Sunday, March 28, 2010

Are Any Baby Items Made In The USA Anymore?

In general, I try to avoid purchasing foreign made goods.  I see no long-term financial benefit from transfering our nation's wealth to another nation.  This is especially true when the other nation involved is China.  Unless you've been living under a rock, you're probably aware of China's civil rights violations, as well as the many international safety recalls involving Chinese-made products, including those imported to the US.  Melamine-tainted pet food and lead-loaded children's toys attack us where it hurts the most, by injuring those most precious to us.  Yet, our government doesn't do a whole heck of a lot to intervene.  Perhaps that is because we owe China a boatload of money?

Over the past couple of weeks, I've spent a good amount of time putting clothes away that friends and family have given us in expectation of our daughter's birth.  Almost without fail, each item has originated in China (the few exceptions being items made in Korea, Cambodia, and Thailand).  It was the same thing when our son was born.  In order to find baby items made in the USA, the only option was shopping online.  No local store, whether discount, specialty, or department, carried baby clothes or toys made in the USA. 

Even if one wanted to make their own baby clothes, blankets, sweaters, etc., just try to find yarn or fabric made in the USA without shopping online.  If you're like me, you'd probably either learn to make these yourself from local sources, or find someone who does and keep the money local.  As a backup, the internet is your next best bet.

For many things that, for one reason or another, I cannot produce myself (lack of skill, time, etc.), I prefer to shop online and have it sent to my home.  It saves me a trip, often there is free shipping on orders over certain amounts, and delivery services (such as UPS) are switching to more fuel efficient vehicles.  But, when it comes to clothes, yarn, and material, I'd like to be able to be able to see and feel it.

For many people, their older relatives still do not shop online.  My mom doesn't.  My parents still don't have a computer in their house!  However, she did tell me that several times when she went shopping for baby items for my son, she was just one of many grandma's looking for items made in the USA.  No one could find anything made in the USA.  Just about everything came from China.

What this tells me is that there is a market demand for baby items made in the USA available beyond the internet.  I do understand that would probably translate into more expensive baby products, as we cannot compete with companies that cut costs with the slave wages paid to Chinese workers.  It can be hard to justify spending a lot of money on baby items, especially when most infants will grow out of outfits after only wearing them a few times. 

From a patriotic-financial point of view, however, I would prefer to see people give away their old baby items to new mothers or bring them to consignment stores.  This would reduce the amount of money spent on new purchases of Chinese imports, while reducing the amount of money spent overall our of the ever-shrinking American Wallet.

If you know of any sources of baby clothes, items, toys, etc., that are made here in the USA, please pass them along here in the comments section.  Also, for those that know a bit more about raising livestock for fiber than I do, any info on good breeds for baby fibers/fabrics, please pass that along as well!

Live better, a little every day.

Tuesday, March 23, 2010

VBACs, C-Sections, and Pregnant Patient's Rights, Part Three

This is the third and final installment of my series on VBACs, C-Sections and patient rights.  This blog post will focus on whether or not hospital bans on VBACs is legally enforceable or not, and what you can do if your hospital has a ban on VBACs.

First and foremost, bans on VBACs are policies, not laws.  I recall the way my former ob-gyn explained things to me just before I was backed into having a c-section.  She made it sound as if it were the law in Massachusetts that all future deliveries would be mandated to be c-sections.  She didn't come out and specifically say that, but she implied it.  When I was training to specialize in Prenatal Massage, Labor Support Massage, and Postpartum Massage, many other Massage Therapists in my class were also under the impression that our state had made VBACs illegal.  Thankfully, we had several midwives taking the course that set the record straight.

Here's the bottom line: hospital bans on VBACs are NOT legally enforceable.  No hospital can lawfully force you to have any treatment or procedure that you do not want to have!  As a patient, you have the right to refuse treatment.  If your healthcare provider or any medical facility claims that you are required to have a c-section, or any other procedure for that matter, they are violating the law. 

That does not mean that hospital staff and ob-gyns won't try to convince you that they do have the right to enforce the policy banning VBACs.  Dealing with authority figures, and doctors often play that role, can result in a perceived imbalance of power unfavorable to the patient.  This is where it pays to be properly informed about your rights as a patient. 

Hospitals are also required by law to treat any woman who comes to their facility in active labor.  If that hospital has banned VBACs, you may NOT be turned away for refusing a c-section.  You are protected by the federal Emergency Medical Treatment and Active Labor Act (EMTALA).  A common response for hospitals with a ban on VBACs is to attempt to transfer you to a different hospital by ambulance.  However, the hospital must get your consent to move you.  Understand that they are trying to skirt the law, and stand your ground.  They are in the wrong- not you!

For a step-by-step guide to protect your rights, check out the International Cesarean Awareness Network (ICAN) web site, specifically this page where you will find instructions on how to file a grievance with the hospital's Chief Compliance Officer, what to do if they dismiss your complaint, how to document your refusal to an automatic repeat c-section, how to report EMTALA violations, and information on filing lawsuits. 

As a reminder, my posts are referring to repeat c-sections that are not medically necessary, but repeat c-sections to accomodate policy only.  The first surgery was risky enough, even in those cases where they were necessary. 

Live better, a little every day.

Sunday, March 21, 2010

VBACs, C-Sections, and Pregnant Patient's Rights, Part Two

Welcome to part two of my series on VBACs, c-sections, and pregnant patient's rights.  This entry will focus on why I'm covering this topic here on this blog, and why some hospitals have a policy banning VBACs.

Some readers may be wondering how this topic fits into the blog's focus, which is doing something every day to make our lives better through prepping, homesteading, and building our level of self-sufficiency, please consider this: c-sections are the most common surgery performed on women in the US.  We're talking half of the population who are at risk for having a major surgery, necessary or not.  This comes with the risk of severe complications, including death, not only at the time of surgery, but for the rest of the woman's life. 

Almost everyone will either know a woman or be a woman who has to face the choice of whether to have this kind of surgery.  Sometimes, it will truly be a lifesaving, necessary proceedure.  The mother's ob-gyn can absolutely provide all the reasons for having one.  As someone who was not provided ALL the facts in order to make an informed decision about medical interventions during my son's birth which forced a c-section to become necessary, I feel it is better to have all the information, both pros and cons.  An ob-gyn isn't going to give you all the cons, and the cons they do discuss, they will gloss over.

The decision to have a c-section can have implications for the rest of a woman's life.  It is something that can effect one's preparations, family size, and so much more.  And that is why I'm spending so much time covering the topic here.

Why ban VBACs?
There are three primary reasons hospitals ban VBACs:
  1. Their decision is based on severely outdated and manipulated information.
  2. They are attempting to protect the hospital from litigation.
  3. C-sections are more profitable.
The mindset that "once a c-section, always a c-section" is about 100 years old.  More recently, studies showed that the primary risk of a VBAC, a uterine rupture, only occurs about 1% of the time.  However, a study was conducted by Mona Lydon-Rochelle et al, and published in the New England Journal of Medicine in July 2001 that has been used by the American College of Obstetricians and Gynecologists (ACOG) to scare women out of attempting VBACs. 

Even though the study does not show any real statistical change from other recent studies showing VBACs to be a safe alternative for 99% of women, it has been cited by media and doctors as proving sgnificant risk to laboring women who have already had a prior c-section and their babies.  Unfortunately, there are issues with the accuracy of how the data was collected, and in some cases not enough data was collected for it to be statistically significant enough for any conclusion to be drawn.  What it did show was that an increased risk of uterine rupture is actually linked to common medical interventions, such as inducing and augmenting labor.

The study is further limited to information gathered through insurance records of hospital births only.  No data was collected from VBACs from homebirths or birthing centers.  The problem with using insurance codes to collect data for analysis is that the codes cover several conditions and ultimately do not represent only women who experienced a uterine tear during an attempted VBAC, thus skewing the results to look like this complication occurred more often than it did.  For a more thorough critique of this study, please check out the article found here.

The misuse of this study often leads to hospitals banning VBACs in order to protect themselves from lawsuits.  As this study does not actually show any increased risk over 1%, which was the same risk level used for years as evidence of how safe VBACs statistically are, one should really question, "why the change in policy?"  How can a 1% risk mean "safe" one day, and "too risky" the next? 

Hospitals often base their decisions on recommedations for laboring patients from ACOG.  The purpose of the ACOG is not to protect the health care of women, but to protect and further the careers of their membership.  ACOG is an organization that makes its decisions by consensus. This consensus is of doctors who's livelihoods depend on women giving birth in a hospital setting and plugging into the hospital and medical insurance system.  This often includes recommendations of induction with the use of Pitocin, a synthetic form of oxytocin.  The use of Pitocin results in far more intense and painful contractions than with the body's natural oxytocin.  The use of Pitocin is specifically what the Lydon-Rochelle study linked to an increased risk of uterine rupture in VBACs.

As for cost, the cost of a vaginal delivery is significantly less than a c-section.  According to an article at CostHelper, in 2008, the average cost of a vaginal birth ranged from $9K-$17K, while a c-section ranged from $14K-$25K or more, depending on location.  Labor induction (which is most always Pitocin) is at an extra cost. 

Care from a midwife, however, costs about 1/3 less than care from an ob-gyn, and is statiscally more likely to result in a lesser expensive, vaginal delivery.  Midwives often advocate for VBACs for their patients who have had prior c-sections, providing that the scar is a low, transverse scar with no jagged edges (as sometimes happens when a tear happens during the c-section).  Such a delivery is generally healthier for both mom and baby, but does not generate as much income for the hospital.  And that is, quite literally, the bottome line.

Live better, a little every day.

Friday, March 19, 2010

VBACs, C-Sections, and Pregnant Patient's Rights, Part One

As we get closer to our daughter's due date, medical appointments, tests, and filling out hospital policy forms are kicking into high gear.  This is especially true since this birth is a planned as a vaginal birth after cesarean, or VBAC. 

On one hand, we're lucky to have a hospital within a workable distance of our home that permits VBACs.  On the other, the hospital is an hour away.  There are four other hospitals less than half that distance from our home.  However, they each have a ban on VBACs.  In order to deliver at this more enlightened hospital, I had to switch midwife practices, and accept driving an hour each way for each prenatal appointment, test and ultrasound.  This also meant lots of extra time and fuel, and some extra nerves trying to make sure I'd be back home in time for my husband to get to work on time.  There were several times, involving tests and ultrasounds, that he had to request time off because there was no way to get there and back in time.

Of course, I did have the option of sticking with my first choice midwife, and either going in for a sceduled c-section with her back-up surgeon, or to fight the policy while in labor.  After dealing with a cruel and sadistic hospital staff (probably the result of the nurses being understaffed and undervalued, and a doctor who did not provide me with enough information to make a truly informed decision) during the birth of our son, I wasn't up for another patient rights fight in the middle of labor again.  Perhaps, if I were 10 years younger, I may have taken on the fight.  This time around, I just want a supportive hospital staff without all the tension.

Some folks may ask what the big deal is about a hospital policy that requires a woman that has had a prior c-section to deliver all future babies by c-section.  The reason often cited for repeat c-sections is to prevent a uterine rupture, which could result in severe trauma to both mom and baby, including death. 

That sounds pretty scary, until you look at the frequency of such complications.  For women with a low, transverse scar, a uterine rupture occurs in fewer than 1% of women attempted a VBAC.  This means the risk of a uterine tear is about the same as it is for a woman with an untested uterus- in otherwords, all first-time moms!  And, we certainly do not require all first-time moms to deliver by c-section.

C-sections are common.  But, just because they are common, "common" doesn't equal "safe".   A c-section is a major abdominal surgery.  The manner in which the placenta separates from the uterus is different than in a vaginal birth.  In a c-section, the placenta separating leaves scarring that can endanger future pregnancies.  That same scar tissue also increases the mother's risk for uterine cancer later on.  In a vaginal birth, the placenta seperates leaving no scar tissue.

The risks do not end there.  There can be complications from anesthesia, including paralysis and death.  There is a risk of the surgeon accidentally cutting unintended organs and tissue.  The risk for hemmorhage increases the likelihood of a hysterectomy.  There is also added risk of major infection, pulmonary embolism, and stroke.  Any of these c-section risks may lead to death.

Of course, there are times when c-sections are life-saving procedures.  I am not referring to those kinds of emergency c-sections.  All too often, unfortunately, they are performed for convenience or out of fear.  Some women, who only have media images of birth for their prior birth experience, are afraid of the pain of a vaginal birth.  Television and movies show a completely distorted image of birth, usually of a woman who goes from saying "my water just broke" to saying "the baby is coming" in 2.2 seconds.  Usually she screams through the ever so brief labor, looking completely out of control, and then deliviers in the back of a taxi, or in the best of circumstances, barely makes it into the hospital.  If it is a hospital scene from the beginning, the woman will still be depicted as out of control and screaming, but this time screaming for pain medication. 

That simply isn't how labor is.  While there will always be an exception to every rule, and a precious few women will have a labor that is too quick to get to the hospital, that really only happens on tv or in the movies.  Labor typically lasts for hours, and most of that time, the contractions are very manageable.  For those women who schedule c-sections out of fear, please know this: recovery from a c-section is much longer and more painful than a vaginal birth.

Some women may schedule c-sections because they want to plan exactly when the baby will be born to accomodate a work schedule, vacation plans, or some other event.  This is a case of a major elective surgery that is totally unnecessary.  Perhaps this is born out of the "common" equals "safe" misunderstanding.  But very often, ob-gyns do not adequately explain the risks associated with c-sections.  When a woman expresses her desire to have a c-section, it isn't questioned.  Of course, the c-section will result in a higher fee for both the doctor and the hospital, so why would it be questioned?

There is another circumstance where c-sections happen for convenience, and this is the most reprehensible circumstance- convenience for the surgeon.  Unfortunately, pregnant women are often seen as unreasonable, written off as being "hormonal", and are forced to advocate for themselves while in the middle of labor, which is next to impossible.  If the birth is not a sceduled c-section, the mom has no guarantee that she will have her own ob-gyn attend the delivery.  Usually, she will be at the mercy of whoever is on call at the time she goes into labor.  All too often, doctors are quick to recommend c-sections, especially if the patient is perceived as "difficult", just so that the doctor doesn't have to deal with a mother who actually insists on being treated like a human being with respect.

Clearly, some c-sections are absolutely necessary.  C-sections, however, are the most common surgery women receive in this country, with the percentages climbing every year.  Many hospitals have c-section rates as high as 35-40%.  Compared to deliveries with midwives (either at home or in a hospital/birth center environment) of closer to 5-10% resulting in a c-section. 

This is a highly-charged subject. As such, it will be handled in multiple blog entries. There is much more to cover, including why some hospitals ban VBACs, are such bans enforceable, homebirths, and the quality of women's health care in general in the US. 

Live better, a little every day.

Thursday, March 11, 2010

Recipe- Karl's Favorite Oatmeal

Karl may only be two years old, but he knows how he likes his oatmeal.  Forget the instant stuff.  He can't be fooled into thinking that microwavable, artificially flavored mush is acceptable.  It's either old fashion or quick-cooking for our little man.  Also, that better be real maple syrup.  It must be genetic, but the fake stuff drives us both over the edge into the realm of "how dare you!"

Karl's Favorite Oatmeal
  • 1/2 cup quick cooking rolled oats
  • 1 cup water
  • Pinch of salt
  • 1 Tablespoon vanilla extract
  • 1 teaspoon ground cinnamon
  • Real maple syrup to taste
In a small pot, combine oats, water, salt, and vanilla extract.  Bring to a boil, then reduce heat to simmer.  As the oatmeal simmers, it will thicken.  Add the ground cinnamon and stir to mix well into the oatmeal.  Stir frequently as it should only take a minute or two longer to cook.  When you have just about reached the desired consistency.  Pour into bowl and allow to cool.  Oatmeal will continue to thicken as it cools.  Add maple syrup to taste.

Consistency may not be a major issue for most folks.  When you're teaching a toddler to feed himself, however, the more that the food sticks to the spoon instead of sliding off the spoon the better!

Live better, a little every day.

Wednesday, March 3, 2010

Easiest Homemade Chicken Soup

This post was supposed to be published yesterday, but we had kind of a crazy day.  My husband and our 2 year old were rear-ended in a hit and run (luckily, the police caught the offender).  The little one wasn't phased at all, but the 40 year old dad is a little worse for wear.  He's got a bit of whiplash, and the muscle relaxers are not helping.  On the bright side, he has a chiropractic treatment this morning, so healing is on the way! 

Back to chicken soup... if you check the labels on most store bought chicken soup or chicken broth or stock, you'll be startled by the amount of sodium.  Even the low-sodium varieties are a cause for concern.  Labelling can be misleading.  For istance, "reduced-sodium" doesn't mean "low-sodium".  It just means that version has less sodium than the company's standard product.  To make matters worse, many companies substitute MSG which works on brain cells to trick the brain into thinking the food item has more flavor. 

Normally, I make my own chicken stock from a roasted chicken carcass and drippings.  Being pregnant, I cannot handle extra heat- even in winter- and haven't wanted to get the oven going until late in the evening when the brownie cravings outweigh the heat aversion.  This weekend, we had a defrosted chicken in the fridge slated to satisfy a chicken salad craving, so I put the bird, breast-side-down, in the crockpot on low for 7 hours.

When I took the chicken out of the slow cooker, there was a substantial amount of juice at the bottom of the crockpot.  I added 6 cups of water, one quartered onion, a chopped celery stalk, a sprinkle of pepper, a pinch of dried sage, and the picked clean chicken bones to the chicken juice, and cooked in the crockpot overnight (about 6 hours for me these days). 

The next morning, I strained the contents into a plastic container, let it cool on the counter, and then put it in the refrigerator.  When the fat rose to the top, it was removed, and the broth put on the stove top to simmer for about 30 minutes with garlic powder, onion powder, carrots, celery, green beans, peas, and left-over chicken.   I added a handful of rotini, and cooked until al dente.

The soup made about 5 servings.  It wasn't fast, but it was mostly slow-cooking-and-walk-away prepping.  The only thing that could have made this better would have been some warm, buttered, crusty bread.  But, then we're getting back to the whole hot oven vs. pregnant woman thing.

Live better, a little every day.