Ban Spanking at School

Should Colorado legislators ban spanking in public schools? Absolutely.

First my own experience: I grew up mostly in and around the peach orchards of Western Colorado, where my grandfather was a farmer. But then my stepfather went to flight school and started working his way up the pilot seniority ladder—and that meant moving to some less-desirable places. During my grade school years in the early 1980s, we moved to Muleshoe, middle-of-nowhere Texas.

In my pleasant and comfortable Colorado schools, it never occurred to me that teachers or school staff might beat students. It occurred to me in Muleshoe right away—because teachers and staff beat students with wooden boards on practically a daily basis, sometimes in private but often behind a thin screen where other students could hear. Frankly it was terrifying. Continue reading “Ban Spanking at School”

An Elegant Solution for Storing Breast Milk

My wife and I have found that storing breast milk in one-cup canning jars, and using a plastic lid for pouring, works well for us.

Breast Milk Storage

It’s great if babies can be exclusively breast fed from birth. But, for many of us parents, that just doesn’t work out, so we turn to pumping and, with that, breast milk storage.

My wife and my baby was born prematurely, so he started off with a bottle in the NICU, first with donated breast milk, then with my wife’s milk. He has never exclusively breast fed. Now that my wife is back to work, she pumps there and I bottle feed throughout the day.

As far as I can tell, Madela sets the standard in breast pumps, and our older model (donated by a friend) works great. (Contrary to advice from hospital staff, we found that the “hospital grade” pump isn’t actually much of an improvement; if anything, we prefer the home model.) But what about storage of all that pumped milk?

After some trial and error (including a late-night spilled cup of milk), we hit on a solution that works for us. It might work for you, too. (It is up to you to properly clean and sterilize whatever equipment you end up using and to check with qualified health professionals about all such matters.)

We tried bags, which are basically glorified ziplocks at a shockingly higher price. I didn’t like trying to pour milk out of those floppy things.

So we started storing milk in standard one-cup canning jars. But how do you get the milk out of the jar into the bottle? It’s too messy to try to pour straight out of the jar. At first we used syringes, but after a while those tend to stick. So we bought an eight-dollar plastic cap via Amazon, one that claims to be “FDA approved-Food Safe, BPA-free & Phthalates-free.” I don’t know what Phthalates are, but apparently I can rest assured they won’t end up in baby’s bottle.

This cap works great for us. It seals well on the jar, it has a tight cap on a hinge, and it pours the milk very well with no spillage.

Incidentally, we’ve found that one-cup canning jars with standard lids also work great to freeze extra milk—just be sure not to fill them too full so as to allow for ice expansion.

Sometimes with parenting, we’re finding, simple, inexpensive solutions can work wonders. We’ve found that to be the case with our capped jar approach to milk storage.


A Great Course for Helping Children Learn Self-Control

“Scientific Secrets for Raising Kids Who Thrive,” a Great Courses offering taught by developmental psychologist Peter Vishton, offers some great advice for helping young children learn basic motor skills and older children learn self-control.

Maryam Abdulghaffar
Maryam Abdulghaffar

How can parents help their children learn self-control? As a new father, I’m keenly interested to learn. (I’m also interested in improving my own self-control.) I was thrilled, then, to discover the Great Courses offering, “Scientific Secrets for Raising Kids Who Thrive” (currently on sale), taught by developmental psychologist Peter Vishton.

The course features twenty-four half-hour lectures, the first of which (on which I’ll focus) covers helping young children learn basic motor skills and older children learn self-control. Other lectures cover topics such as getting kids to eat their vegetables and the pros and cons of video games.

Vishton discusses the importance of “tummy time,” placing a supervised infant on his tummy so he can build muscles and coordination and, eventually, crawl. In this segment, I was especially interested in Vishton’s cross-cultural comparisons of swaddling practices and efforts to help infants develop.

To me, far more interesting was Vishton’s discussion of impulse control. Among other things, Vishton discusses the famous “marshmallow experiment,” in which children could eat a small treat immediately or wait for a larger treat. I had heard about this before, but Vishton fills in many fascinating details. For example, he describes how, at age three, most children were bad at delaying gratification, while, by age seven, most children were pretty good at it. He discusses a follow-up study finding that children who were good at controlling their impulses tended to be more successful later in life by a variety of measures.

So how can parents help? Vishton discussed a study of children taking Taekwondo, a type of martial art. Classes that emphasized self-control, the study found, helped children be more self-controlled generally. Another study that Vishton mentioned found similar results for yoga classes.

In all, the lecture surpassed my expectations. The production quality is fantastic, with good lighting and sets and an excellent lecturer. The video streaming was good overall, with just one glitch that resolved when we went back a minute.

This was the first set of video I’ve purchased from Great Courses. I’d purchased audio before, long ago, and decided to invest in some video courses on history, music, math, and science. I’m glad I added Vishton’s course to the mix.

I have just one complaint about the first lecture. Vishton discusses Taekwondo as an activity a parent might choose for a child. But what about what the child wants? As Craig Biddle writes in his recent article on parenting, “because our children’s use of their faculty of choice is what enables them to live proper human lives, we should enable them to choose their own values within the range of reasonable, life-serving, developmentally appropriate alternatives.” I would have enjoyed hearing Vishton’s thoughts on allowing a child to choose which activities to pursue and on whether and in what ways a parent should encourage a child to pursue activities that foster self-control. Without such a discussion, some parents might confuse fostering self-control with fostering mindless obedience. I’ll be interested to hear if Vishton addresses such matters in subsequent lectures in the series.

That minor complaint aside, I’m thrilled with the course, and look forward to watching more of the lectures from this and other courses. And, now that I’ve finished this brief review, I think indulging in a piece of chocolate is entirely appropriate.


The Expectant Parent’s Guerrilla Guide to Preeclampsia

c-sectionTrust me on this one: You do not want to first learn about preeclampsia the night your wife is diagnosed with a severe case of it, resulting in an emergency Caesarian delivery of your child.

I learned this lesson the hard way. Here’s what happened. In January, my wife and I learned that she was pregnant. This was something of a surprise, because we had been unable to get pregnant for years. What I think happened is that my wife’s fibroid embolization procedure in 2012 cleared a blockage (perhaps of the fallopian tubes), eventually allowing the pregnancy. We signed up at Mountain Midwifery near Denver, went to classes there, and planned on a normal delivery around August 15.

That’s not how things turned out. We went in to the Midwifery on July 10, and attendants there got high blood pressure readings for my wife of 163/96. This was a surprise, as my wife had not previously had trouble with high blood pressure. I didn’t know what was going on, and I had no idea how to gauge the seriousness of the reading. An attendant also tested my wife’s urine, and it showed high protein counts—an indication of possible kidney problems.

The Midwifery sent us to Swedish Hospital. The Midwifery’s relationship with Swedish to handle emergencies is a major reason why we chose the Midwifery. The thinking is that, for most cases of child delivery, you don’t need the intensive medical intervention of a hospital setting, but, in a small fraction of cases, you really do want access to all the technology and expertise that Western medicine offers. We turned out to be in the minority.

We saw a doctor at Swedish, and she confirmed that my wife had high blood pressure. She ordered an ultrasound to check the health of the fetus; thankfully, he was fine. She also rechecked my wife’s urine, and again found elevated protein.

My wife had preeclampsia. At the time, I had no idea what that meant. One thing I soon learned is that there are mild and severe forms of it. At first it was not clear where we were on that spectrum. At first, the doctors thought they might be able to send us home with some medications and deliver in a couple weeks. But, after my wife’s blood pressure did not respond well to medication, we heard the diagnosis of severe preeclampsia. That narrowed our options to inducing delivery right away or going in for a C-section. We started the induction process, but then, when a doctor found the fetus was breech (head up), we started prepping for a C-section.

One thing I appreciate about the staff at Swedish is that they gave us the information and the space to make an informed decision. Going in for a C-section was not an easy option to face, especially given that my wife had read extensively on traditional vaginal birth and was committed to that path. When I asked the staff to give us a few minutes to absorb the information and discuss our options, they gave us the space we needed.

The decision came down to two main facts. First, my wife’s preeclampsia was not going to improve, and was likely to get worse, until she delivered the baby. Second, the baby was breech, meaning that a vaginal birth was unlikely anyway. Everyone at Swedish was on board with the C-section, and so was our primary care doctor (with whom I was able to speak by phone). That wasn’t the path we had planned or thought much about, but, we soon realized, it was the medically optimal path for us given the circumstances. We both felt that we were making an informed decision and that we remained actively in control of our health. I will always be grateful to the staff at Swedish for giving us the information and time we needed to reach the conclusion on our own, rather than trying to push us into the procedure before we understood the relevant issues and had the time to absorb the emotional shock.

We went in for the C-section around two in the morning of July 11. My wife remained awake, and I could observe both sides of the sheet: my wife’s face and the doctors at work. Watching the C-section was another shock for me. What I had imagined is a doctor gently slicing open the belly, then reaching in with fingertips and gently pulling the baby out. But “gentle” is just not a word that applies to a C-section. I tried hard to conceal my shock so my wife couldn’t see it on my face.

The process was much more—shall we say active—than I had imagined. The main surgeon and her assistant forcefully cut through the belly, then the uterus, then pulled out the baby a limb at a time. At one point, it seemed that the surgeon’s whole arms disappeared into my wife’s belly. I thought for sure the baby would end up with broken bones (of course he didn’t, although he did have some bruising). I vividly remember my baby with his entire body out of the womb except for his head, which remained stuck inside. It was quite a process just to get the head out. Of course, during this process tubes sucked away the blood and amniotic fluid.

Child Birth Swedish HospitalFinally, baby delivered, the doctors stitched back together my wife’s uterus—as it sat atop her belly. “Is that normal?” I asked; I was assured it is. I even saw a couple of fibroids left from the embolization procedure. One larger fibroid was on the bottom of the uterus, which might have made a normal vaginal birth difficult or impossible, even had my wife not had preeclampsia.

I’ll pause here to praise the lead surgeon, Susan Peck. Her work during the surgery, as well as her interactions with us before and after the surgery, were outstanding. I’m convinced she shaved several weeks off my wife’s recovery time with her skillful work. “Beautiful” is sort of an odd word to refer to a surgical scar, but it is in fact beautiful as a mark of excellent work, and several staff members at Swedish used the term in that context, as did I.

My son owes his life largely to two doctors: Brooke Spencer, who performed the embolization procedure and thereby made his conception possible, and Susan Peck, who performed the C-section and thereby made his delivery possible.

The delivery finally over, my wife went to recovery while my son went to the NICU (Neonatal Intensive Care Unit). I spent the rest of the night wandering between my wife’s room and the baby’s room.

So what is preeclampsia? Please note that I am not a doctor or health professional of any kind, so nothing I discuss here is intended as medical advice. As far as I can tell, no one really knows what causes preeclampsia. They do know how to treat it, thankfully.

“Eclampsia” refers to seizures during pregnancy. So a preeclamptic woman is one at risk of suffering seizures or stroke. Here’s a summary from the Preeclampsia Foundation:

Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly advancing disease report few symptoms. . . .

Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.

Notably, my wife showed no external symptoms of the disease. But for the blood pressure test and subsequent tests for her kidneys and liver, we would not have known she was preeclamptic. That’s horrifying in retrospect, because I don’t know how long my wife had the problem (her previous blood pressure check was three weeks prior), and I imagine what might have happened had we not caught the disease when we did.

As Mayo points out, the precise causes of preeclampsia are unclear. One theory I heard is that the genetics of the placenta (and possibly the fetus) somehow trigger an autoimmune response (or something similar) in the woman.

The cure for preeclampsia is to give birth. However, as I learned, the “cure” can take some time to take hold. Doctors put my wife on a twenty-four hour magnesium drip soon after delivery to protect her from stroke and seizure. With the drip and with blood pressure medications, finally they got my wife’s blood pressure under control. However, once she went off the drip, we had another scary night with high blood pressure readings, so doctors put her back on the drip and increased the dosages of her other meds.

In all, we spent eight days in the hospital, a grueling slog that felt like it would never end. (Note to hospital equipment designers: Please stop making every single last piece of equipment beep unnecessarily and incessantly.)  Apparently, such severe residual preeclamptic symptoms are fairly rare in patients, so our doctors struggled a bit to get the meds right.

My wife continued to take blood pressure medication for another three weeks at home, until finally her readings returned to normal.

While my wife recovered from preeclampsia, my son developed in the NICU. The nurses there are excellent, and they helped train me to feed and care for my son.

We were delighted to learn that, thanks to the Mother’s Milk Bank, our son would be able to drink donated breast milk until my wife’s milk came in. This was a huge relief, as I was slightly horrified the last time I read the ingredients list of formula. I was so grateful that our son could have the best available nutrition.

At 35 weeks, our son was a premie but a relatively developed one. Some babies in the unit were far younger. Our son needed a feeding tube at first, in addition to pressurized air to help him breath. He also got the “hot box” and the jaundice light for a few days.

Our son spent ten days in the NICU, two days longer than my wife spent in the hospital. We were thankful to get everyone home, yet I was also grateful that we could stay at the hospital when we needed to. In general, we were extremely happy with Swedish from the moment we walked in the door until, finally, we drove away.

I had spent all my time planning for a “normal” vaginal birth in mid-August, so an emergency Caesarian delivery in early July was a difficult thing to adjust to. The time in the hospital was extremely stressful and exhausting. And we were in the middle of some major home projects—I thought I still had five more weeks—so coming home was not the restful and serene experience I had envisioned. But we made it through fine, and the results are excellent. We didn’t take quite the path we had planned, but we arrived at the same destination; ours is a success story.

So what are some of the take-home lessons for other expectant parents?

1. Learn the basics about preeclampsia early in pregnancy, so you are better equipped to handle it if it happens to you.

2. Plan for a “normal” delivery—I highly recommend the Mountain Midwifery if you’re in the Denver area—but have a contingency plan in case something goes wrong. The Midwifery’s contingency plan is to send patients with complications to Swedish, and, for us, that worked spectacularly well.

3. If you’re pregnant, consider buying a home blood pressure kit and taking your pressure every day or two. One doctor advised us to sit still for five minutes and have your arm level with your heart to take a pressure reading. If I had it to do over again, I’d take regular home readings to supplement doctors’ readings. That way, I’d have a better ability to notice sudden changes and promptly seek professional guidance if needed.

4. If you do end up with severe preeclampsia, take heart that modern doctors know how to handle it. You want to take the disease seriously, but there’s no need to worry excessively about it, given the technologies and expertise of modern medicine.

5. Be prepared for contingencies. Get your “to go” bag ready early on. Include earplugs and eye shades, as sleeping in a hospital can be challenging. Get your house in order early if you can. Line up someone to watch your house and your pets if necessary.

6. Prep yourself for the potential stresses of a hospital visit. During the first night at the hospital, I did not sleep a wink, so I started the process utterly exhausted. It was a very busy and stressful time.

7. Be an advocate for yourself or your patient while respecting the time and expertise of hospital staff. Generally, we had very positive interactions with everyone at Swedish—something made easier because Swedish is an excellent hospital. However, I had a couple of unnecessarily testy exchanges with doctors, largely because I was tired and stressed; I later apologized to those doctors and we resumed a good working relationship.

8. Do what you can to get mother with baby, but recognize the limitations of the hospital setting. At first, I did not understand why baby could not be in the same room as mother. Then it became apparent to me: The NICU is very specialized, as is the Labor and Delivery ward, so sometimes it’s not feasible to keep mother and baby together. That said, do try to facilitate meetings of mom and baby until they can get into the same room or come home.

To me, preeclampsia was terrifying. But largely that’s because I didn’t know what it is or how doctors treat it. If you’re an expectant parent, do yourself a favor and spend a bit of time reading about the disease and preparing for the possibility of going through it. Then you can take comfort in the knowledge that most pregnant women don’t get preeclampsia, and, if a pregnant woman does get it, doctors are in a great position to effectively treat it. Preeclampsia is a problem for some women, but a manageable one with modern medicine.


Freaky Unintended Consequences

I’m a fan of the Freakonomics books, though I don’t always agree with them. (I’ve written about them a couple times before.) The documentary of the same name includes some material not found in the books.

I enjoyed this line: “You can teach a kid just as much at a grocery store as you can at a museum, maybe more.”

But perhaps the most poignant new story from the film is of Steven Levitt’s experiences potty-training his daughter. As he relates the story, his wife for months had trouble getting their daughter to use the toilet. So he figured that, as an economist, surely he could come up with an incentive structure to encourage potty training.

So Levitt decided to offer his daughter a bag of M&Ms if she’d use the potty. Immediately she did so. And for a couple of days, she consistently used the potty in exchange for M&Ms.

But on about the third day, Levitt’s daughter said she had to use the potty, and she went a very small amount in exchange for the M&Ms. She immediately said she needed to go again, so she went a small amount for another bag of M&Ms. Levitt points out that his incentive structure had encouraged his daughter, in three short days, to develop excellent bladder control. What it had not done is accomplish his purpose of getting her to use the potty normally.

The moral of the story? If a genius-level economist can screw up the incentives to potty train his daughter, why do so many people think that politicians and unelected bureaucrats can centrally control vast swaths of our economy?

Prenatal Planning

As I’ve discussed, my wife Jennifer and I are planning to have a baby. While not pregnant yet, we’ve decided where we (probably) want to deliver the baby, and we’ve verified that our high-deductible insurance will cover emergencies related to the delivery and infant. Assuming a normal birth, we’ve already saved ample funds in our Health Savings Account to pay for the prenatal care and delivery, and we’ll have our full deductible saved well before delivery.

Obviously another big key is for Jennifer to prepare her body for pregnancy. As a point of general health, we checked Jennifer’s cholesterol counts. Jennifer also went to the dentist so she won’t need to do that during pregnancy.

Jennifer started taking a prenatal vitamin; her book What To Expect When You’re Expecting suggests that Vitamin B6 can help alleviate morning sickness, and obviously other vitamins are also important. A midwife at Mountain Midwifery suggested that Costco fish oil is a good source of Omega 3 fat, so we’re sticking with that (as opposed to an algae based form of the fat, which is considerably more expensive, even for the Target brand).

One thing I’d never heard of is an “Rh factor” test. According to What To Expect, “In a pregnancy, if the mother’s blood cells do not have the Rh factor [an antigen] (she’s Rh negative) while the fetus’s blood cells do have it (making the fetus Rh positive), the mother’s immune system will view the fetus… as a ‘foreigner.'”

Conveniently enough, PrePaidLab offers the Rh test, so Jennifer signed up for it. So if she tests negative, then apparently I also need to get tested.

While we were at it, we thought we’d get her level of Vitamin D tested. (PrePaidLab also offers that test.) The Vitamin D Council has more general information. One study suggests that a deficiency in the vitamin can cause underweight babies. A second study seems to confirm those results. Another concern is that a deficiency can harm the child’s bone health.

One big question we have is how much fluoride Jennifer should be taking. According to our dentist, she should be drinking regular tap water for its fluoride content during pregnancy and breast feeding, so as to give the child enough of the mineral for strong teeth. A child needs it for several years thereafter, according to my dentist. I’ve heard the claim that fluoride per se is bad, but such claims strike me as unsubstantiated hysteria. However, it’s unclear to me exactly how much fluoride Jennifer should be taking, and when she should be taking it. (If anybody has good, objective evidence on the matter, please share in the comments.)

Tracy Ryan of Mountain Midwifery suggested that Jennifer should have gone off the birth control pill long ago (and in general she prefers the IUD to the pill). But Jennifer is off of it now, so she’ll have at least a complete cycle without the extra hormones.

The next step is the obvious one.



Lady Baker April 26, 2010 at 3:41 PM

FYI, you might be able to save the cost of the rh test if she’s ever donated blood (it would be noted in those records). Also, it’s almost never an issue with a first kid. If sensitized, an rh- mom can attack a subsequent rh+ fetus. (If there has ever been a miscairrage early enough that the mom didn’t know, she can be sensitized for a first child.). Just sharing from my high risk maternity nursing background :). Rachel
P.S. This may not bs the best time for her, but donating blood could be a free way for you to find out your blood toe and rh status. It’s a bigger needle, but still just one poke.

Pamela Clare April 27, 2010 at 9:25 AM

Enjoy that next step. Very exciting!

Jenn Casey April 27, 2010 at 2:03 PM

It’s been a while since I’ve revisited the fluoride issue, but I read about it years ago and decided against consuming too much of it. We get bottled water, and I switched at that time to non-fluoridated. This was when my oldest child was a baby. None of my kids have had issues with cavities (anecdotal, so fwiw). I have chosen to have their teeth treated topically with fluoride at their dentist appointments. But none of us drink fluoridated water, and I didn’t drink it while pregnant (except for the first time) or nursing.

PDM April 30, 2010 at 9:23 AM

The National Academy of Sciences did a thorough review on fluoride in 2006. They documented numerous deleterious effects of fluoride on many organ systems including increased potential risk for bone fractures (the well characterized disease of skeletal fluorosis) possibly increased risk of osteosarcoma, reduced IQ, thyroid dysfunction, endocrine dysfunction and others all 300 pages is online if anyone cares to confirm it. Of course don’t forget fluoride induced dental fluorsosis (i.e. teeth mottling and a sign of toxic exposure to fluoride – the rate has increased dramatically subsequent to widespread water fluoridation with the CDC and others putting the prevalence somewhere around 30%) The NAS study ended with recommending that the EPA should more strictly regulate fluoride. Their findings mirror those in the peer-reviewed medical literature, while Harvard trained toxicologist Phyllis Mullenix also extensively documented behavioral changes in mice upon exposure to blood levels of fluoride not far greater than those experienced through water fluoridation and other sources of exposure. Former, well credentialed EPA scientists have been fired for bucking the political line on this issue. Meanwhile 90% of the fluoride placed into our water supply is not industrial grade sodium fluoride, it is silicofluorides, quite simply, scraped from the sides of Florida phosphate plant smokestacks. If it weren’t thrown into the water supply it would have to be disposed of as hazardous waste. You can read more on this starting here,

Ari April 30, 2010 at 9:40 AM

Sorry, PDM, but those claims are entirely unbelievable. I do not doubt that too much fluoride is harmful, and that is all the cited science demonstrates. But too much of anything is harmful. Too much Vitamin D is harmful, too much protein is harmful, too much iodine is harmful, yet all of those things are necessary for life.

The question is, are modest amounts of fluoride useful in building strong teeth, without causing serious side-effects? To date, I have seen exactly zero evidence demonstrating that moderate levels of fluoride are unhealthy. -Ari

Insurance Covers Emergency Birth

As I wrote yesterday, Jennifer and I are planning to have a kid. One of the major outstanding issues was how insurance would handle this. I was relieved to confirm that our health insurance would cover emergency contingencies related to delivery (after the deductible). Moreover, we have 30 days to add a newborn to our plan, and the child is covered from birth.

We have a high-deductible plan with Assurant that costs us $148.16 per month (for both of us). We don’t expect our insurance to cover any of our routine or moderate-cost care; that’s why the premium is relatively low. Instead, we save the maximum allowable in our Health Savings Account, which is pre-tax money. We already have ample funds in our HSA to cover a routine delivery at Mountain Midwifery.

But, as Tracy Ryan, the owner of the facility, warned us yesterday, in a minority of cases a woman may need an expensive C-section, and the infant may need expensive intensive care. The worst-case scenario could easily cost tens of thousands of dollars.

Our family deductible is $10,000 per year. So, given our insurance covers delivery emergencies, that’s the maximum bill we’re looking at, and by then we’ll have more than that in our HSA.

Assurant also gave me an estimated premium to add a newborn: a family total of $202.69 per month. While decades of political controls have mostly destroyed the market in health insurance, that’s a premium I can live with. The big question for us is whether and how long ObamaCare will allow my high-deductible insurance to exist.

Blog housekeeping: I’m adding a “family” label for posts related to pregnancy and children. I use “PPC” — for People’s Press Collective — for posts on politics. I’ll use a “home” label for everything pertaining to food and the household. I’ll also use a “religion” label.

Kid Planning and Mountain Midwifery

Jennifer and I have been married for over a decade, and we’ve been talking about having a kid since before we were married. We’ve finally decided to go through with it. Further, we’ve decided to share our experiences, not only as a record for ourselves, but perhaps as a useful point of reference for others. Perhaps experienced parents will also be motivated to write in and offer us guidance when we seem to need it.

Today we went a long way toward resolving one of our big decisions: where to have the baby. We visited Exempla Good Samaritan in Lafayette yesterday. Very nice, but not especially welcoming or reassuring. We visited Mountain Midwifery Center (MMC) today, and we both fell in love with the place, so much so that we didn’t make it to our third appointment at Avista in Louisville. (We may tour other facilities in the coming weeks.)

To back up a bit, Jennifer is not yet pregnant. Thus, there are a lot of things that could go wrong between now and birth. We could fail to get pregnant. We could miscarry. We could suffer a seriously deformed fetus — personally my biggest fear — in which case we would obtain an abortion, as we’ve discussed at some length. We could suffer problems during the delivery that could endanger the life of Jennifer or the baby. But we expect a normal, healthy birth, and of course that’s what every parent-to-be hopes for. As with much of life, then, the goal is to expect the best but plan for the worst.

MMC, we learned this afternoon, is the largest midwifery center in the nation, with five registered nurse midwives and eight nurses. The center has facilitated 592 births in its four-year history. (I’m not sure if this included a birth today prior to our visit.)

The visits to Exempla and MMC were completely different. I’ll begin by highlighting some of the major differences.

Detail of information — At MMC, Tracy Ryan, the owner, addressed a room full of about 20 prospective parents for over an hour. She told us what to expect, answered in detail questions about medical contingencies, and talked about general birthing facts. At Exempla, frankly I learned more about the in-hospital store than I did about the medical aspects of birthing.

Ritz — Exempla is beautiful. The building is beautiful and the rooms are beautiful, with beautiful views and hardwood (or faux wood) floors. I began my notes at MMC, “Looks like an old Spanish-style Super 8.” There were toys on the floor of the main room. Something was covered by a colorful sheet. It had a definite urban-hippie feel. I wondered in my notes whether this meant that MMC didn’t waste money on frivolities or if it meant that the clinic was unserious. I soon became at ease at MMC, finding its less-formal environment to be “lived in” and meant for real people.

Pricing information — Before we went to Exempla, I spent twenty minutes or so on the phone with a representative of the hospital. After getting a range of prices, the representative noted that she was giving me only the insurance rates. “What are the self-pay rates?” I asked. “I can’t tell you that,” the representative replied; I’d have to call another business office. I got no additional information from our visit to the hospital in terms of pricing. Moreover, Exempla offers a “complimentary welcome home” dinner as well as diapers for the baby. Complimentary, my ass. Somebody’s paying for that nonsense at jacked up rates, and that somebody obviously would be me. At MMC, Tracy made a special point to discuss pricing. And MMC’s prices are much lower, “around” $4,000 plus fees for outside tests. (Of course this is the cost of a normal delivery, not an emergency one.)

Water delivery — Exempla will let the mother sit in the tub during labor, but it offers no water delivery. That’s a facade of “natural childbirth,” not the real thing. At Exempla, you end up on a hospital bed, and that point is pretty much non-negotiable. MMC features water delivery tubs as well as birthing stools. Tracy explained that mothers often have to try different approaches and positions. The point at MMC is to let the woman’s body do what it does naturally, work with the baby’s body, and use gravity to natural advantage.

Expected recovery — I thought it was odd that Exempla offers a room for delivery, then moves the mother into another room for recovery. Obviously this would add to the cost, I thought. I asked, “Can a mother just leave straight from the delivery room?” Oh no! Heaven forbid! Absolutely not! That sort of thing just isn’t done, apparently. Tracy said the normal delivery at her facility is quite different. Often a mother has her child and goes home to bed after a few hours (provided all the health markers are normal, of course).

Crowd engagement — The general attitude at Exempla was “fill out this form and figure out how we do things around here.” The general attitude at MMC was that the mother and her partner are in charge, and it is the job of the midwives to educate the mother and facilitate her decisions. This attitude was reflected among the prospective parents, who chatted before and after the class and peppered Tracy with difficult questions. (One of the prospective fathers there was a doctor, and he asked some great technical questions.)

I felt like Exempla was a good hospital and we’d be in good hands, but we hardly felt like we had found our birthing home. I don’t have much else to say about Exempla, though I thought I’d share my photos of the building and the two rooms:




I have a lot more to say about Mountain Midwifery Center. I’ll start with pictures, which capture the tubs, a stool, the building, and Tracy standing by photos of her birthday babies:





I’ll start at the beginning of my notes. Tracy entered the room looking confident, nice, and down-to-business. She was wearing jeans, but in a way that conveyed a let’s-get-busy attitude rather than a casual one. After finding everybody chairs (a few sat comfortably on the floor), Tracy sat in a folding chair facing everyone and began her spiel. MMC is the only licensed birthing center in Colorado, though there are 200 in the country. Tracy is hoping to expand to other locations in Colorado. As noted, her facility has helped with nearly six hundred births in four years.

MMC accepts thirty-six families per month. Five midwives work there. The facility has three birthing rooms. I asked what happens if more than three women go into labor at the same time; Tracy assured me that’s practically impossible.

Tracy said that a typical delivery might happen at noon with the woman walking out by her own power by four.

“Pregnant women aren’t sick. That’s just something our bodies do,” Tracy said. Usually there aren’t big medical complications. She urged us to see the film The Business of Being Born — which we own but haven’t yet watched (perhaps tonight!), and said the “best maternity care is not in hospitals.” MMC is “more like a home-birth center,” Tracy said.

However, she quickly added, “We are not anti-hospital.” In fact, Swedish is literally just up the street, and MMC has a good relationship with that hospital and has sent several mothers and babies there who needed extra help.

I learned some new terms today. An “episiotomy” is when the medical assistant basically makes an incision to enlarge the vaginal opening. (Sounds unpleasant.) MMC can do an episiotomy, but it rarely does one, Tracy said. Half the women who deliver there walk out without a stitch.

“We use intervention appropriately,” Tracy assured us. It is definitely not true, she emphasized, that all babies come out naturally and easily. If one looks at a developing region (she mentioned Ethiopia), one finds that more babies die there and women sometimes suffer severe physical trauma.

Eleven percent of the women who have gone to MMC have ended up at Swedish. This drops to a single percent for the second baby, which often more or less “falls out.” (That’s not how the mother would describe it, Tracy clarified.) While most babies do come out naturally, “some babies need help.”

Few “certified nurse midwives” — nurses with additional graduate training — work in Colorado, Tracy said (find more through the midwives association), and five work at her facility (including her). They can do all sorts of things from sew up tears to order lab work.

Tracy said that typically there’s a blood test of the mother-to-be between eight and ten weeks into the pregnancy. While sometimes a nurse at a hospital will draw a woman’s blood without so much as an explanation of the purpose, at MMC the goal is the inform the woman, educate her on the pros and cons, and then enact her decisions. That’s exactly the attitude we’re looking for.

MMC offers all sorts of classes, covering nutrition, birthing, feeding, and so on. She repeated the refrain, “diet, exercise, and three liters of water a day.” (Later she guessed that Colorado’s high premature birth rate is linked to dehydration.)

The staff of MMC will discuss money, family, work, and the “fear of doing labor.” “Everybody has fears of doing labor, but you can do it… Labor is tough. But at the birth center, you get support.”

The attitude at MMC, Tracy continued, is that as a pregnant woman “you are normal and healthy.” Birth is an active event. MMC facilities mostly “hands and knees water birth by candlelight.” (She said it rapidly but thankfully repeated it a few times so I could write it down.)

Tracy said that actually about forty percent of births there take place in the water. Another common position is on the bench. She said laying-down births are more common for subsequent babies, which often come out easier. Practically all the women at MMC get in the tub at some point. Women often need to try different things out and shift around, Tracy said. Moreover, babies can prefer different positions.

Tracy said that at many hospitals — and our friends’ experiences confirm this — the spouse needs to act as the advocate for the woman to enact her birthing plan. But at MMC “we are your birth plan. We are your low-intervention place,” so it’s not all up to the spouse to keep things flowing according to the woman’s intentions.

While MMC allows outside guests, Tracy cautioned prospective mothers to invite in only people they’re comfortable with. “You can fake an orgasm, but you can’t fake your birth,” she said. In other words, the birthing process is an extremely emotional process, and “you need that ability to have intimacy” with everyone present.

The staff at MMC tends to cut the umbilical cord a bit later in order to allow the child to get all the available red blood cells. Then, the staff lets a child adjust before breast feeding. “Give that baby time, give that mamma time,” is the usual advice.

Every mother meets every midwife. That way, whoever is on call can handle the birth. Tracy said she used to serve as a midwife in homes, but she was on call all the time. After missing her own kids’ birthdays one year (and she has five kids of her own), plus her anniversary and Christmas morning, she and her husband decided it was time for a change. Her husband quit his job with Ball Aerospace to become the business manager at MMC. Working from a center allows the midwives to spend time with their own families, too. And pregnant women have the assurance that somebody will be available to help handle the birth.

After the birth the clinic follows up with in-home and in-clinic care.

Tracy believes that inducing pregnancy with drugs, while sometimes necessary, can interfere with the natural, hormonal communication between a woman and child. While such drugs can be “a really great tool,” Tracy said, often they are used when women are “under the gun” to deliver.

Tracy said that the national C-section rate is 33 percent. She said the rate should be much lower than that, and the rate at her clinic is six percent. Of course, the MMC figures look good in part because women with problematic pregnancies go elsewhere to deliver, but I’m convinced that a big part of the reason is the fact that MMC works hard to work with the woman’s body.

“We’ve only called an ambulance four times,” Tracy said, once for a vaginal breech birth (which means the kid comes bottom first, I learned).

MMC features two consulting doctors, and “the best thing about the birth center is our relationship with them… they’re helpful and they’re not adversarial… and it’s the part that you most likely won’t need to see.”

When needed, “then we ask for tools and drugs, because you’ve tried the natural thing here, and it’s not working.”

There are some cases that MMC can’t handle, such as gestational diabetes and high blood pressure. What I like about Tracy’s approach is that she is not irrationally wed either to a “natural birth” or to an interventionist birth, but she instead treats natural birth as the reasonable default and calls upon more intervention when it is objectively needed.

Tracy’s passion is to facilitate a woman’s choices: “I’m a convincing person and I love what I do, but this is not for everyone,” she said.

Tracy said that she could be making more money elsewhere, but “we’re all very idealistic here… We believe this will change your life.”

Jennifer and I also talked with Nancy, another midwife. We had a question about whether Jennifer needed to switch from fish oil (for Omega 3) to algae-based oil. Nancy recommended Kirkland brand fish oil, which happens to be the kind we use. She also recommended pro-biotics. We discussed screening tests with her as well.

Tracy gave us some great advice on birth control (she likes the IUD over the pill). And she encouraged me to make sure our high-deductible insurance covers maternal care. (I have no idea whether it does or not.) Reviewing our insurance is our next major step before getting ourselves into this. I would hate to leave my high-deductible plan, but, as I’ve long argued, the insurance market has been totally screwed up since long before the Democratic health bill. At this point I don’t even know whether or how long my high-deductible plan will remain in existence. So that’s the big variable at this point. But, even if we switch insurance, we’ll use MMC regardless of the plan. (We already have ample funds in our Health Savings Account to pay for a non-emergency delivery.)

At one point Tracy discussed the barriers she’s faced in starting the clinic. Sure, she has faced challenges, but, she noted, “I’ve pushed five babies out,” so she can face anything else.

UPDATE: Here’s a video of a water birth at Mountain Midwifery:

And here’s another water birth that Jennifer and I watched on video:



Amy April 12, 2010 at 12:06 PM
Congratulations on your exciting decision, and I hope you enjoy the whole process! My entire pregnancy and water birth experience with midwives at a birth center was wonderful.

You’ve found what sounds like an excellent birth center. This approach is not easy to find:

“What I like about Tracy’s approach is that she is not irrationally wed either to a “natural birth” or to an interventionist birth, but she instead treats natural birth as the reasonable default and calls upon more intervention when it is objectively needed.”

TJWelchApril 14, 2010 at 7:30 PM
One thing you may want to look into, if your wife intends to breastfeed, is if they have lactation consultants available on-site. I will say, however, that at the facility where my wife delivered (eight years ago), they insisted on getting the baby to feed within the first 24 hours, and if the baby did not feed successfully in that time, they urged formula feeding. That policy caused us some unnecessary angst, as we later read that most babies will do just fine without feeding within the first 24 hours.

Ari April 14, 2010 at 10:05 PM
They definitely have “lactation specialists” available, and they seem very supportive of breast feeding, which I am convinced is important for good health of the baby. (A delay of 24 hours seems like quite a long delay to me, but I haven’t researched the particulars.)

Kelly Elmore April 16, 2010 at 8:21 AM
Ari, this birth center sounds fantastic. I wanted to comment that the rate of 11% hospital transfer is pretty good. The homebirth midwife that I used (and worked for) had a 10% transfer rate for first time moms, and it was one of the lowest I found. Good for you and your wife for researching so carefully and finding a place you feel comfortable in! And I labored in water and loved it!!

catherine April 17, 2010 at 5:32 AM
Congrats on your decision! I love being a parent, I wish the same amazing experience for you two! Two thoughts: I have read that nursing within the first hour is a good way to launch breastfeeding, that’s what I was able to do with my full-term birth, and close to it for the preemie birth (pumping). Went to a couple LaLeche meetings before birth that proved very helpful. 2nd thought: Since you are already visiting birth centers, I would recommend reading up on parenting a little bit over time as well. I recommend the Nursing Mother’s Companion, Your Self-Confident Baby, Healthy Sleep Habits Happy Child. Will reserve my conception advice!! All the best!