a tandem nursing mother site for information. I typed in all capitals and it took my a long time... and I got blasted in the reply. I was told not to shout. So much for that contact. I earned an "A" for effort.

Slowly but surely, my real life friends and I connected by e-mail. Getting out with two boys, talking on the phone with boys crying and demanding is not practical... e-mail worked.

Eventually, I was joining several several statewide and internatinal groups for breastfeeding. That's when I got the idea to start a local breastfeeding yahoo group. That's the I thought I'd be laughed at for forming "another internet group." But it was a success and the group is still held together by e-mail.

When medscape offered free websites to physicians, I was one of the first. My staff at the medicenter encouraged me along, "It's so nice to have a physician who can tell all about herself on the web."

I've had several freebie websites before E-mail has been a continuous form of communication with like-minded women I probably would have not had a chance to stay in touch with otherwise, and of course, now I'm Blogging about Birth and my Boys. What would I do without the Internet?

Wednesday, February 6, 2008

Time to Deal with ACOG

My comments in red to this new ACOG statement.

For Release: February 6, 2008
Contact: ACOG Office of Communications
(202) 484-3321

ACOG Statement on Home Births

Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies. Monitoring of of both mother and the unborn do occur at home. Complications are more likely to arise following the medical interventions introduced by the medical team in the hospital.

ACOG acknowledges a woman's right to make informed decisions regarding her delivery oh, really... and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).

Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Hospital birth is trendy. Babies have been born at home and in fields with and without midwives long before hospitals and physicians participation in birth. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. following intervention, that is. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Attempting a VBAC, immobile, tied down to monitors and receiving pharmaceuticals is far more dangerous. Surgical birth is almost always more dangerous than vaginal birth. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk. Why won't OBs just cooperate and back up homebirth midwives?

Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, What are you doing to reduce it? Nothing that I can see.but there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age My age has nothing to do with it. Why are young women having so many cesareans, then? , overweight, obesity and diabetes what is ACOG doing to help women with nutrition. NOTHING. Most women tell me their OB never mentioned nutrition except for prescribing vitamins. Most women tell me, I am the first physician to mention pregnancy nutrition and referral to the Brewer Diet.

The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospitalof course, it does!, or a birthing center (So kind of ACOG to extend their support to a birth center)within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.
It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child. Most OBs in America would have not been able to deliver my third son feet first safely in my own bed.

ACOG encourages all pregnant women to get prenatal care and to make a birth plan Most OBS don't look at birth plans. . The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. I'd like to know what ACOG member has attended a homebirth, ever? For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.
# # #
The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

I am so glad I am not an OG/GYN.

More responses from the natural birth community can be read at The True Face of Birth

Tuesday, February 5, 2008

Time to Deal with Bedwetting

Bedwetting is a problem nobody want to talk about and nobody wants to deal with. It's a problem in many houses. I found out in one week two close friends had bedwetters (never told me before). Ironically we had two sleepovers with our friends at a time we moved and I found out then that both families had bedwetters. In my years in urgent care, families didn't include this in the medical charts. After this I started asking at every school physical. I am really shocked at how many wetters there are.

Sooner or later, I am going to have to start a treatment plan for enuresis (bedwetting). My four year old is a bedwetter. He stopped wearing diapers during the daytime before he was three. Maybe he was a little younger, I don't remember exactly. But he continued to saturate his night diapers. I recognized this as bedwetting because of his resistance to put diapers on at night and him pulling them off when he woke. If he didn't mind the diapers and didn't comprehend, I'd say he just wasn't trained.

I am familiar with Dr. Collins' encopresis program because on of my older sons suffered with soiling.

Dr. Collins' behavioral treatment is recommended for 4 years and older. It involves a parent sleeping in close proximity to the child and the use of an alarm with vibration and noise. The parent is to respond to the alarm and take the child to the bathroom no matter what. It involves charting to measure progress. It takes a committment. It is not a program that relies on medication or only on alarms.

David sleeps right next to me. We are in close proximity. That part is easy. I put off treatment before he was four. But I find myself continuing to put off treatment. Why? For a few weeks he was actually dry. We went out of town for the first time without diapers. Then it started again! I also thought he might cut back on his night nursing and the need to wet might be gone, but he hasn't cut back on his nursing. Seeing that the nursing or wetting is not going away. I need to make a plan. I have Dr. Collins' books, I need to re-read them. I need to get the alarm and get my charts ready. I've even talked to David about the alarm and suggested that it would be his "beeper" like Dad's that goes off all night.

I keep procrastinating starting this treatment. Hopefully posting about it is a way to get me organized and start treatment. I will post on more specific treatments and theories soon and I will also add encopresis to my list to write about.

Sunday, February 3, 2008

My Near-Collision with Cesarean

(When I turned in my manuscript, I thought I was done with everything I could ever say about my births--guess what, I was wrong!)

I was most vulnerable the first pregnancy. I was professionally educated and not at all empowered.

The first threat of a C was with the diagnosis of a partial placenta previa (placenta overlying the edge of the cervix) during my first pregnancy. "If it doesn't move, you'll need a C." The OB knew it would likely move (and not a big deal to him) and was just an automatic comment to let me know what I might be faced, but his verbalization caused me to worry. The OB's also insisted I stop working. I remained anxious, sendentary and bored for the rest of that pregnancy.

The placenta moved up as it usually does. With another US, they told me it had move. I was cleared for vaginal birth.

After three hours of pushing and exhaustion, I pleaded for the labor to be over. I begged for anything to get William out. I thought that I would be better off dead, then to have one more contraction. This is when I came the closest to a C. Had a cesarean been performed on me, I would have been convinced that my body was abnormal and malfunctioned. At least at the time, I would have been convinced that birth was risky and OBs were necessary. I think that I would have eventually figured out that a C was an end-result of a fearful birth culture. In anycase, even with a vaginal birth, I was left feeling humiliated and very unempowered.

I have wondered why he didn't do the C. I didn't have an epidural, so "easy anesthesia" wasn't on board. Physicians have high rates of C's, so I can't say being a physician protected me. Since 12 years the C rate has exponentially gone up. Today the same labor would no doubt end in a C. Who waits three hours for a primigravida to push? No one.

I was so close to that C. I have wondered how it would have impacted my future healing births, if I would have been allowed to have them. One birth has such long term implications. My second birth occured before the VBAC ban. VBAC wouldn't have been the huge issue it is today.

The next worry was with my second pregnancy. At some point Scott was positioned breech. I again heard the threat, "If he doesn't turn, then C!" Probably no one took it a serious as I did. I worried. I was not given breech turning techniques or anything active to do. Scott did turn and I had a very nice birth with my heaven-sent doula. The first time I heard about breech turning techniques was during my third pregnancy. I was editing an article written by a chiropractor on the Webster technique for our locally published Mother to Mother... I was sure I didn't have to worry about breech.

There was no C threat during my third pregnancy. When I had abnormal triple screen results my husband demanded that I go to an OB. I resisted. He then requested "just a ultrasound." I refused. The morning labor started he reminded me "to get that US." Let's make sure the placenta is out of the way. Can you imagine if I did get that US and found the placenta clear but the baby breech (if indeed he was breech early in labor)? I would have been sent in for my C right then. I never imagined breech could happen to me and I wouldn't have been prepared to explore last minute other possibilities. I'm glad we didn't know. By Trusting birth, I was Rewarded.

Most women have to put up with the threat of Cesarean several times through pregnancyand labor, it's a wonder anyone has a Vaginal birth.

Saturday, February 2, 2008

What My Next Birth Plan Would Be...

No! I am not P! Then why even consider what the next pregnancy & birth plan would be? BECAUSE so few woman have healthy images of pregnancy and birth plan, if I don't tell you, who will?

Plus, I can always hope, that there will be another baby. Pregnacy and birth planning should start prior to pregnancy. Once pregnant, it's often too late to know your options and prepare emotionally.

I'd follow the Tom Brewer Diet from the beginning. ( I am already eating like that for the most part.)

I'd have no Ultrasound-I didn't have one with my third. The first time around the doctor wanted way too many. The second I capped it. I knew way back then they were unnecessary. I am frequently requested to order a pregnancy US by my patients for their own reassurance of fetal well-being. I am not sure I understand why they are so reassuring to moms. As a physician they tell ME nothing about well-being except for that moment there is a heart beat. (You don't need a whole US for that!) One mom requested it for placental position. Since she may be having an unassisted birth that reasoning made sense. On my subsequent research more recently, a midwife told me she could determine placental position by listening AND she could use an US only to confirm her suspicion if the placenta sounded low. To give the mom credit I scheduled an US for her, she doesn't have a midwife and I don't have a doppler. I guess she had a good reason to have an US. Women want to know the sex of the baby by US. I didn't mind waiting for David's birth to find out he was a boy. It made me feel strong and Trusting that I could wait.

I am concerned that one US leads to more ultrasounds to follow "problems" that don't exist. This causes maternal worry and anxiety. They cause due dates to change, even when a mom knows her conception and dates exactly.... I'm sure I can write a whole post on the problem with US and how they are interpretted.

NO triple screen, NO amnio. I made a big mistake having triple screens. It was positive for Down's and Spina Bifida in my third pregnancy. I refused amnio. I never had an amnio. Fortunately with a granny midwife and no OB, there wasn't much pressure on me to have an amnio. There is no need to have the blood screening tests if you aren't following through. As my readers know, my sons are healthy without Down's or Spina Bifida. (whole chapter on this in the book that better be published soon)

NO routine vag exams prenatal or labor (a whole topic in itself) just to see "what's happening." Preferably no vag exams period. I declined GBS at 36 weeks with David.

NO herbs or OTCs (over the counters) as a 5 week pre to tone and prepare my uterus for labor. (another topic in itself). No herbs in labor. Herbs, OTC and pharmaceuticals to induce and augment labor are very dangerous in labor.

I'd have a low profile midwife if one would have me since I'd refuse US and Vag Exams.

Membranes rupture by themselves.

Surrounded by doulas and birth friends at HOME.

NO pregnancy ticker to make me paranoid and obscessed with my dates. Discussed in a previous post.

Labs I would have, include blood count, HIV (for attendants benefit). The intracellular vitamin analysis (worthy of another post) and Urine dips and blood pressure.

If I had another breech baby, I know I can do it. Twins wouldn't scare me from vaginal birth at home. Provider or no provider. Could I say this before my first birth? No way. Not even before my 2nd or third birth would I be so confident. It took having a breech birth and then going to a twin homebirth to be so confident.

A placenta previa is the only reason I could think that I would have to have a C in my imaginary birth plan.

I could write so much more on all these topics.....

Friday, February 1, 2008

Not sure about Cloth Diapers

For mothers hesitant about the cost of cloth diapers, I've been thinking about an economical way to start a new baby (under 12 pounds) out in cloth and make the most use out of size ranges and get familiar with the routine before a larger investment.

This is what I’ve come up with: The infant prefolds (<15 pounds) are 2.00. With 2-4 white bummis covers (9.50), makes an affordable initial investment. This would allow part time cloth diapering. If you have a baby who is under 8 pounds the newborn prefolds are only $1.00 and initial investment is even less.

Someone more curious could get 1-2 Bumkins All-in-One and 1-2 Bamboozle from the start. A small Bumkins would last till 12 pounds and a small Bamboozle would last till 18 pounds.

When the baby gets to 12 pounds and you're ready to make a greater investment (and sizes last a long time), with confidence a mother can know styles and prints what she wants. Some mothers have 3-4 dozen diapers. A medium A-I-O Bumkins goes from 12-22 pounds. A size two bamboozle goes from 12-35 pounds! The next size in prefolds goes from 15-30 something pounds. The original newborn/infant prefolds could be used as diaper doublers for night or travel or when dads in charge as the baby continues to grows. I liked having a variety of styles to match our mood or circumstanes. Covers need to be replaced at 15 and 30 pounds. No pins are needed.

There is also a huge toddler prefold and cover which does work great for the 3-4 year old not trained yet, or bedwetter until treatment can be started.

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