Tuesday, November 17, 2009

Questions to ask the Midwife

Going to see a midwife was very intimidating for me. Not because the midwife herself is intimidating- really, all three of the midwives that I have interviewed have been very warm and sweet. It was the process that is intimidating. Everyone knows how an OB works. You call the office, tell them you are pregnant, and they set up an appointment. You show up for the appointment and hand them your insurance card and pay a co-pay. When the baby is delivered, you go to the hospital and have the baby, and fill out a form, and they take care of the birth certificate. With Jonah's hospital birth, the hospital even took care of sending a birth announcement to the local newspaper for us.

With homebirths, it is a little different. There is a lot that was a mystery to me. The whole process from interviewing to making the insurance claims has been a learning experience. When I went in for the first interview, I did not even know what to ask. Since then, several questions have come up that I wish I had known to ask upon that first meeting. So I have compiled these questions that have come up, for anyone else who is thinking of having a midwife attend their birth. I've also included the reasons that I wish I would have asked these questions during the initial interview.
1. What is your reason for becoming a midwife? This is just kind of a "feeler" question. It gives you insight into the midwife's birthing philosophies as well as lets you know her past experiences.
2. What are your views on prenatal scanning such as ultrasounds and gestastional diabetes testing? You want to make sure that you are on the same page as far as screenings go. If you want minimal screening, you don't want to have a midwife that is going to pressure you into the procedures. On the other end, if you would like to have these screenings, you don't want to feel that your midwife is judging you for doing what you feel is the best for your health and the baby's health.
3. How will my insurance be billed, and what happens if they don't cover the costs of a midwife assisted birth? Some midwifes have a sliding scale that can be adjusted to your income if insurance won't cover the bills. It may seem taboo, but it is important to talk about money up front and find out what the payment options are. Be prepared to battle with the insurance company yourself, and if the midwife requires you to file your own claims ask for any paper work and phone numbers that you will need.
4.What do you expect of me during pregnancy and labor? and what duties will I have to fulfill regarding the pregnancy and birth? My current midwife expects mothers that she is attending to exercise regularly, keep track of her diet, and attend birthing classes. She also encourages attending classes and events at her birthing center. This is different from a typical OB, who would probably answer this question by saying "be on time for appointments" (at least my past OB would) It is also important to know what paperwork you will be responsible for. Some midwives require you to file for the birth certificate and social security yourself. These are things that were handled for me in my hospital birth, but need extra attention for this homebirth.
5. What do you expect of my partner during pregnancy and labor? Remember that there are two of you that the midwife will have to work with. If your partner is kind of hands off and skittish, and your midwife is expecting him to be more active than he wishes to be, then you may have a problem. Be up front about your partner's desired level of participation.
6. In the event of a hospital transfer, what hospital will I be taken to? Through casual conversation with my husband last night, I realized that our insurance only covers Toledo City Hospital. If we are transported to an out of system hospital, we may have to pay quite a bit of money or even be refused care. Make sure that the hospital that you will be transported to is covered by your insurance.
7. In the event of a hospital transfer, can I see the physician of my choice? Many women have a "back up" OBGYN in case they need to be transferred to a hospital during the pregnancy or labor. They visit this OB regularly throughout the pregnancy so that the OB is familiar with the mother and the circumstances. Others feel that the on-call OB is just fine. It is important to know how your midwife feels about a backup OB, and if she will transfer you to that OB or one of her consultants.
8. How do you feel about other children being present during labor or birth? What about other family members? If you have other children, it is important to know how the midwife feels about them being present. My midwife allows them, but requires one person to be there who is designated to watch the children. If you are birthing in a birth center, it is important to know if there is a room that your child can play in or take a nap, or eat if necessary. Also, if you want furthur support during your labor, it is important to know how the midwife will handle having extra people such as your mother or sister. This question will also force you to really think about whether or not you want these people present at the most intimate moment of your family's life. Having my mother there seemed like a sentimental thought, but when I really dwelled on it I am not sure if I could handle having her there, as much as I love my mother.
9. What would you consider grounds to transfer me to a hospital? You want to make sure that the midwife will be able to recognize an actual emergency that requires a hospital transfer, and make sure that her opinions are in line with what you believe to be something that warrents going to the hospital. If they are not, ask her why she would not transfer to a hospital for such things.
10. What are my labor and delivery options with you? You'll want to know if you can labor in a tub, or if your partner can assist in catching the baby. Your midwife may be able to tell you of options you've not heard of before. Can you eat during labor? How will she monitor the baby? In general, ask her what your options are for how your labor can be managed.

This is not a complete list. There are other very important questions that you should ask your midwife before choosing her to assist in your birth. But if you google "questions for midwife" every list will have those same questions. These questions above are questions that I have encountered while doing paper work, setting up appointments, and planning my birth. I did not have these questions on my list the first time I met my midwife, because I was not prepared for any of them to come up. No matter what questions you choose to ask during the interview, it is important to make sure that the midwife you select will be compassionate towards the views of you and your partner, and that she is properly trained and prepared to safely deliver your new miracle into the world.

Sunday, November 15, 2009

Food Co-ops

When I was in high school, I would visit a shop with my friends called Kent Natural Foods. They had interesting drinks in their cooler- kiwi flavored sodas, and rootbeer made with natural ingredients. We would head to the shop on warm saturday afternoons to look at the bins full of grains and granola and dried fruits, buy our drinks, and then head to the river to waste the day in ways that only teenagers can do.

Years before this, when I was in elementary school, my parents had told me that this was a special store. It was a co-op, and that meant that you had to join a membership to get lower prices, and you had to take turns working there. As I got older, my friends and I enjoyed taking in the smells and seeing the unique organic foods they had there. This was before Giant Eagle carried organic brands, and stores like Whole Foods and Trader Joes were non-existent. I made friends with a lot of the families who were co-owners, and I really grew to like the idea of a cooperative business. Whenever I'd ask my parents why we weren't members, they'd always tell me "because it's for hippies!"

Well now I am an adult, and I can say with quite a bit of pride that I AM a hippie. And the idea of a cooperative business still appeals to me. There are a lot of different co-op designs, but the one that appeals to me the most is this:
Everyone buys a share of the store for a pre-determined fee. That fee covers the working cost of the store (rent, bills, etc) The owners take turns volunteering work hours to the store, and in return can trade these work hours for a percentage off of their groceries, or for a share in the company. In addition, the company buys locally produced and manufactured goods whenever possible, and only carries "real" food, or food with no preservatives or chemicals.

This is the way that Kent Natural Foods works. This is how I grew up knowing co-ops. This cooperative business initiative really appeals to me, because I think it's important to work within the community to provide the best nutritious food possible for my family. Everyone has a vested interest in the company, because they are all share owners, and so they really care about the ethics of the business and the kinds of foods that are promoted. Theoretically, costs to the members should also be less because the co-op does not need to pay employees to run the store.

I suppose that part of me has always wanted to live on a sustainable commune, and a food co-op such as this is one way to get a step closer while still keeping both feet planted in "the real world." Now that we are setting up roots here in the Toledo area, I thought I'd look into joining a food co-op so that I could get locally grown foods at a lesser cost to my family. I am highly dissappointed in what I have found so far.

There is one co-op that runs the same way that I described above. However, the owners share is not $45, but is $200. Quite a difference. There is no option to trade work hours for the share, but it is possible to volunteer four hours a month to get an extra 5% off of bulk food purchases. Without the four hours a month, an owner gets 5% off of regular food purchases and 10% off of bulk. If we bought a share, we would have to spend $4,000 on groceries to get our $200 return. Since we barely spend $3600 a year on groceries as it is, this is hardly appealing. The co-op is open to the community, which means that the general public, not just co-owners, can shop in the store. This is good, because we can test drive it for a little while before deciding. But as it stands, the only thing that is appealing to me about it is that it supports small local farms and local businesses. I am not seeing, up front, the benefits that I said appeal to me earlier.

There are other co-ops, where you buy a small share of a farm, and get a percentage of each month's harvest. I have a friend who belongs to a co op where she pays a yearly fee and each month she gets a sack full of local organic produce. The problem with these kinds of co-ops, is that you don't know what you will be getting until it is delivered to you. One week you may get a pound of carrots and a few pounds of potatoes, and the next week maybe no carrots and three pounds of celery. Also, in Ohio this means that these kinds of co-ops only work summer-fall. There is a co-op run by nuns in the Tiffin area that works like this, and they have a delivery point in our town. So this is definitely an option for us once spring arrives.

If any readers have any suggestions or tips about food co-ops, please leave a comment! I am really just beginning to delve into all of the details of such businesses.

Wednesday, November 11, 2009

"Mommy's Pregnant Carrot Soup"

The day after I told Daryl that we are expecting our second child, he said to me (in the most loving way possible) "If you're pregnant, does that mean you'll be making carrot soup again?"When I was pregnant with Jonah, I bought a cookbook named The Well Rounded Pregnancy Cookbook by Karen Gurwitz. Some days, the only thing that I could stomach was soup, and so I really lived out of the "soups" section of this book. On days when I felt energetic, I would cook huge quantities of soup and freeze it in individual serving sizes. This way, the next time I felt sick or tired, I could just heat up some delicious soup. One soup in particular became our favorite very quickly: "Carrot Soup with Corriander, Curry, Ginger, and Chives." I shortened the name to Carrot Ginger soup, but it could also be called "Mommy is Pregnant! Carrot Soup" because I do seem to make and eat an awful lot of it while pregnant!The reason for this is: Ginger. The ginger in this recipe is often what I need to stop the nausea. When I am pregnant, I consume ginger in large amounts from ginger tea to ginger capsules to ginger cookies and ginger ale (canada dry has real ginger in it, and there are several local companies that brew and bottle true ginger ale!) Because ginger is such a key ingredient in this soup, I would like to talk about it for just a moment before giving you the much asked for recipe.

You can buy ginger in several forms. Each one tastes completely different and in general cannot be substituted for eachother. You can buy fresh ginger root (pictured above) in the produce section of your market. It usually hangs out by the garlic or the potatoes. This needs to be peeled and grated before use in most recipes. If you have one of those cheese graters that is like a cube that has all the different sides to it, wrap it in plastic wrap and use the side with the small bumps to grate it- all you have to do is remove the plastic wrap from the grater and scrape off the ginger. You could also buy pre-grated ginger. It works the same in a recipe as fresh, but might not be as potent. It is in tubes that look kind of like tooth paste, and it hangs out in the refridgerated section of the produce. There is also ginger powder, which you would find in the spices aisle. This is used mostly for baking and can NOT take the place of fresh ginger. It tastes completely different, and it is not as good for curing morning sickness moans. Candied or crystalized ginger can be found at natural foods stores and some bulk stores, or you could make it yourself. I carry this with me in car trips as I tend to get carsick, but I also usually have some in my purse or bag when I am pregnant to ward off any sudden nausea. It isn't really good for cooking with, but it really helps with motion sickness etc. I just chew on whole bits whenever I feel ill.

So now you know the scoop on ginger! The reason I threw that in here is because when I give this recipe to friends, they usually ask if such-and-such will do for the ginger. In short, no it will not. The way the ginger is prepared highly effects its taste and the way it interacts with the other ingredients. So here is the recipe the way that the book gives it, but I will add my own addendums in (...)

2 Tbl Olive Oil
1 medium sweet onion, chopped
1 yukon gold potato, peeled and chopped (I usually use up to three potatoes to make it nice and thick)
1 clove garlic, chopped
1 Tbl fresh ginger, peeled and grated (I use a LOT more than this! Add it to taste, and if you're feeling particularly sick that day add a little more than usual)
1 tsp ground corriander
1 tsp curry powder
1 1/2 lbs carrots, peeled and chopped
4 cups chicken stock, (vegetable stock or water if you're veg.)
Salt and pepper to taste
1/2 cup heavy cream (optional)
1/2 cup chives (optional- I dont use them)

Heat the olive oil in a large sauce pan or soup pot, over medium heat until it begins to "shimmer." Add the onion, potatoes, garlic, ginger, curry powder, and corriander while stirring. Heat until the onions are transluscent, 5-8 minutes. Add the carrots and stock and bring to a boil. Lower the heat to a simmer and cover. Cook until the carrots are tender, about 20 minutes.

(I allow the soup to cool before putting it into my blender, because I've overheated blenders by making this soup before I learned my lesson! You can always re-heat the soup later if it gets too cold) Puree in a blender until smooth. Add the cream and salt and pepper to taste. Garnish with chives.

I usually will make about three times this recipe and pour it into the zip-loc storage containers. I divide some of it into single and double portions, for when it is just me eating the soup, and some of it into larger containers for family sized portions. Then I freeze it, and have a quick and easy, yet healthy, dinner when I am feeling nauseous and pregnant!

Friday, November 6, 2009

Rashes, Hives, and ear infections

Just when you think you know everything about a topic, you learn something new about it. Ear infections, for example. I thought I knew pretty much all there is to know about them. I've seen an incredible amount of ear infections in infants while working at nursery school. I actually alerted the parents when their child had an ear infection, that they should go to the doctor to have their ears looked at. Ear infections are just something that I can spot a mile away.

I took Jonah to the doctor last week because he had woken up covered in hives. But I was also 90% sure that we would also find out that he had an infection in his left ear. I had been planning on calling the doctor this day anyway because of the ears, as well as the return of the nastiest diaper rash ever (that just won't leave us alone!) but the hives kind of sealed the deal. The reason I suspected an ear infection was because he was very grumpy, refused to eat, and he's teething. He's had fevers off and on, and the biggest sign was that his left ear has been utterly disgusting. It's been a real chore to clean out his left ear. Without going into great detail, it suffices to say that it was gross.

We got to the doctor and found the same news about the "diaper" rash. It's a staph infection. I'm at my wits end over this infection. It first showed up when we went on vacation and used Luvs disposable diapers. The doctor said that it's common, because babies will get a raw rash from the perfumes in the diapers, and bacteria will get into the rash from sweat etc, and a staph infection incurrs. Unfortunately, once we unknowingly put his bacterial infected behind back into his cloth diapers, the bacteria decided to hang out there. I've used everything under the sun to try to disinfect them. My last option is a cleaning chemical called BacOut.

I've heard it's just the thing for this type of heavy duty sterilizing. Jonah doesn't use diapers very much anymore, but he does when I am working and Grandma is watching him. It only takes a few minutes of contact with one contaminated diaper to get the infection again. I'm really getting frustrated with it, and just want to put my baby back in his cloth diapers again! I feel like we are throwing our money away with every pack of disposables we buy.

Now the hives are another story. I suggested, for the third time, that maybe he is allergic to dairy. For the third time, the doctor disagreed. She began to examine him, and I mentioned to her about the ear and maybe it is infected. Remember, I had just cleaned Jonah's ears. She still needed a special tool to clear them enough that she could see inside. I was disgusted! I am a clean freak about things like ears and noses and belly buttons. I can't stand any kind of body gook. And here was my baby, having mounds of earwax extracted from his ears. She finally was able to get a good look and saw that indeed it was infected.

I wasn't surprised. I was expecting this. What I wasn't expecting was for her to say "and there's the cause of the hives!" What? What's the cause again, I missed it.

The ear infection! Yes, really. This is the new thing that I learned about ear infections: hives are a symptom of an ear infection. Who knew! Apparantly when the body tries to ward off infection of any kind, hives show up because it is a side effect of the immune system going into overdrive.

So Jonah and I were big spenders at the pharmacy this week. An antibiotic ointment for the staph infection, hydrocortizone cream and benadryl for the hives, more aquafor for the eczema on his face (which she confirmed once again is in fact eczema) and amoxicillin for the ear infection. It seems like sooo many medications, but Jonah is in a much better mood now that they have begun to take effect! If the hives and other rashes are not gone by our appointment next week, then he will be tested for food allergies.