My archives might be a little outdated especially the older blogs.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.

Monday, June 29, 2009

A Sculpture of Me and My Boys!

I received a special gift today!
My friend Elizabeth, and her daughter, made this beautiful sculpture of me (and William and Scott and David). She hasn't seen me in 5 years. It is an honor to be remembered pregnant, co-sleeping and nursing. I love the the whimsical mood and simplicity, yet shows so much detail about the love and humor in nursing older babies. (Just today I was asked if it's OK to nurse while pregnant. Yes! FYI-- I've nursed through two pregnancies!). I laughed when I saw how she placed the baby's hands on each sculpture. I like how my right hand is up by William's hands. Each image has a perfect latch! Really!
When I set the statues on my shelf, they reminded me of a La Leche League meeting.

Don't you love them!

Thursday, June 25, 2009

AAMI Childbirth Reading Room

Ancient Arts Midwifery Institute will be discussing my book, Permission to Mother, in their childbirth Reading Room for the month of July and August.

Everybody is welcome!

Grab your book and join in the discussion on yahoogroups.

I'll be there, too!


Wednesday July 1-4 Post Introductions and be reading the Forward and Preface.
July 5-11 Part 1, pages 5- 41
July 12-18 Part 1, pages 45-83
July 19-25 Part 2, pages 91- 119
July 26- August 1 Part 2, 121-162
August 2-8 Part 3, pages 165-189
August 9- 15 Part 3, pages 191- 218
August 16- 22 Part 4, pages 223- 242
August 23- 29 Appendices, pages 245- 257
August 30-31 Closing comments.

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Wednesday, June 24, 2009

Ordinary and Fun Wednesday

I started out this morning with Scott's lessons. We are working on Level 4, Lesson 14. The closer to the end of this level we get the longer it seems to drag on. As the world of reading opens up for Scott, I see him being occupied with books and magazines more.

I prepared my crockpot with Tam's split pea soup and made Bok Choy cole slaw per Gerrie. I usually can season veggies to my taste if I make it. Not this slaw. It did not turn out well.

I was in the office in the afternoon. It's nice to have a steady flow of young mothers. This week I've talked to mom's about adoptive breastfeeding, VBACs, reviewed prior birth records for appropriateness of homebirth referral, co-sleeping & SIDS ( I don't fall for the Back to Sleep campaign) and frenotomy amongst other topics. I've had one patient drive 2 hours from Boca and another 3 hours from Ormond Beach, several from Jensen Beach and Stuart. It's nice to have families so receptive.

With dinner prepared ahead of time, we got to spend a few hours at the Cabin this evening. We threw bread crumbs to a turtle in the river from our deck, watched some big blue crabs peek out their tunnels in our yard. David was great at spotting wobbly flying fruit bats once we showed him what to look for. The other day we saw an iguana on our deck. We harvested some mangoes and mananza bananas from our trees. I am keeping a good eye on our trees before the critters get to them. Not sure if I'll get everything before the raccoons do.

Monday, June 22, 2009

William's Virtual School Progress

William finished 6th grade Math last week through Florida Virtual School. He's been taking one or two classes at a time: First keyboarding, then Languague Arts and Science, and finally Math.

I knew he would do well with LA and Science, but I wasn't sure if our informal learning style would give him the background to perform well in structured Math. Sure enough he easily comprehended most topics easily. The three core classes offered Advanced credit and he completed all the lessons to get his honors credit and high numerical scores, do I dare say 99 and 100 in each semester of Math. I am happy!

I opted not to do Social Studies/History this year because John is so good at explaining those topics. I thought I'd wait for a greater challenge in the upper grades.

William is going to start Advance 7th grade Language Arts in a few weeks. When his friends start school, I'll add to his load. He's chosen this class to start next because he liked his 6th grade class.

One of the things I really like about Virtual School is that with my virtual presence I can advocate for William to have an opportunity to take the Advanced classes. There is no placement testing. You only need to have the desire to try the assignments (and if you don't like it, you can opt out for the Regular class) . In physical school, I don't think that William would independently assert himself for the challenge and I may not be there at the right moment to advocate for his placement. BUT I love the opportunity the on-line classes has given him. On-line learning is the perfect match for William. The teachers respond quickly to my inquiries. Day or night, when I have a question I shoot an e-mail. I don't have to wait to call or make an appointment.

I have also found that classes don't take 9 months to complete. 5-6 months is more like it. Think about all the half days and teachers days that public school kids don't have class. I like plugging him along while the topic is still fresh in his mind and minimal interruptions.

Really the little bit of prep William did for his 6th grade Math was DK workbooks prior to entering the course. Academically he is now on schedule with a remarkable record.

It's my responsibility to give my boys the opportunity to go to college. They are bright and creative and while I never know what surprise the future holds and other opportunities might come around, I definitely feel the course we are on is the right direction.

Saturday, June 20, 2009

Kayak Adventures

Scott loves this little spot we found to get off at.I know I am looking like a dork. :

This is what Scott likes about this place--the little tree house
going out over the water.

It's really cool, we weren't alone in the water.
We ran into
a church group on field trip.
Kayaks Dominate Till about 3 weeks ago I never had been on a kayak.

I dumped a canoe over once.

I love the upper body work out.

I love the wild life.

I love getting my boys outdoors.

It's so peaceful.

Tomorrow I am getting William out!

Thursday, June 18, 2009

Canada Supporting Vaginal Breech Option

From page 68, Permission to Mother:

When I told my father-in-law, a retired obstetrician, about his grandson’s grand arrival, he told me, “I used to deliver footling breech babies, but an obstetrician at my [Ivy League] residency decapitated a baby. They stopped delivering breech vaginally.”

Intrigued to know why, I found results of a study conducted in 2000 known as the Term Breech Trial concluding that breech babies born by elective cesarean resulted in fewer complications for both mother and baby than born vaginally. Despite ACOG’s (the [US] professional society for obstetricians and gynecologists) follow-up recommendation that all breech babies should be delivered by cesarean, around the world, midwives are still delivering breeches.

I read a story in Midwifery Today about a midwife who planned to attend a known double footling breech. Kudos to him! My training as a physician would have made me decline a vaginal birth had I known ahead of time that David was breech. However, I have now been empowered by my “culturally unacceptable birth.” I continue to read on the topic and found a more recent analysis shows no difference in outcome between vaginal and abdominal deliveries of breech babies.

Now Canada's Society for Obstetrics and Gynecologists officially agrees:

No more automatic C-section for breech births, says Ob/Gyn Society

Halifax – June 17, 2009 – Physicians should no longer automatically opt for caesarean sections in the event of breech birth, according to new guidelines for Canadian health professionals released today by the Society of Obstetricians and Gynaecologists of Canada.

The guidelines are based on a comprehensive review of research and clinical evidence regarding the safety and outcomes of vaginal breech births compared with that of caesarean sections. In the final weeks of pregnancy, most babies will align themselves in the womb into a head down position, in preparation for birth. However, in approximately 3-4% percent of pregnancies, the baby will not align into this birthing position, and instead will present as a breech pregnancy, with its feet or buttocks positioned downwards towards the birthing canal.

“Breech pregnancies are almost always delivered using a caesarean section, to the point where the practice has become somewhat automatic,” said Dr. Robert Gagnon, a principal author of the new guidelines and Chair of the Society’s Maternal Fetal Medicine Committee. “What we’ve found is that, in some cases, vaginal breech birth is a safe option, and obstetricians should be able to offer women the choice to attempt a traditional delivery.”

I suffer inside everytime I hear that a woman couldn't find a provider to deliver her breech baby. I am excited that we have a current and official opinion.

So will ACOG share their opinion on this statement or will they declare War?

Wednesday, June 17, 2009

Produce List

Half way between pick-up days it is good for me to take inventory and see what I have left to use. I have plenty. I highlighted my favorites (almost everything).

Last week got:
cucumber-- went in salads, I savour the few cucumbers we get. I'd like to eat one a day. I don't like sharing.

spinach-- salads, smoothies, pesto. I sauteed just a little for John's eggs.

red leaf lettuce--- beautiful salads

leeks -- sliced on salads, sauteed for John's eggs

grape tomato -- a few went on a salad and than I ate the rest of the container

carrots -salads and juice

cremini mushroom -I traded Lauren most of my mushrooms for most of her bananas. I kept two mushrooms. I offered them sliced to John for his eggs. John will not eat "Organic" mushrooms even though he likes mushrooms. I don't eat them because I just don't like looking at them. When he didn't want them and I didn't want to look at them I decided to add them to the spinach/basil pesto and blend them up. He didn't know they were in there and I didn't have to look at them.

I treated myself to a little chinese food. The veggies were plentiful and piled up. I kept tasting something good in there. I figured it was the mushrooms. :) Why do they have to be so ugly?

eggplant-- I am going to make more eggplant hummus like I did two weeks ago.

spaghetti squash- I cut in half. Bake open side down in water, covered with foil till soft. I have added sauce and mixed vegetables to this and it is always delicious.

colossal garlic-- goes with everything

yellow peaches -- ripe and juicy treats

banana-- a favorite snack for my kids and a great smoothie ingredient.

tommy atkins mango -- the boys like this. The mangoes on my tree are becoming ripe and are very tasty. John has an issue with our mango tree. I save the co-op ones for him. I'll eat our locally grown.

bok choy -- It really hasn't been my favorite green,

valencia orange -- juice

flame seedless grapes -- the kids and I snacked on all of these

Fruit Share: gold kiwi, strawberry and golden pineapple-- I sure am enjoying my gold kiwi!

Sunday, June 14, 2009

Summer Cabin Fever

We've been hanging out our new house on the weekends while we renovate. I dubbed the house as our Summer Cabin. The amenities are similar to camping: Cell phones and great outdoor facilities without Internet or cable. No xbox or laptop. It's a great way to bring my Type A family together to relax. I can tell you it can be hard to SIT and relax when you are used to being on the go constantly and checking email and messages. The boys next door are the same ages as William and Scott! I love the outdoorsmanship those boys have.

When we brought them on the boat, it was like having Lewis and Clark to guide. They show us all the wildlife (or the signs of wild life): gators, owls, manatee, wild boar, wood peckers, turtles. The boys brought their cast fishing net on the boat and use it off their dock. David loves casting a reel. It's amazing all this exists just a few miles from my current home. The island across the water is protected. Unlike the manicured (or sometimes ignored) landscaping in my current community, the mostly native landscaping here provides for such wildlife diversity.

I got a kayak. The first time I took it out with John( we weren't gone long), I came back to find that William and Scott and David were swimming with the other boys. William proudly announced it was his first party with parents not home.

My boys have had tons of swimming fun with Lewis and Clark. They've come up with one game after another. You know its a pleasure to see my boys being active and CREATIVE. I told them to get out of the pool the next time I couldn't keep my eyes on them and they decided to jump in the river instead, from the sea wall. As crazy of a thing that is to do, I am kind of glad to see my boys adventuring and doing new things. They are so proud to confess the kind of dangerous stuff they do. David thinks he's as big as the big boys. He does everything the rest does.

As hard as it is to slow down and relax its can be hard to get back to seriousness. If I don't go to work tomorrow it's because I have Summer Cabin Fever.

Thursday, June 11, 2009

My Golden Kiwi!!

I've waited for Golden Kiwi to be available this Spring and it's finally here!! The Golden Kiwi is one of my most favorite fruits I have gotten from the organic co-op.

I ordered a whole case which looked so small to my eager eyes. They'll be gone in no time.

They are so delicious. And they are so different from the more fibrous and thick skinned green kiwi, which I am not nearly as fond of.

I would have never heard of Golden Kiwi if it wasn't for the co-op as I have never seen it in any local store. (If you have, let me know!). These kiwi come from New Zealand. Locally grown is great, but this is one little treat that we should all get to experience. I don't miss refined cane sugar at all when I have a treat like this.

Tuesday, June 9, 2009

Thanksgiving in Manhattan (part 2)

My reply to Science Geek got so long, I decided just to bring my comment to the top.

Yes, Scott tries to figure out words he hasn't studied yet. When we started with blends on the end, he anticipated there would be blends on both ends. (Blend is a good example of a word with a consonant blend on both ends.)He now is recognizing the silent "k". He knows that some vowel teams are going to sound like the long sound of the first letter and he knows that there will be advanced vowel teams with unusual sounds that don't make sense (yet).

He remembers from Hooked on Phonics about silent "e". Common words like like, make, race he can sound out. HOP doesn't teach any (at least I don't remember them teaching) what happens to the "e" in making and racing. When I don't know the rule, I tell him we will have to wait and find out. If I've listened to the DVDs ahead of time, I go ahead and tell him if I know the rule.

When he is talking, and he hears a schwa, he questions me if he is correct.
He knows that the rotten letter "r" takes over the vowel sound sometimes, like in the word "over" so sometimes he can sound out "vowel r" words we haven't studied yet.

In any case when he has figured out a reading rule ahead of time, the lessons, when we got to it, will always clarify the spelling rule.

I have done a little bit of paired reading with Scott. He knows if I see a word we haven't covered in Barton it will be my turn to read the word and I just jump in. From the High Noon books I got the explorers series. We are s-l-o-w-l-y working through Magellan now with paired reading. The local library had "The Tug" and a few in that first series, but it was a little dry for Scott. I also got the great classics series with Swiss Family Robinson in it and a Earth series with Desert in it. We haven't done anything with these other two series yet, but just have it for when he is ready.

Scott also likes learning about the Holocaust. I ordered the Barton stand-alone book based on the Holocaust. That is the only stand alone book I've ordered for now. If it seems beneficial to him, I can later review the other titles. It seems like other reading opportunities will be opening and he won't be limited to stand-alone books. As far as Scott's Holocaust studies go he wants to read (have me read to him) all of William's 6th and 7th grade Hebrew Class books to him this summer (what will be left to learn next year!!)

One Sunday in April, I sat in on his Hebrew School class. I saved the Holocaust handout that the class read Round Robin style (except they skip Scott). It looks like at the end of Level 4 he will be able to independently read it. I am excited to show him how far he has come by using something his 5th grade classmates read which he is familiar.

Scott has been able to explain his spelling rules to his brother and Uncle. His Uncle has a BS in English and the Barton approach is all new info to him. Likewise, there are many vocabulary words I look up for Scott within the lessons. There has been a few words he knew the definition and I never used the word before. This is a great opportunity to point out to Scott that no two people know exactly the same thing. Our goals, experiences, and purposes shape what we know and we don't have to compare our selves with anyone.

Saturday, June 6, 2009

Thanksgiving in Manhattan

Scott has learned the syllable division rules for three syllable words including Thanksgiving and Manhattan. In January, Green Eggs and Ham was challenging the upper limit of his (?)reading(?) level, if you can call what he was doing a reading level versus guessing.

As the words in his reading program got longer I have seen some other amazing things. His concentration is better. His handwriting is improving. His confidence is amazing. I have seen him pick up more books from around the house to scope out. His expressed desire to learn has improved. He has always wanted to learn, but there is not as much frustration anymore. I don't have to plead with him (as much) to sit down and be tutored.

These lessons also taught him how to use a Franklin Spelling Ace. He likes having a little palm computer all his own.

I know that I definitely was concerned if he would be ever be able to divide syllables. At times he also wondered, "Why is this program going to be any different than all the others?" he questioned. I think he's long forgotten that fear. With each passing reading lessons, his reading vocabulary expands immensely. I no longer need to fear illiteracy. Still a long ways off from finishing the Barton Levels, he is no longer locked out.

BartonReading is taught in a logical way that appeals to his curiosity.

Wednesday, June 3, 2009

Spring Vegetables

It's half way between shares and its a good time for me to take inventory of my 'fridge and see what's left to use. I've been making smoothies (and juicing) over a year now. I find the possibilities for variety through the year are amazing. If you haven't tried a green smoothie yet, what are you waiting for?

We got:
asparagus- I marinated
baby bok choy- probably will juice and put in salads
red beet w/ top- beets can be juiced or put into a smoothie, which is what I mostly have done. I put the tops right in too. They can also be grated and put on top of a salad to make it very colorful.
green cabbage- I still had purple cabbage from two shares ago and made this salad. You can make it from just green cabbage also. This batch turned out really well. John even had 2nds.
carrot- lots to do with carrots. I've been juicing them a lot lately and I am beginning to feel orange. I need to back off.
Italian parsley- What I don't use here in there in this weeks recipes, I will dehydrate next week.
eggplant- Not sure what I am doing with it yet. Maybe this hummus.
red leaf lettuce- makes beautiful salads
jumbo vidalia onion-
green pepper- I took only one cause its not my favorite, and right away, John asked me if he could use it. Yeah.
garnett sweet potato- baked. I was thinking they don't go too well with smoothies, but Tam proved me wrong.
green kale- John used up some Kale with his peppers. I will make some marinated (EVOO, garlic and Tamari Say Sauce) salad with it .
kiwi-cut in half and scoop out or add too smoothie
white grapefruit- juice
cantalope- ate it up on the first night, it was perfectly ripe
tommy atkins mango- these were perfectly ripe. I took some extra off the bonus table and Scott ate three the first night!

Fruit Share:
golden pineapple- I will be planting the top of it in my garden.
snjou pear


artichokes- as a group we ordered an extra case of artichoke. I have never had artichoke before. I was in for a pleasant surprise when I dipped it in some oil and vinegar. I see artichoke is coming again next time and I am going to plan for a few yummy healthy dips. Kristen, Earthmother--what do you do with artichoke?

Last time we got (and I never published):

Green Leaf Lettuce, Red Leaf Kale, Asparagus, Squash, Zuccini, Sweet Potoato, Peaches, Spanish, Onions, Tomato, Carrots, Ginger, Honey Dew, Strawberry, Mangoes

Tuesday, June 2, 2009

High School, Not so Musical

"Mom, can I get prepared to go to Public School in a year or two?"

Previously we have talked about ways to make friends and I know exactly where my older sons stand on this. There was more to this question than just "friends."

Really what stood out to me was that this question perhaps was a sign of our homeschool success. It showed me that he was now willingly participating in learning and thoughtfully expressing interest in planning for the future and not afraid to tackle the unknown.

These are reasons he gave me and my replies:

"I'd like to learn more history and social studies."

I' m open to consider his request. What if you get to school and you found out that your Dad has taught you more history than anyone there knows and school is boring. (John KNOWS history.) What if you realize we have better history and biography books than the school has.

"I'd like to get into a good college."

Homeschooling doesn't hold one back from going to a good college.

"If I go and don't like it do I have to stay."


"Plus it would give me a chance to play football."

You've given me plenty of time to think about it and plenty of time to prepare you.

I really appreciate the realistic expectation that this isn't going to happen now or this fall.

As you know not all teachers are always nice. They can be very demanding and not always understanding. I can't remember his exact reply, but he seemed that he recalled that it was their weakness and problem and not his. On the other hand, I realize you may get a teacher who finds you particularly interesting and is full of opportunity.

I'm glad to see eagerness! I'm glad he he's optimistic and motivated and feels that his learning differences don't limit him! All the power to him!

Unfortunately I am not as excited about the idea. I read the opinions and thoughts of these known homeschoolers which is helpful.

We've been conscientious of including friends and social time in our planning. I try to find the boys interests and pursue them. I am not sure how to get involved in local football or if I even would want to be involved. One of the articles suggested shadowing a friend for a day. That is a good idea. I would definately go for that idea. I know about sitting in on one class or just for sports is a possibility.

Mostly I liked the suggestions from several experts to include the children (over ~12 years) in on the planning and find out what they want to get out of schooling which is mostly what my son did explain to me and I am trying to incorporate into our goals.

Never a dull moment...

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