Thursday, March 21, 2013

Homeschool Carnival

The Carnival of Homeschooling is up for this week at momSCHOOL. I really appreciate the work of those who put together the carnival each week so that I can learn from other homeschooling families.

Friday, March 15, 2013

Thoughts on Home Birth

Some people, unbelievably, still seem to think that homeschoolers are either like the "quiverful" Duggars or hippies living off the grid and eating/wearing organic whenever possible. We're religious, but my girls go to public school part-time and wear pants most of the time. We try to eat and live healthily, but I vaccinate my children, give birth in the hospital, and buy whatever produce I can afford without worrying about whether it's organic.

When I embarked on the adventure of childbearing back in 2004, my husband and I took a Bradley childbirth class in the Philippines. We read books by Dr. Sears and Ina May Gaskin. We determined to do everything possible to avoid a C-section, partly because of what we were learning and partly because of the fact that I had decided to opt out of returning to the USA to give birth and didn't want to undergo major surgery in the Philippines (among other concerns, my blood is Rh-negative, which is uncommon in Asia). Since I have low blood pressure and pass out easily from needles (good-bye, epidural, not going to mess with you...), information on giving birth without pain medication was quite welcome. 

However, despite having a sister and good friends who homebirth, I have never felt like that was a good choice for me personally. I know of too many things (like eclampsia, postpartum hemorrhage, shoulder dystocia, cord prolapse, placental abruption, cord wrapping issues, maternal heart attack, fourth-degree tears, obstructed labor, uterine rupture, life-threatening but previously unknown physical abnormalities in the infant that require life support measures followed by surgery as soon as possible--this happened to my nephew--and infant respiratory issues--meconium aspiration contributed to the death of an infant cousin of mine--just to name a few) that can unexpectedly go wrong and need the prompt medical attention available in hospitals.

A year ago, I found out that an acquaintance of mine, who had been due to deliver her baby a month before mine, lost the baby after a home birth attempt. There is no doubt that this was a previously healthy baby who died as a result of birth complications that could not have been dealt with outside a hospital. The experienced midwife had reason to think that the baby was in an oblique breech position but decided to go ahead with the home birth; she even brought student midwives so they could see the birth. After an excruciating labor that went on too long and during which their midwife discouraged them from going to the hospital, my friend and her husband finally went to a hospital where their baby, who was most likely the victim of a cord prolapse, was born by C-section. However, because he had been deprived of oxygen for an hour during labor, he suffered extensive brain damage and passed away after being taken off life-sustaining machines. The heartbreak that she and her family did and do suffer is immense. The midwife, who I assume was also greatly saddened by the baby's death, had an official complaint lodged against her and no longer practices midwifery here in Colorado.

While I once praised home birth, I now hold a negative opinion about both the practice of home birth and the legislative choice of many states to permit minimally-qualified (i.e., neither nurses nor doctors) midwives to attend out-of-hospital births. Even experienced, highly-knowledgeable midwives sometimes face unanticipated situations that require immediate remedies which they cannot provide, and those who practice a healing art outside hospitals should attain a high level of education and supervised training, such as occurs in nursing and medical schools. As I've been following this issue for the past year, I've learned that Colorado has a high (compared to hospitals) death rate for home birth attempts with non-CNM midwives. Today I found out that out-of-hospital birth attempts in Oregon result in a 6-8-fold increase in the rate of intrapartum and neonatal demise of full-term babies. Here is part of the testimony about this, the entirety of which is online at https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585:

Oregon now has the most complete, accurate data of any US state on outcomes of births planned to occur in the mother’s home or an out of-hospital birth center.
***
On the 1st row, you can see that nine babies died during or soon after labor in homes or birth centers.
The total mortality rate for planned out of hospital births was 4.5 per thousand, as seen in the last column of that row.
I have included the number of neonatal deaths both with and without the death of one baby who died of congenital abnormalities. That death cannot be attributed to the care given by the DEM attendant.
The 2nd row shows data on deaths associated with planned OOH births with direct-entry midwives as the planned birth attendants.
The total mortality rate associated with those births – excluding the one involving congenital abnormalities – is 4.8 per 1000.
For comparison, data on births planned to occur in hospitals is provided in the bottom row of the table. [The 2012 mortality rate in Oregon for term births planned to be in the hospital is 0.6/1000.]
Note that the total mortality rate for births planned to be attended by direct-entry midwives is 6-8 times higher than the rate for births planned to be attended in hospitals. The data for hospitals does not exclude deaths caused by congenital abnormalities.
Many women have been told that OOH births are as safe or safer than births in hospitals. This is true in some places, including British Columbia.
But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting.

I'm not an OB/GYN, nor do I work for one. Sure, my dad was a family doctor who delivered some babies in his day, but there are no surgeons in my immediate family. To make four TMI stories short, I have experienced four non-medicated births in hospitals in three different countries. I am a natural childbirth success story. (I'm not sure I can really take credit for that, for I come from "childbearing stock"; my mom had ten children vaginally--the first one was breech--and all six of my sisters have had multiple children with nary a section required.) I'm all for supporting women who want to move while giving birth, eschew epidurals, engage in natural methods of relaxation during labor, breastfeed, room-in, etc. I have no financial motive to make midwifery look bad. The mortality statistics sadly speak for themselves. Midwife-attended home birth, at least as practiced currently in my state and Oregon, unnecessarily and significantly increases the risk of a helpless baby dying. To me, the life of a precious child weighs far more heavily in the balance than the short-term comforts of giving birth in one's own home.

Do I persuade or do I offend in writing this post? And if the latter, what has happened to the natural childbirth culture if someone expressing concern about practices that contribute to avoidable infant loss is considered offensive?

Sunday, March 3, 2013

Dorothy Sayers and TLTOL (part fifteen)

The next segment of Sayers' essay, "The Lost Tools of Learning", is about science and mathematics:

Science, in the Poll-Parrot period, arranges itself naturally and easily around collections--the identifying and naming of specimens and, in general, the kind of thing that used to be called "natural philosophy." To know the name and properties of things is, at this age, a satisfaction in itself; to recognize a devil's coach-horse at sight, and assure one's foolish elders, that, in spite of its appearance, it does not sting; to be able to pick out Cassiopeia and the Pleiades, and perhaps even to know who Cassiopeia and the Pleiades were; to be aware that a whale is not a fish, and a bat not a bird--all these things give a pleasant sensation of superiority; while to know a ring snake from an adder or a poisonous from an edible toadstool is a kind of knowledge that also has practical value.
The grammar of Mathematics begins, of course, with the multiplication table, which, if not learnt now, will never be learnt with pleasure; and with the recognition of geometrical shapes and the grouping of numbers. These exercises lead naturally to the doing of simple sums in arithmetic. More complicated mathematical processes may, and perhaps should, be postponed, for the reasons which will presently appear.

I have four children now, and because I don't want big messes, I rather discourage physical collections. Blame the four months I spent as an au pair/housekeeper in Germany back in my college years, but clutter depresses me. However, I think my science practices are basically in line with Sayers' educational philosophy because I encourage my children to read nonfiction books about science all the time. Do they really need to have pinned butterflies on cards to learn about the natural world? I think it's adequate to have a supply of engaging science books ready at hand and read them to my children on occasion. They get hooked and before you know it, they are reading DK's Big Book of Knowledge in bed at night instead of fairy tales. Besides providing science books, I also show my children science videos (they love Bill Nye and the National Geographic videos starring Dustin Hoffman as a globe named "Spin"), and when the weather is nice we go to the zoo and nature centers.

Math. Amen, Dorothy. Help them memorize those math facts as young as possible. Dd8 is still struggling to get to automaticity with her addition facts, while dd6 consistently outdoes her in addition drills on their daily Xtra Math practice sessions. Dd8 can memorize poems, no problem, but I think I waited too long to get serious about requiring her to memorize the addition facts and contributed to her developing a math facts mental block.

I wish I could buy a Barney or Dora DVD that helped children sing and memorize the basic addition facts. Computer math games haven't worked because my children want to have fun when they play on the computer, and math fact recall is not yet easy enough to be "fun" for them. Besides games and flashcards, I could find only lame math fact song collections or number "appreciation" cartoon DVDs.  I'm positive my children would appreciate numbers more if they could use them with greater facility! If someone from Nick Jr. is reading this, I beg you to produce a good addition fact memorization DVD using Diego and exotic animals; the same goes for PBS and the Dinosaur Train characters.