Feeding Babies in Emergency Situations

Nursing in a hotel room

In late October 2012 the historic hybrid storm, or "Frankenstorm," named Hurricane Sandy devastated the East Coast of the United States, especially New Jersey, New York, and Connecticut. When disasters such as this happen it conjures up all sorts of feelings, and people are especially compelled to help. But what happens when an act meant to be a good deed results in more death?

This is exactly what can happen when infant formula is donated and improperly distributed in disaster areas. It should also be noted that many relief organizations do not have first responders trained in proper infant feeding protocol and infant formula distribution.

I know it may be hard to wrap your head around why it is so dangerous to donate infant formula to donation drives or shelters. I know the feeling of urgency to help, especially the tiniest victims. And I know that it might feel like I am saying that formula fed babies should not be fed. Of course, formula fed babies need to be fed, but it needs to be done safely to prevent illness and death.

First, I will outline the dangers of formula distribution and improper feeding protocol in emergencies, and then I will offer alternatives and practical ways to make a difference.

Dangers of Infant Formula Distribution:

* The majority of the deaths of infants in emergencies are due to diarrhea from drinking formula mixed with contaminated water and/or unsanitary formula feeding conditions (ie. no way to sterilize equipment).

* It can be difficult or impossible to keep infant formula safe from spoiling if power goes out.

* There is often a disproportionate amount of infant formula donated. This leaves relief agencies with a lot more formula than they need, and/or the wrong type of formula (powdered should not be distributed). Surpluses mean that formula may have to be discarded or it will be handed out to breastfeeding mothers (which has a negative impact on breastmilk supply). Surpluses of any one item also take away from donations that are truly needed.

* Formula should not be distributed without the complementary supplies to make it safe. These supplies include things like bottled water, liquid soap, cups for cup feeding, storage container, paper towels, and a gas stove or other cooking stove for heating water if the formula is not ready-to-serve. Hand sanitizer can be useful, but be aware that it is harmful to children if accidentally swallowed.

Breastfeeding in Emergencies:

Breastfeeding is important under the best of circumstances, but during an emergency it is lifesaving. Breastmilk is clean, full of antibodies, requires no special equipment to deliver, and adjusts to meet the baby's needs (contains more water when it is hot outside and more hydration is needed, for example). The act of nursing is calming for both mother and child. During nursing the mother's breasts will change temperature to either warm or cool the baby, as needed.

But breastfeeding can be undermined in emergencies by well meaning, but uninformed, volunteers. There are many myths that even nursing mothers themselves might believe.

Myths include that breastmilk will "dry up" when a mother is under stress, that a malnourished mother can't breastfeed or will make inadequate milk, and that breastfeeding mothers are safer with some formula "just in case."

In reality, breastmilk supply is not impacted by stress, however the milk ejection response, also known as "letdown," which makes the milk available for the baby to swallow can be impacted when a mother isn't relaxed. Once the baby starts nursing and MER happens, both mother and baby will become more relaxed. The solution is not to discourage nursing or offer formula, but simply to provide an environment where the mother can relax.

Unless a mother is severely and catastrophically malnourished, she will make adequate breastmilk. Her body will protect her baby's nutrition first.

The dangers of formula samples for breastfeeding mothers are magnified in times of crisis. Having formula on hand for "just in case," especially if handed out by someone perceived as an expert (relief worker, shelter volunteer, nurse, etc) can impact breastfeeding, even if the sample is never used. It sends the message that breastfeeding and breastmilk supply are fragile and prone to failure.

Parents of breastfed babies can put together an emergency kit, especially if there is advanced warning of a disaster. Some things to include are diapering or EC supplies, instructions for building milk supply, tips on nursing in an emergency, a baby carrier, and contact information for breastfeeding counselors.

During and after a disaster, there are a few things you can do to preserve breastfeeding. Breastfeed frequently to maintain or increase your supply, as well as keep both mother and baby calm. Nurse while your baby is in a baby carrier so that you are able to have hands free for other things, to make it easier to nurse frequently, and to feel more comfortable nursing in crowded areas.

Infant Formula Feeding in Emergencies:

Extra care needs to be taken to formula feed safely in emergency situations. The first thing that can be done by families is to prepare in advance. An emergency kit for formula feeding can include a 1 week supply of ready-to-serve formula in individual serving sizes, a knife or scissors to open the formula packages, sanitary wipes, bottled water, bottles/nipples or cups, paper towels, and a storage container.

You may want to learn how to cup feed your baby and use disposable cups instead of bottles and nipples. You may be in a situation where it is impossible to clean or sterilize feeding equipment.

Put formula preparation and storage guidelines in your emergency kit. Under times of stress you may not be able to think clearly and it can help to have them written out. It can also be helpful if you get into a situation where someone else needs to prepare the formula.

Consider inducing lactation or relactating, especially with younger babies or babies who have nursed at some point. Put an induced lactation/relactaion instruction sheet with breastfeeding counselor contact information in your emergency kit. You may also want to put some milk inducing herbs in your emergency kit.

Wet nursing, if available, should be offered to and accepted by formula feeding parents. If you have any breastfeeding friends close by make sure to have their contact information in your emergency kit. In emergency situations, wet nursing can be safer than formula feeding.

Mixed Feeding and Breastmilk Expression in Emergencies:

If you have warning prior to an emergency, begin to increase time nursing to build supply. If you lose power, have limited water, or need to evacuate you may need to switch to full time nursing. Put instructions for building milk supply in your emergency kit. You may want to start taking milk inducing herbs, or put them in your emergency kit. All the Breastfeeding in Emergencies tips will also apply.

If you express milk using an electric or manual pump, learn how to express milk by hand. Put instructions in your emergency kit.

Consider how you will protect your frozen supply of breastmilk during a power outage. Consider purchasing a back-up generator in case of loss of power. A deep freezer will keep cold longer than an upright freezer. Move milk to the center of your freezer, but away from any frozen meat. Fill empty spaces with containers of frozen water, "blue ice," or even newspaper.

What you can do:

* Donate money instead of formula so that relief agencies can buy the amount and type of formula that can be used. Excess formula ends up being wasted or given to breastfeeding or mixed feeding babies.

It is best to donate money above anything, not just infant formula, because there are often not enough volunteers to sort donations and money can buy exactly what is needed in the correct amounts. Here is what FEMA says about donations:

Cash Contributions
Cash donations are very useful in situations where supplies must be acquired quickly. This is the most efficient way to make an impact with your donations. If you need help in determining who to give to, the National Voluntary Organizations Active in Disaster website has a list of major nonprofits that are active in disaster work or you can make your offer through the National Donations Management Network.


Don't Send Unsolicited Donations
One of the biggest issues around disasters is the amount of unsolicited item donations that start to come in immediately. It's better to wait until communities assess and confirm their needs before you start to send things in. At that time, you can make your donations through non-profits in the National Donations Management Network.

* Donate your time. Contact a relief agency or local shelter and find out how you can donate your time. Often, this is needed more than donations. FEMA offers great tips and resources for helping in a disaster. This is the page specifically on Hurricane Sandy.

* If you are a breastfeeding counselor or lactation consultant, donate your time and expertise in disaster areas. If you have breastfeeding experience, become a breastfeeding counselor or lactation consultant so that you can volunteer if a disaster strikes.

* Shelters and food distribution centers should have the contact information for local and regional breastfeeding support including lactation consultants, breastfeeding counselors (such as through La Leche League or BACE-NMC), WIC breastfeeding counselors, midwives, and postpartum doulas.

These volunteers can offer help with proper breastfeeding support and information, relactating and building milk supply, teaching mothers to hand express, supporting emergency wet nursing, information on protecting expressed milk stashes, information on proper storage and handling of both expressed breastmilk and infant formula, supporting the emotional needs of all mothers.

* If you are a breastfeeding mother it may be appropriate for you to act as an emergency wet nurse. If you have recently weaned a child, you may be able to relactate.

* Donate complementary items to help infants such as diapers, diaper wipes, sanitary wipes, hand sanitizer, and bottled water. Even baby slings and carriers can be crucial in devastated areas. They can help keep infants and toddlers safely attached to parents, keep children calm, provide a buffer between baby and a stangers' potential germs, and offer a way for breastfeeding mothers to feel more comfortable even in crowded areas.

* Contact relief agencies about the importance of having breastfeeding counselors included in front line responders, and having emergencies workers trained in the proper protocol of infant feeding in disasters.

* Donate blood. When an emergency happens, the need for blood may increase. As a result of Hurricane Sandy, many blood drives across the East Coast were cancelled. Blood products, especially platelets, have a short shelf life.

* Donate breastmilk to a HMBANA milk bank. Milk banks are currently facing critical shortages. Do not donate to Prolacta or National Milk Bank because they are for profit companies rather than non-for-profit.

Resources for Infant Feeding in Emergencies:

World Health Organization:
        Breastfeeding: A vital emergency response. Are you ready?

        Guidelines for the safe preparation, storage, and handling of powdered infant formula

UNICEF:
        Breastfeeding a crucial priority for child survival in emergencies

International Medical Corps

United States Breastfeeding Committee

International Breastfeeding Journal (includes detailed information on formula feeding in emergencies)

La Leche League:
        La Leche League Resources

        Infant Feeding in Emergency Situations

        Relactation

Kellymom

Breastfeeding USA

Relief Organizations and Volunteering:

UNICEF
Experts in proper infant feeding protocol, including breastfeeding, in emergencies

Save the Children
Have set up safe breastfeeding areas in Hurricane Sandy shelters

The American Red Cross
Accept blood donations. Volunteers may or may not understand proper infant feeding protocol in emergencies.

Salvation Army
Accepts donations and volunteers

FEMA
FEMA has updates on coordinated relief efforts and great tips on how to help.

National Donations Management Network
This is a great page to go to if you want to donate cash or supplies, or donate your time.

The Importance of N.I.P (nursing in public)

Nursing Frankie at my pottery studio

There have been a couple of situations recently that have again started up dialogues and debates about nursing in public. They have both gotten media attention, and one sparked a nation-wide "nurse-in."

The first involved a college professor who brought her daughter to class on the first day because she was ill and had no child care options. She nursed her child during her feminist anthropology class, Sex, Gender and Culture, as one normally would throughout the course of the day.

This simple act created an uproar when a student tweeted negative comments about it during class. The school newspaper picked up the story, sensationalizing it into a major campus incident rather than life as usual for humans.

Some have claimed that they didn't have a problem with the baby nursing, but rather with the fact that a sick child was in class. If that were true, then why isn't it a news story each time a professor teaches class sick or students show up to class sick?

In Georgia, a mother nursed her baby at an Applebee's restaurant and was told by the manager that she needed to go to the bathroom or leave the restaurant. When the mother stated her right to nurse in public, the police were called. The police backed up the parents' statements of the law, but there is no punitive provision within the Georgia law.

Due to this humiliating and unfair treatment of this family by the Applebee's manager, a nation-wide nurse-in took place on Sept. 29, 2012. These peaceful protests went a long way towards raising awareness for breastfeeding.

These two stories shouldn't have to be stories at all.

The fact of the matter is that it is important to nurse in public, not to make a political statement, but to return nursing to the biological and cultural norm. There are many reasons why it is important to return to a culture where nursing children is just a normal part of life.

Nursing is normal:
I'm about to make a controversial statement... There are no benefits to breastfeeding. That's right, there are no benefits. How can there be benefits to a normal part of biology? We don't say, "There are benefits to using your body's own insulin." Instead, we say, "There are risks to being diabetic." It is important that nursing be viewed as normal.

When mothers separate themselves from the rest of society to nurse, it sends the message that they are doing something wrong. They send the message that they should be ashamed.

Nursing will only be viewed as normal when it is done wherever, whenever, as needed. The more it is seen, the less it will be sensationalized.

Nursing is a learned skill:
We are mammals, named for our mammary glands and defined, in part, by our ability to nurse our young. It is natural and instinctive, yet it is a learned skill. It is not the type of thing best learned by taking a class or reading a textbook. It is best learned by seeing it. Nursing needs to be seen in everyday life, not as clinical sketches.

Nursing is social:
Humans are social. We participate in many different activities to socialize. Eating is one of the biggest social activities we have. A baby should be able to nurse in a restaurant without sparking a national incident or starting a movement.

The argument has been made that because breasts are also sexual, it makes public nursing inappropriate. Well, mouths are sexual and are also used for eating, and yet public eating is not considered provocative.

It has to be something more. I clearly remember a Nurse Out celebration I hosted for World Breastfeeding Week. It had been going well all day with a lot of positive responses. Towards the end of the day, my 3 month old needed to nurse. I asked my sister to stay by the table display while I nursed him a few feet away on a blanket.

Shortly after I left the table, a grandmother, mother, and two kids got out of their car. The kids were naturally drawn the the poster with the two ice cream scoops with cherries on top. The grandmother came over to get the kids and express her disgust at the poster. She was offended by the poster vaguely representing breasts and said that we should not be promoting breastfeeding. She did not even notice that I was nursing a baby with my own real life breasts just a few feet away in plain view.

I have heard comments many times that whether or not any part of the breast is seen, it is the idea of it, of nursing, that is offensive.

When mothers are shamed and humiliated until they retreat to the bathroom, car, or their own home to nurse, they wean their babies earlier. Mothers need to continue to be part of society. Many mothers report feeling isolated after giving birth, and some mothers suffer from postpartum depression. It is important for mothers to be embraced, not shunned.

Nursing is ancient, nursing is modern:
If you could take a peek into an indigenous, hunter-gatherer culture you would see mothers nursing anywhere and everywhere, not held up in huts or on the outskirts of the village. Nursing would be infused in village life, yet not given a second glance.

Some people are put off by breastfeeding because they equate it with "primitive" life or something that's done in developing countries because they have no choice due to poverty.

The fact is that nursing is both ancient and modern. When we nurse our babies, we are honoring our ancestors. When we look to them for their wisdom, we are not regressing. We are only moving forward. Why re-invent the wheel? If we waste time trying to re-invent something that does not need re-inventing, we are wasting time.

In our busy modern culture time is more important than ever. Nursing helps us multi-task. It helps us to sit down for a minute and relax. It keeps kids and moms healthy, reducing time spent at the doctor or sick in bed.

Nursing is practical:
For some reason we have become a culture critical of mothers. The pressure on mothers is enormous. Anything that can make the blending of biological wisdom with modern lifestyle easier reduces this pressure.

The formula industry has worked hard to portray breastfeeding as difficult and inconvenient and bottle feeding as easy and convenient. But the fact is that nursing is much more convenient. It is essential to support nursing. Nursing becomes difficult when it is not supported. It becomes impractical when barriers and restrictions are imposed by an overly critical society.

What do you think? Does this post change your view on nursing in public? What are your stories, good or bad, of nursing in pubic?

Tales: Father's Day



helping Frankie eat

I was recently asked to find pictures of my son Jack with his dad for a special Father's Day gift. I scoured hundreds and hundreds of photo and could only find a few shots. It wasn't because of him not being involved, in fact, it was because he is so involved. I realized he wasn't in most of the pictures because he takes most of the pictures.

Frank's involvement started right from the start, during pregnancy. Now he cooks dinner every night, and that started when I was pregnant with Frankie. I was so tired and nauseous all the time that cooking was impossible.



Frank with Frankie and Bekah

  
It was also with Frankie's pregnancy that we took Bradley childbirth classes together. The Bradley Method is also known as Husband-Coached Childbirth.





Frankie was born 45 minutes after getting to the hospital and there really wasn't a lot of time for Frank to use the childbirth coaching skills he'd practiced. He did manage to film the birth with 2 different cameras, on a tripod and a handheld.

falling asleep

Frank comforting a fussy Frankie

Frankie turned out to be a very high need and sensitive baby. He went through a difficult period of colic, and I don't know how I would have gotten through it with out Frank.

finally sleep

When Frankie was scared to start kindergarten, Frank gave him a special key to hold to remind him of home. It helped him get through the rough beginning. Frankie's teacher commented on his ability to rhyme, something he always enjoyed doing with his dad. Frank also volunteered during library and on field trips.

carrying Frankie at Disney

And Frank was the one who had to say Frankie's long goodnight wishes in the exact right order before Frankie could fall asleep.

cuddling Bekah

Bekah was the first to be born at home. Not only was Frank able to document the birth on video, but I never felt like he wasn't there for me as well. After Bekah was born, Frank made all of my meals and brought them up to me in bed, sometimes with flowers.

mini golf with Jack

For the other 3 homebirths, Frank documented the births, set everything up for the midwives, cleaned up afterwards, and even played host by making food and coffee for everyone. And I still got my trays of food in bed for weeks so I could focus on our new babies.

hangin' with Jack at the pool

Frank took care of the older kids and always made sure I had a glass of water close by while I was nursing. He was always available to hold a newborn so I could shower or take a nap.




Singing Happy Birthday to Lillian







As the children have grown, Frank is always there. He has documented their growth in his "wall photos."

And his voice is always heard in the background of the video clips he records (especially when he's trying to teach them to say "dada" instead of "mama.").



foofing Bekah while teaching her to swim

He's helped the kids learn to swim and ride bikes. The kids help him with chores, like grocery shopping and taking out the trash. Together they love to play basketball.


the whole family


So, even though you don't see him in most of the family photos, you can feel him in there. As I look over years of photos, I see Frank in every single one.

holding Luke's hand

Tales: Luke's Birth Story

I found out I was pregnant with Luke after I had started dancing a lot again. I was also working at a dance supply store and teaching several dance classes. I got pregnant in September which meant I was due in June, right around the end of the year dance concert at the studio where I worked.

I continued to dance through my pregnancy and for the first time I had a hard time gaining weight. I would often not gain anything, or even lose weight, from month to month.

I continually tried to convince the studio director that I should perform, after all I had done it while I was pregnant with my oldest. Of course, I wasn't 40 then and it wasn't a week before my due date. Still, I thought I could pull it off.

The week before the dance concert, I had resigned myself to not performing, but I still had a lot to do to get my students ready. I was still demonstrating full out, even in Irish Step Dance, but I remember feeling very tired and "funny" after my Thursday classes.

On the morning of Friday June 13th, I woke up not feeling right. I felt like it was getting to be that time. I was supposed to take the train and then a bus to Arlington to see my midwife, but I didn't think I could make it. Thankfully, she came to me.

After checking me out, she thought it would be soon but could still be a few days away. The baby's head was still up pretty high. That was all I needed to hear for the "green light" to finish up everything I needed to get done. I would be at the dress rehearsal that evening. I also had a load of pottery I needed to fire.

I carried 2 boxes of pottery a couple blocks up the street to my kiln. I unloaded finished ware and loaded the kiln back up again. One the way home carrying the boxes of finished pieces, I felt a small gush. Soon after I got home and rested, it slowed to less than a trickle.

I put on a pad and went to the dress rehearsal. My daughter, Lillian, was performing and I wanted to be there for her in addition to my students. I had mild cramps throughout the night, some strong enough that I stopped talking to breathe through them. I left at about 9pm and immediately went to bed.

At about 5:45am strong contractions woke me up. I went over to the computer and started timing them on a website to monitor contractions. After a very short time, I decided that it was not only time to wake up my husband but that we should also call my midwife.

I wasn't totally sure I was in labor because my water had very obviously and dramatically broken prior to labor in all 5 of my older kids' births. I also generally retreat and get very quiet in active labor. This time I was more stir crazy and wanted to sit up rather than relax lying down. Still, I could not talk through contractions.

My midwife came over as quickly as possible, knowing how fast I can go.

In the meantime my husband got everything ready. I was sitting on the edge of the bed when my midwife arrived and the assistant. I asked my midwife to check to see if I was dilated because I still wasn't sure if I was really in labor. She checked and said I was fully effaced and dilated, and that my baby was about half way down the birth canal.


Several contractions later, at exactly 9am, Luke was born. He was my 2nd Saturday birth. Lillian was also born on a Saturday, and also at 9am. All my other kids were born on Tuesdays.

getting ready to sneeze...

He sneezed twice immediately after being born!

the sneeze!

5 minutes old

He nursed right away with no problems. Since we had practiced Elimination Communication (EC) starting at birth with 2 other kids, we were able to catch his meconium and first pees in a potty. He wore tiny little training pants and undies.

needs the potty

It is amazing and empowering to recognize facial expressions and other signs expressing various needs.

 

hungry

That evening was the dance concert. I did Lillian's hair and make-up and my parents brought her to the show. They announced Luke's birth during the performance.

Soon after Luke was born, the kids came in to meet him.

Bekah holding Luke

Six weeks after Luke's birth my family was in a family member's bridal party. I needed to have my bridesmaid dress altered so that I could nurse Luke, and I had to find a halter style nursing bra. My mom made me a brocade sling to match my bridesmaid dress.

When Luke was a few weeks old, I took him with me to help out at the dance supply store. The wonderful owners bought a baby swing for Luke to sleep in while I worked. Most of the time, though, Luke just liked to be carried in the sling. By now I had plenty of babywearing experience, including working and wearing.

Luke turned 4 years old yesterday. He is smart, funny, energetic, imaginative, and extremely empathetic. Happy Birthday Luke!

The Parent I Want to Be

An incident happened recently that offered instant clarity about the kind of parent I want to be. I was walking home from the train in the snow. I was rushing along, deep in thought, when I saw a child and a woman who appeared to be his young grandmother emerging from the dentist. They were at their car, parked on the side of the street surrounded by snow, when I reached them.

The grandmother was on the driver's side opening the door. The boy struggled to hold several items including a jigsaw puzzle box. The boy lost his footing as he stepped off the curb. All in an instant the jigsaw puzzle flew everywhere! He wailed as he looked at the tiny pieces strewn about, simultaneously upset about his puzzle and filled with worry that he would be reprimanded for his clumsiness.

The grandmother hustled over, alarmed by his cries. When she reached him and saw what had happened she did not reprimand him. She instead let out a big laugh. She then said, "That's okay. Let's just pick them up." in a calm, reassuring tone as she stooped down to help. They were both picking up puzzle pieces and laughing about the sight as I walked off towards home.

As I walked home I reflected on the incident. What would I have done? I would want to be as calm, but I honestly doubted I could have been. I wondered if they were in a rush. If they were in a rush, would she have been so calm? My mind was spinning. It was just a simple interaction, and yet so out of place. I had seen so many interactions with children over the years. Grandparents were often more patient, but this stuck out because I had never seen patience and understanding to this degree.

I often see children being bombarded with disappointment, impatience, disgust, and anger. Caregivers frequently send mixed messages. They expect children to be patient, yet model their own impatience. They praise children for being patient when they are really whining and complaining about having to wait in a line or for an order to be ready.

Ironically, children are often held to higher standards when it comes to things like this. Would you yell at your spouse or best friend for dropping a puzzle in the snow?


I wanted to be like this grandmother, the storehouse of patience and reassurance delivered in the precise amounts at the precise right time. I wanted to be able to put things into perspective exactly when I needed the clarity.

I tried to take a little bit of that day with me as I walked home. I knew it was unlikely that I would be able to be as perfectly patient, at least before I'm a grandmother, but I also knew that the knowledge was the first step. Modeling is a powerful teacher and I received the lesson of a lifetime that day.

Tales: Jack's Birth Story- You Better Work!

I remember the day I figured out I was pregnant with Jack. I was out at a meeting for a parenting group and I got a tell-tale headache. The longer it got between eating the worse the headache got. I took a pregnancy test as a formality. Of course, it was positive.

My pottery studio had been closed for nearly a year which meant less income but more time to rest. The resting helped with the nausea. I never even threw up with this pregnancy.

My last two homebirths had been paid for with tax refund money. In fact, both times the checks arrived the day of the birth. This time we wouldn't be getting a refund. We thought about our various options. I did not want to be in a hospital to give birth. After two homebirths there was no way I was going back.

We thought about a birth center but with my history of fast labors and no car that didn't seem right either.

We also considered an unassisted homebirth. Frank was excited about the idea after he caught Lillian. We bought a book on unassisted childbirth and a copy of Emergency Childbirth.

I knew that having to think too much in labor, rather than letting myself go, resulted in pain in labor for me. The only way I could let go enough would be to have my midwife there. We decided that we wanted to have the same midwife who attended our first two homebirths.

We needed to find a way to pay for the birth. We held a fundraising baby shower through Unique Baby Boutique. Guests bought us things we needed and we got a portion of the sales. It didn't amount to much though, nowhere near enough.

I had started setting up exhibit booths at conferences and events back when I still had my pottery studio so I continued after the store closed. This year I again set up at the Partners in Perinatal Health conference. It is an amazing conference unlike any other I've exhibited at. This year was especially amazing because Ina May Gaskin was the keynote speaker. She signed one of my hand painted pregnant pitchers!

I also set up an exhibit booth at the La Leche League of MA/RI/VT Area Conference to sell slings and my custom pottery. It was at that conference that I met Melinda Rothstein at a booth she had set up for DiaperFreeBaby, an organization supporting families practicing Elimination Communication (EC). After ECing Lillian from birth until her "graduation" to toilet independence at 1 1/2 years, I was excited to meet other ECers.

When I was about 37 weeks I set up our carnival size popcorn machine to sell popcorn at the local Earth Day festival. It was a rainy year but we were initially set up outside. When they made the call to move us inside I was already popping popcorn and I didn't even have anyone to help me move the huge machine. I waited for a festival worker to come help me move inside as I continued to pop popcorn in the rain. Finally when someone came to help, it was too close to the end of the event to set up inside. I didn't make much money, especially for the amount of effort it took.

In the end it was family that came through with funds to pay for our homebirth, especially my in-laws. It was so heartwarming to me that they cared so much about us. I am still grateful to this day. I am also grateful to our midwife for giving us a discount to make it more affordable.

If you read Lillian's Birth Story, you know that Frank was under the impression that I could control when my water broke by this time. So, the Monday evening when I was at 39 weeks Frank requested that my water not break between 9-10pm because he wanted to watch 24. I laughed and said that I had no control over that but I'd see what I could do.

That night after the kids were asleep and Frank was just getting settled downstairs to watch 24, I relaxed doing some light yoga on my bed to try to relieve the agonizing rib cage pain on my left side. I was in a modified child's pose when I felt an unbelievable sensation and heard a loud "pop". I'm still not sure which came first- Jack moving causing my water to break or my water breaking causing Jack to move rapidly down. Whichever it was it was an incredible sensation.

I called for Frank while enormous amounts of amniotic fluid gushed out. Frank, relaxing and feeling confident that he had at least an hour uninterrupted, tried to get up to run upstairs. He wouldn't normally try to rush so fast for just my water breaking but he must have heard the urgency in my voice after the startling way my water broke. Unfortunately, his foot had fallen asleep and he wasn't able to get upstairs as fast as the rest of his body wanted to. It was about 9:30pm.

We called our midwife and my aunt and started to do all the things we needed to do to prepare for the birth. I sat on the office chair in our bedroom with a chux pad under me while Frank put the plastic sheets on the bed (he would never put them on beforehand because he hated the feeling of them while he slept).

My aunt, midwife, and assistant midwife all arrived pretty quickly. For some reason CSI Miami was on the TV and my aunt kept commenting on how cute she thought David Caruso was. We had a water bell fountain set up in the room.

Lillian had just started sleeping in her own bed in the next room with her sister and she woke up several times during the labor. Frank had to continually leave to put her back to sleep. The rest of the kids stayed asleep.

The labor was moving pretty quickly and I felt like I was just about ready to push only the urge wasn't that strong. Something didn't feel quite right and doubt was starting to set in. My midwife, who had not done an internal exam with my other two homebirths, checked to see how dilated I was. I was just about fully dilated with just a "lip" to go. I remembered from my first birth that I did not want it to be manually pushed open during a contraction. So I continued to labor without pushing until the urge got really strong.

I think Jack must have been in a slightly odd position because the pushing took longer than my other babies. I had to work much harder too. My midwife commented on how strong and powerful I was while pushing. I felt that way too. I wasn't feeling pain and more than any other birth all my energy was channeled into pushing. No pain, just work.

I was in my usual spot and position- semi-reclining on my husband's side of the bed. The assistant, who had never attended one of my births before, asked if I wanted to try some other positions. My midwife, who knew me well by now, knew that this was my preferred place and position.

As he started to crown, my aunt commented on his red hair. Frank wasn't sure if she was joking or not because he was expecting dark hair like our other babies. Frank commented on how big his head was. He also had the cord around his neck like Frankie.

Finally, at 2:52am, Jack was born. He was my 4th Tuesday birth. He was 8lbs 5oz.

The first thing Frank noticed was his unbelievably beautiful umbilical cord. It was truly amazing! It looked silvery-white and had prominent bluish-purple veins that looked like pearls. The midwives loved his cord too. Our midwife explained that it was the way it formed in utero and it was rare.

As usual for me, it took a little while to birth the placenta. I had to give a few coughs and a few little pushes to coax it out. It was just as amazing as Jack's cord. It looked like a beautiful tree. My midwife spent about an hour making beautiful placenta prints.

Jack made the cutest little noises. He sounded like a puppy. He was pretty much born laughing and squealing. He was, and still is, a happy little guy. He has a funny sense of humor

He nursed well right from the beginning. I was involved in a lot of breastfeeding advocacy and support and Jack came with me to meetings and events. I held a "Nurse Out" when Jack was a few months old.

When Jack was a couple months old I thought about going to a DiaperFreeBaby meeting. I checked out their website and found information on becoming a Mentor. I filled out an online application. I went to a meeting while I was waiting for my application to be processed.

I couldn't believe how many other families were at the meeting. There was a NY Times photographer there too.

Just prior to going to my first DiaperFreeBaby meeting the Boston Globe did a story on the organization. Media outlets had started getting interested in doing stories on EC and DiaperFreeBaby. Once I became a Mentor, I noticed a lot of other Mentors needed media relations support. My father is a news photographer and I had just attended a PR and media relations workshop. I started offering tips to other Mentors and I created PR resources for our Yahoo! Group.

About a month later, the NY Times article came out and a People magazine article. I had also done an interview for a local newspaper. More and more media requests came in. DiaperFreeBaby did the morning talk shows- the Today Show, Good Morning America, the Early Show. I continued to offer advice and support. I was then asked if I would be the Communications Manager for the organization.

It was so busy at the time that I would spend 12 hours a day at the computer coordinating media pieces. I nursed and pottied Jack at the computer. He slept on my lap or in the bed a few feet away. I ate all my meals at the computer. If I left to go to the bathroom I'd come back and have 10 more emails in my inbox. It was a very exciting time and I learned a lot about media relations and PR.

We also took part in many interviews ourselves. After the filming of one local TV segment I ran out of cloth diapers on the way back home. I stopped at the mall and bought Jack some size 2 underwear. Even though he was 4 months old, they fit him perfectly. He wore undies from then on.

Jack is 5 years old today as I write this. Happy Birthday Jack Jack!

Tales: Lillian's Birth Story- She's One of Those People, She's Always Gotta Be Different

Lillian's pregnancy was the opposite of Bekah's in that I suspected it the moment I conceived. I was late right away so when I started having very bad morning sickness there was no mistaking it for a "weird flu." I had had it with my first 3 pregnancies but this was even worse. I tried just about anything over the course of the pregnancy to make the relentless nausea, fatigue, and headaches go away.

I started trying the usual things I do- eating small frequent meals of whatever I can stomach at the time and eating a lot of protein.

I was still having trouble functioning with the constant overwhelming feeling of sickness so I tried acupuncture. I had success with acupuncture for migraines. Some of the points were so sore that I bled, something that had never happened before. Since the acupuncture seemed to help a bit I started wearing sea sickness acupressure bands constantly. The only time I would take them off was in the shower or if they got so sore I bruised.

I had to be even more aware of what I was eating and when. I couldn't drink water in the morning or early afternoon. I had to eat about every 20 minutes, usually high protein, just to take the edge off of the unrelenting nausea. I drank a little soda to settle my tummy but I could only drink it with crushed ice. I couldn't eat bland food, like crackers. People's suggestion that I just eat some crackers and drink ginger-ale made me laugh or cry, depending on the day.

It got so bad that the smell of the water, not just shampoo or soap, but the actual water would make me throw up in the shower. I carried a bag with me everywhere I went in case I had to throw up. I cried a great deal of the time because I felt so bad. At one point my back-up midwife (a CNM) wrote me a prescription for Reglan to control the nausea. I never filled it.

I read about hyperemisis gravidarum and just reading stories helped a lot. I never had to be hospitalized for dehydration, though I did come close. The physical and emotional feelings from the extreme, relentless nausea led me to contemplate all sorts of horrible solutions to end my misery.

It was an unusually hot summer in Massachusetts and in addition to working full-time at my paint-your-own pottery studio, I was bringing my homeschooled oldest son into Cambridge by train every morning to go to camp at the Museum of Science and another camp at Boston Dance Company. It was extremely difficult while dealing with morning sickness.

One day I took ballet class with him at Boston Dance Company which actually helped temporarily. It was fun and funny to take class again with the former artistic director of the ballet company I was dancing with when I got pregnant with Felix.

In spite of the debilitating morning sickness, I managed to keep the pregnancy a secret while my sister, who worked at the pottery studio with me, contemplated having a 3rd baby. I actually encouraged her to have another baby because I didn't want my pregnancy to be a reason for her to hold off on having another child. I just figured we'd work out the logistics of running the store somehow. My sister did get pregnant, and then she found out I was pregnant too.

My daughter Bekah nursed throughout the whole pregnancy. She really loved to nurse! When I was about mid-pregnancy I developed yeast in my breasts. It is painful and a long process getting rid of it. In addition to making some diet and lifestyle changes, I used gentian violet. Bekah did not like the color or taste. She said the gentian violet was "spicy." She stopped nursing for 3 weeks while I was treating myself for the yeast. She slowly started up again after the purple was gone, and then really got interested after Lillian was born and there was more milk.

After having my last 2 babies at 36 weeks, I thought I would have another preterm birth. I had several risk factors too- short cervix, evaluation for preterm labor at 26 weeks, excessive walking and standing on my feet all day. However I made it to 36 weeks and celebrated by making a belly cast. Frankie started asking me when the baby would "crack out."

My sister and I also had the best baby shower ever around this time. We went to the fabric store and each picked out fabric to make a baby quilt. We cut the fabric into squares and had all of our friends and family decorate squares to be sewn into the baby quilts. We also asked everybody to bring a silver charm representing their hopes for the babies.

 

At the shower my sister and I each had beads we had picked out that we strung into necklaces with the charms. I continued to wear my necklace throughout the rest of my pregnancy. Guests also brought their favorite children's books to give to each baby. We had a tea theme and gave out goody filled tea cups as favors. We had a great time and I was elated that I had gotten in everything I ever wanted in a baby shower.

I figured I would give birth soon after the shower since I only expected to get to 36 weeks. I had a lot of work at the pottery studio and I was taking a local Family Strengthening workshop. I had a big project due painting platters for Epiphany School, a local Episcopal middle school. I wanted to complete the order of 30 platters before giving birth. I just kept painting, glazing, and firing as I got to 37 weeks, 38 weeks, 39 weeks and then finally reaching my "due date" at 40 weeks.

I only had 2 platters left to finish at 40 weeks 2 days. I worked all day at the store and finished painting and glazing the last 2 platters. I loaded them into the kiln and walked over to my acupuncturist's office about a 1/2 mile away. I couldn't believe I was actually getting "Chinese take-out" needles put in to encourage labor. The extra small flexible needles were held in place with round band aids on spleen 6 and great eliminator points on both sides of my body. They could stay there for a week and then be replaced with new ones.

After I had the needles put in I picked up a couple pizzas for dinner and walked the mile to my house. It was snowing out, but just lightly. It was just enough to make the town look magical. I often think that Concord looks so beautiful that it is surreal.

Back at home my husband discussed a birth request with me. He said he was tired at the other births because my water had broken in the middle of the night before he had a chance to sleep at all. He asked that my water not break until about 6am so he could be more rested. I laughed and told him that that wasn't something that I could control.

It was a Friday. Since all of my children had been born on a Tuesday so far, I figured that I wouldn't go into labor for a few days. I went to sleep early so that I could be rested up for work the next day. My in-laws were also coming to visit. They had been waiting until the baby was born but this was their last weekend they could come, so they decided to come anyway. We were all hoping the baby would be born during their visit.

I woke up suddenly at 5:45am when my water broke. I waited until 6am to wake up my husband Frank. He couldn't believe that I actually did it; I actually granted his wish for a 6am start to labor. I couldn't believe I was in labor on a Saturday instead of a Tuesday. Frank's parents and sister, Christine, were heading out from New York at around the same time. I wondered if they would arrive while I was still in labor.

We called our midwife to head over but at first there was no real urgency. Pretty quickly after I hung up the phone my contractions became intense and close together. I sat on the birthing ball breathing and low moaning to get through the contractions. By the time our midwife called her assistant and started heading over I was unable to talk through the near constant contractions. It was clear I was in transition. It was close to 8am.

Frank had planned a webcast of the birth to share with family and friends but since his family was already on the way over he put the idea on hold. Things were moving very fast and he had a lot to set up. After already being through one homebirth he knew exactly what to do. He turned the heat up, put the foil wrapped blankets in the oven, put the plastic sheets on the bed with old sheets on top, put some waterproof underpads on the bed, poured me some Gatorade, started boiling water to sterilize instruments, and started getting out the birth supplies, crock pot, and cookie sheet to hold the supplies. He also set up the video camera.

We had called my aunt to head over and she arrived at about the same time as both midwives. They were all grateful that Frank had done so much set up because I was sounding like I needed to push. I was shaking. My contractions had slowed down and I was in-between the intensity of transition and real pushing. I was feeling like I needed to push but was holding back until the urge was really strong.

I was on my husband's side of the bed in a semi-reclining position. Frank's nonchalant attitude kept cracking me up. I commented on the intensity of the labor.

At one point my midwife checked my daughter's heart rate with the Doppler and I could hear that it was very slow. It was clear it was her heartbeat and not mine. I wish that I didn't hear it for myself because it took me from "labor land" straight into my head. Labor gets painful when you are too "in your head," especially when there is also fear involved. I think, for the mother, labor is meant to be more on an instinctual level rather than a cognitive one.

My midwife asked me to turn onto my side to push. The act of moving and this new position brought up the intensity of labor. I prefer to give birth semi-reclining. I think the reason I instinctively choose this position is that it keeps the pushing stage at a slow to moderate pace making it more comfortable.

 

When I turned to my side, the contractions started coming faster and the baby moved through the birth canal faster than the slower forward and back pushing stage of my last 2 births. Even Frankie's 2 hour labor had a slow and controlled pushing stage. 

The intensity of the pushing was in sharp contrast to the Latin Lullaby CD that was playing in the background. I clutched the quilt made by family and friends. We had decided Frank would catch this time so he left the room to wash his hands as Lillian started to crown. 

Frank cheered me on as he guided Lillian's slippery body out and onto my chest. He was as elated and energized as I was after what seemed to me the most collaborative event the 2 of us have ever experienced together. It was 9:03am, a little over 3 hours after my water broke.

Lillian had no vernix left and her skin was dry and starting to peel a little. She weighed 8 lbs 8 ozs and had lots of dark hair. The kids all came upstairs to see her before the placenta even came out. My sister stopped by to see her on her way into the studio and the midwives were still filling out paperwork when my in-laws arrived.

While doing some online research on the Continuum Concept, a book I had read that really resonated with me, I came across some information on Natural Infant Hygiene, also known as Elimination Communication (EC). I had just finished reading Diaper Free! The Gentle Wisdom of Natural Infant Hygiene just before Lillian's birth. I decided I wanted to start right away. When the midwife asked if we wanted diapers on Lillian I said "no." The first time I offered Lillian the potty she peed.

Lillian came to the pottery studio with me starting just before her cousin, my nephew, Elessar was born 2 months later. She nursed, slept, pottied, and was carried in a sling all day 5 days a week at the studio until we had to close when she was 6 months old.