Sunday Brunch with Christy Anderson, OB nurse extraordinaire - Part II

Christy Anderson and a really amazingly adorable baby

Ladies. I present to you... Christy Anderson. Yes, she was over for brunch last week. But her interview is our third-most-popular post of all time, so I thought y'all might enjoy hearing the rest of what she had to say.

Christy Anderson is an obstetrics nurse with over seven years of experience in assisting women deliver their babies. She will soon enter a midwifery training master's program and is going to be pretty much the sweetest, most compassionate and no-nonsense midwife you could have.

Over last week's Sunday Brunch, Christy shared with us her experiences working at St. Francis Medical Centre, a mother-oriented hospital in Minnesota. This week she discusses the need for patient advocacy and her daily, woman-to-woman work in counteracting society's misconceptions about birth and the female body.

Gero apetito!

– Svea Boyda-Vikander
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SV: In the first part of this interview (click here to read) we talked about some of the amazing (well, they should be standard practice so maybe I should say, unusual?) policies your hospital implements. I'm wondering what proportion of women feel good about their births on leaving your hospital?

Water birth is amazing.

CA: When surveyed, most mothers, around 91%, would recommend our hospital to other women. I think most women have positive thoughts about their births with us though of course this is only a guess. I think introducing water births significantly increased the percentage of women who have positive experiences. If I had to estimate maybe something like 10-15% of women are disappointed in some way of their birth experience. Sometimes that has to do with having very rigid expectations of exactly how their birth will go, or not being open-minded about the fact that birth is unpredictable.

SV: Is the idea that it will go according to a plan the biggest misconception about birth that you've encountered?

CA: Not really. The biggest misconceptions are in regards to pain. Our society tells women that this is an extremely painful event and that it will be just horrible and that their bodies might not be able to do it. In reality, it is something that while intense and requiring a lot of concentration and effort, will not last long compared to the length of their life. Not to mention it can be one of the most empowering moments of their life. There are many ways to manage the intensity of pain through non-pharmacological and/or pharmacological options.

(ed. note: The book 'Water Babies' pictured above describes the work of Igor Tjarkovsky, a Soviet crazy-man who thought babies should spend most of their time in the water. Strange and all, but we have to give him props for bringing water birth to the West.)

Sims, the good doctor, is depicted
preparing to perform forced, unaesthetized
reproductive surgery on a female slave.

SV: I think Obstetrics medicine itself has a lot of these misconceptions embedded within it. Maybe this reflects its spotty history – for example, the man commonly credited as “the father of gynecology” performed forced unanasthetized hysterectomies on slaves in the American South. I wonder how this past has influenced the field today.

CA: It can change from patient to patient and hospital to hospital. In fact, patients have a lot more rights than they are familiar with and actually advocate for. I've seen patients work in partnership with a midwife a little more often than I have with a doctor. Perhaps this has something to do with the power dynamics from the history of medical care, as you said. Often patients with a doctor as provider will just do anything and everything the doctor says without any questions. This is very frustrating when the patients don’t even know how to advocate for themselves. Sometimes the patients don’t like or trust their provider but have no idea that they can transfer care to another provider or clinic.

SV: What are some of the most common mistakes women and their families make in preparing for birth?

CA: Over-preparing for birth, self-diagnosing via the internet, thinking that losing your mucus plug means you should rush to the hospital, and coming to the hospital too soon. An educated patient is better than an ignorant one but it’s important to remember that experiences written in books are just one of many paths or outcomes that can happen in labor. Sometimes, a woman will lose her mucus plug minutes/hours/or weeks before birth. This is normal. Most often it means just that: you lost your mucus plug and you will eventually have your baby! Whereas having your water break is a sign of imminent labor, this distinction is often lost on first time mothers. 

Lying on your side? Not if your bathtub is this bathtub.
But who owns this bathtub?
(I want this bathtub!)

 Often women are not well-educated on when to arrive at the hospital. They can stay home as long as they are comfortable. Our suggestion to patients is not to come to the hospital until their contractions are 3-5 minutes apart (timing from the beginning of one to the beginning of another), where each one lasts about 60 seconds, when this has been going on for over an hour and the mother has to stop and breathe through the contraction. If this is going on, it's good to get into the tub at home and get as much of your belly submerged as possible. This often involves lying on your side in a traditional tub. If the contractions get better and go away, this is just early labor. If they continue and get worse you are probably in active labor and ready to come to the hospital if you wish.

SV: Can you share a particularly heartwarming or funny anecdote from your work?

Crowded waiting room, 1950's style.

CA: I picked up an extra shift for a Friday night. I showed up at 11pm and they told me there was a patient waiting in the family lounge for a room to be cleaned. I checked and it was ready so I went to get her. Once I looked at her and then at her chart I realized that she was only 16 years old. Not only that, but the ENTIRE family lounge was full with her family and friends. I went to the room with her and we went through her admission. After that we had a long discussion on what her preferences for birth were. She preferred to only have her mother, sister, and father of the baby (fob as we call him) in the room with her. She preferred to have an un-medicated birth if at all possible.
 Upon hearing this I knew I needed to get these people involved in her birth process to help me support her because at this time she was only 4 cm dilated but in active labor. I was able to show her mother and the father of the baby how to massage her while she was on the birthing ball. After a while we changed positions and she walked the halls for a while, squatting when having contractions.
 I could tell she was progressing and now starting to work harder with her labor so I suggested we get her in the bathtub. She spent some significant time in the tub with the lights low, some flameless candles on, quiet music on, lavender essential oil on a cotton ball near her and her family next to the tub with her supporting her through each contraction. After a while she wanted to get out of the tub. At this point she was 8 cm dilated.

In case you were wondering what 4 and 8,
and 9.5cm dilated looks like!

She got into the bed and I showed her family how to push on her knees to help release some of the back pain she was having. She began to involuntary push at this point and had progressed to 9.5 cm dilated. The little bit of cervix that was left was on the anterior side so I had her flip to her hand and knees. In this position she started to get a bit nauseated, she vomited, her water broke and she was fully dilated.
She pushed about 20-30 minutes to deliver her baby boy over an intact perineum. She had complete control while pushing and listened so well to just breathe when her body was stretching. I have never been so proud of someone in my life. She delivered at about 3:30 in the morning so in only 4.5 hours she dilated 6 cm, and pushed her baby out. She did it just the way she wanted to, with her family all there and supporting her. It is amazing what a woman/teenager can do with the right support! I feel so good about being there for her and showing her she was able to do it.

SV: That's a great story. I have goosebumps. I feel this is the kind of birth experience we should all have access to – but when you're part of a marginalized population (being a young mother, for example), so much choice is taken away from you. To sum up, what has working in this field taught you?

Little children are so good at surrendering.
The average grown-up needs a little support.

CA: Patience, how to work well with others, the amazing power of the female body, that the mind might trick you while in labor. Just at the point when you feel as though you can’t go any further or any longer, this is when you need to continue as you are getting close to the end. Often, if I can get a patient to believe me when I tell them this, then surrender and go with the process, they will deliver quickly. It's a beautiful process and I feel honored to be a part of it.

SV: Thank you so much for sharing your education and experiences!

Sunday Brunch: Interview with Christy Anderson, Obstetrics Nurse Extraordinaire

Christy Anderson, OB Nurse

I first met Christy Anderson, an obstetrics nurse and a dear friend, in the early summer of 2009. I was a few weeks pregnant but (having taken one of those super-expensive, high-tech pregnancy tests purchased in a Manhattan pharmacy) I didn't know it. My then-fiancé and I were driving around the US, stopping for beer and hashing out such monolithic couples' disagreements as whether or not we should have a wedding and if we did, if we should have a band, and if we did have a band, if they should play classical music or songs more germane to our generation.

But I was planning to be pregnant soon so I picked Christy's brain over a campfire and a bottle of wine(!), looking for her educated opinions about the birthing process. I like to think that, in the three years since, Christy and I have both experienced a sea change toward natural birthing processes—she, from an informed place working within the medical system; and myself from a general obliviousness and belief that it's all a bunch of hippie hoo-haw. Christy's entering a nurse-midwifery master's program in January and I keep telling people I lured a nice nurse over to the placenta-eating dark side. 

For this week's Sunday Brunch, the first of a two-part interview, Christy talks about the amazing hospital she works for (seriously, they offer prenatal yoga. how sweet is that?) and her experiences as a compassionate and fiercely hard-working obstetrics nurse. Her later interview will examine some of the reasons she is looking to further her education in the midwifery field.

Buon appetito!

– Svea Vikander

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SV: Let's start at the beginning. How did you know this was the field of nursing you wanted to go into?

Christy, after assisting in the delivery of her cousin's baby, Bree.
Let it be said... Newborn babies sometimes cry too!

CA: I didn’t immediately know. In high school I thought I wanted to be a pediatrician. I was so lucky to be able to job shadow a wonderful pediatrician. I learned a lot of great things from her but the most powerful lesson was that I didn’t want to work in pediatrics! Crying babies with ear infections all day was not my idea of a great job. However, I knew that I wanted to work with babies so my next thought was about newborn babies. This led me to do a summer job shadow with certified nurse midwife named Lori. I spent a good portion of my summer with her and fell in love with the job and the amazing process of labor. From then on I knew I would go to nursing school and one day become a certified nurse midwife. 

SV: And now that you're doing it, what's it like to be an OB nurse? What does your typical shift look like?

CA: I work 12-hour night shifts, which means I arrive at work at 7pm and leave at 7:30am. I wear one of three hats while at work during these shifts. The first would be as a charge nurse. This means I answer all phone calls and triage all patients who come in who might think they are in labor or are having some type of pregnancy problem. I am responsible for knowing what is going on with all the patients on the floor at all times, assisting other nurses with help when they have questions, and attending all births to be the “2nd nurse.” Being a 2nd Nurse means I am there to care for the baby once it is born for the first half hour. As a charge nurse I am also responsible for staffing the unit.
The second hat that I could wear would be a labor and delivery nurse. This is by far my favorite hat to wear. It is during this time I am able to really connect with my patients and help them have the birth experience that they are hoping for. This is where I am responsible for the laboring mother, supporting her during her labor.
The third hat I might wear would be as a post-partum nurse. During this time I am responsible for either three or four mother/baby couplets. I help facilitate bonding, breastfeeding, and teaching a wide range of infant and mother care practices. I also assist the families to finish some of the hospital paperwork that needs to get done so they can go home with their babies.

SV: Shift work is so hard. Especially all night. What's the hardest part about your job?

CA: Breastfeeding assistance. No matter what position I put myself and the mother in, it always hurts my lower back! So that is a personal thing. In general, though, nurses can find it hard it to make a connection with the patients. Often you only have minutes to meet the patient before almost immediately being in an emotional and stressful situation. You have to get them to trust you and make a connection as soon as possible. Sometimes that is hard to do at the end of a labor that is very intense or when patients come in thinking we are the enemy. Patients’ attitudes are often the result of thinking we are merely agents of the hospital’s policies, here to enforce practices that they would not choose for themselves, rather than as a partner in their birth experience.

(from the Aspen Women's Health Centre, via Denver Doula)
It's nice to know not all OB Nurses are created equal.

SV: And, in your case at least, this simply isn't true...

CA: Well, no. The thing is, I can't say our hospital, St. Francis, is typical. Recently I have been reading more blogs, hearing from friends, and attending more conferences and have noticed there is something special about the hospital I work for. We are a regional hospital and usually do around 1200 deliveries a year. Our providers consist of OB/GYN’s, certified nurse midwives and some family practice physicians. Within the last year we have started offering water births with our midwives. A few months ago we began to use aromatherapy to help our patients with pain, stress/anxiety, nausea and relaxation/sleep. A large percentage of our nurses are trained in integrative health techniques such as: massage, guided imagery, meditation, music therapy and deep breathing techniques. These have proved to be very helpful for our patients. We also have a lot of our nurses trained by Gail Tully and her Spinning Babies techniques. We have a different approach from most hospitals when it comes to cesarean births. I think some of this has stemmed from a few of our nurses, personally, having bad experiences at other hospitals during a cesarean birth.

SV: That's amazing! Policy informed by people's actual lived experiences!

CA: (laughs) Yes. Another thing that has shaped this new approach is our belief in the research that supports immediate skin-to-skin contact between mother and baby. Most hospitals during a cesarean will show the mother the baby quickly if at all and then take the baby away. The mom will then see the baby again only after her recovery phase. Our hospital is very different in that aspect. If a patient is going to have a cesarean birth, myself or another labor nurse plans to be in the operating room the whole time. Once the baby is born the doctor places it on the warmer (they are sterile and need to place it in another safe sterile place). As the nurse, I will wipe off the baby quickly and if any stabilization needs to be done, it will be done quickly. Then the baby is placed skin-to-skin on the mother’s chest as long as she likes while the surgery is finished. Some mothers choose to do skin-to-skin the entire time, others choose to have us weigh and measure the baby in front of her while still in the operating room.

SV: That's exactly what maternal-issues therapist Helen Dunn recommended when I interviewed her, in terms of dealing with C-section trauma: giving the mother choices. It can help to give her a sense of control and reduce the incidence of PTSD.

Want to learn more about V-BAC, TOLAC, and the BAC-lash?
Check outICAN: International Cesarean Awareness Network

CA: It also helps to simply ensure that she has the birth that she wants – or as close to it as possible. After the surgeon is finished the mother is moved to a new bed and then mother and baby are transferred back to their room for recovery. During this phase the mother can continue skin-to-skin contact if desired or start breastfeeding. Breastfeeding during this time can sometimes be difficult as the mother is in a mostly reclined position. Nurses have been known to stand and hold the baby in a good position during this time, in order to better facilitate this first breastfeeding. I actually do not think elective primary cesarean birth is something that should be an option to people. I think it might be a while before that is a rule.

SV: Really? No elective cesareans? Why is that?

CA: I think often women make this decision based not fact or need but more of a socially accepted norm these days. Some will choose it because they don't want to push or don't want to ruin their sex life. These seem like trivial things when you look at the recovery period and increases in potential complications with next pregnancies and next potential cesarean delivery. Often times once women are educated on what it truly means to have a cesarean and what it could mean for future deliveries they realize this is not the easy way out. I think there is a time and a place for elective cesareans for those people that aren't just looking for the planned delivery to try to fit it into their schedule. I would hope that any provider that is willing to offer an elective cesarean also talks about the potential risks, what this means for future deliveries and the possibility of emotional distress that can happen between a mother an her new infant from this type of delivery.

SV: And I guess something a lot of women aren't told is that having one C-section will make their later labours more likely to end in C-sections – in fact, a lot of doctors won't do 'VBAC' (Vaginal Birth After Caesarian), they insist you have another C-section.

CA: There is a time and a place for a trial of labor after cesarean (TOLAC), which could become the VBAC you're talking about and in certain situations I would really recommend it. Sometimes, I have a hard time recommending it to friends who ask as I have seen it go really bad really fast, but that's a very small percentage.

SV: What about the commercial aspects of C-sections and birth interventions?

Vintage shot of Ina May Gaskin
in The Business of Being Born

CA: Many people have seen the movie The Business of Being Born and I have to be honest – I only watched it for the first time last night! As this movie insinuates, a lot of hospitals are keen to induce their patients, give them epidurals and offer elective cesarean births or at least push towards cesarean birth when it is convenient for the doctor. This, however, is not my hospital. We now have a policy on the induction of labor, which reduced our induction rate significantly. We use pitocin conservatively. As more of our nurses become competent in the above techniques, we are having more and more “natural” un-medicated vaginal births. That being said, we are still a hospital and have certain policies and procedures that some may consider controversial. But we have a much more holistic approach to labor and delivery than other hospitals.

SV: I remember when we first met, you said that you'd seen a doctor write 'birth plan' on a patient's record, under the reason that a labour had failed to progress. What are your personal feelings on birth plans?

CA: Birth plans are very interesting. It is my recent opinion that they should be called “birth preferences.” The semantic of birth “plan” means your labor will be this way and you will not stray from it at all. Sometimes that is fine but sometimes it needs to be a little more fluid. One of my favorite quotes from a fellow co-worker is, “I have read your birth plan and it is so very lovely and I will do everything in my power to have it the way you prefer. However, sometimes we make plans and God laughs.” I think this sums up a lot because we can plan all we want and sometimes things just don’t go the way we were planning them to go. I think the best thing to do is have an idea of how you want things to go and inform your provider and nurse of these things. A written plan may not be necessary.

SV: I guess that makes sense if you really trust and feel connected to your care-providers. What about rooming in?

CA: Rooming in is great, it facilitates on-demand breastfeeding and attachment. We promote it but also offer the nursery at night. More often than not, parents take advantage of the nursery. I think they think I only have one or two nights that I might be able to do this so I might as well do this after having had such a long labor. If I had to guess, at our hospital at night maybe about 70% or more of parents send their baby to the nursery, to be brought back when the baby is ready to nurse.

Christy, during The Night Eight Babies Did Not Room In

SV: Have your ideas about pregnancy and childbirth changed over the course of your education and career?

CA: Yes, looking back over the last seven years, my thoughts have changed quite a bit. When you start a career like this there is so much information to learn that it is easiest to learn the black and white parts of the job. The more mechanical things, such as electronic fetal monitors, starting IV’s, epidurals. As I became more proficient in these areas, I started to work on really understanding and being able to support natural childbirth. I have always loved it and I’m in awe of it. I am the first to volunteer to take natural birth patients when they arrive. I am just truly amazed by the human body and how it works. I have seen so many of them now that I can actually hear when a woman is ready to give birth. I love that even though every woman is different the body is so similar that at the end of labor you can just hear when a woman is going to deliver. It isn’t always necessary to do an exam... you can just have a sense of it.

SV: That's amazing. I remember when I was in labour with Sweet Baby James, the labour progressed much faster than we expected. Zu called my mom to ask her to get the car ready in an hour or so. She told me later that she could hear me having contractions in the background and she 'just knew' that I would have the baby very, very soon so she went to get the car started right away! (she forgot the keys and had to backtrack to her place in the middle of a Montreal February night, but that's another story). That kind of primal knowledge really is incredible.

CA: Exactly. And that's what I want for my own births. When I first started I thought for sure I would want to have an epidural when I have a baby of my own. As I have grown in the profession and my own learning I think I’m going to trust my body to tell me what I need.

SV: What kind of a birth do you hope to have? Where would you hope to give birth?

CA: I hope to have a very open mind in this situation. I would like to keep my mind and body healthy and continue to practice yoga in preparation. I would like to think I would be able to have an un-medicated water birth but I am going to try not to have any expectation on my birth and just see what my mind and body need at that time. I feel very safe in the hospital that I currently work. I work with some wonderful midwives that I would like to provide my care. I think I could have the birth I hoped to have with them with the medical backup right there if needed. Not to mention to have all my wonderfully supportive co-workers there to help me through it.

SV: That sounds great. I'm sure that your experiences from working in labour and delivery will inform your birth, and your birth will then inform the further work you do.

Sunday Brunch: Interview with a Storyteller

I met this Storyteller on Clarissa Pinkola Estès' facebook page. Estes is the author of Women Who Run With the Wolves: Myths and Stories of the Wild Woman Archetype (WWRWTW to her adoring legions), a bestselling book that explores the use of traditional folk tales in empowering (mostly Western) women. It came out twenty years ago, and though it sometimes crosses the line into cultural appropriation (we can't very well avoid it if we're finding our strength in... the stories of another culture, can we?), it's a beautiful book that lives beyond its era. It goes further than most in acknowledging the mystery: the mystery of life, the mystery of humanity, the mystery of woman, body and – yes! – motherhood.

So I 'liked' Estès on facebook and occasionally I get her updates. One day she posted the story of Jiang Xiojuan, the 'Madonna of China', a policewoman who is nursing nine (!) orphaned/milk-deprived babies. A conversation about milk and nursing ensued, and one commentator in particular caught my attention. She wrote about her experience trying to donate breast milk (and being rejected) twenty years ago. Since that's a topic I'm interested in (remember my 'Une Vache à Lait, Let's All Donate Milk' post?), I contacted her to see if she would consent to be interviewed about her experiences. 

I'm so glad I did.

Colladay is a film-maker and 'professional student'.
She runs with the wolves.

First of all, this Storyteller (also known in real life as Kaitlan Colladay) has – you guessed it – an excellent way with narrative. Second, she's had four kids, the oldest and youngest being 22 years apart. She's seen both sides of the drastic changes in birth and childrearing that occurred in the West between the 1970s and the 1990s. As she puts it, "With my first child, I tried to get them NOT to give him formula and I couldn’t stop them. With the last one, I just wanted a bottle to tide her over and they refused. Who are these health care professionals anyway?"

Enjoy this week's Sunday Brunch, as we discuss reproductive autonomy, applause after birth, going to the bathroom with the door open, and stealing infant formula from the NICU. And remember, as Clarissa Pinkola Estès says, ''If you have never been called a defiant, incorrigible, impossible woman, have faith. There is yet time."

¡Buen provecho!

 - Svea Boyda-Vikander

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SB-V: If you could summarize your parenting philosophy into one word, phrase, or sentence, what would that be?

GS: Mothers are important and serve a much-needed value to our society and our future. Just love them.

SB-V: What do you wish you had known before you had your first child?

GS: That I didn’t have to be like my parents. That I could pick and choose which attitudes and behaviors I adopted when raising mine. That took a long time. My mother was a very caring, attentive mother but she was also a bit “emotionally absent” and had ideas about routine and fitting into the box – all of that was quite normal for the period of time she raised me and my sisters. By the time I had babies, obviously starting young, I had my own ideas of course but I found that I did a lot of things in those early days that were just a mimic of the patterns my parents did and really weren’t necessary. Would have helped if I had known that my parents weren’t going to help in any way whatsoever.

SB-V: What is the absolute worst advice anyone has given you, about parenting?

GS: You’ll love this, it came not just from my mother but also a team of child psychologists when I went to a “parenting group” once for a few weeks. It goes like this: If he’s been fed, cleaned and changed, put him to bed and let him cry himself to sleep. I look back on that and just can’t believe I ever did it. I would sit in the other room and cry while I let him “cry it out.” I should have listened to my instincts. Poor baby. Makes me want to cry even now when I remember it. What a stupid thing to tell someone about a baby. They cry for a reason and maybe the reason is that they just need a little more cuddling. We are the only animals on the planet (Western societies) that make it a social practice NOT to touch or hold our babies very much. Even elephants spend YEARS constantly touching and being close to their offspring.

SB-V: And the best advice?

GS: Do what feels right and don’t worry about what anyone else thinks. Love them for who THEY are. (That’s my advice.)

SB-V: What were your childbirth(s) like, and were you happy with the care you received?

GS: Oh, but mothers can talk about their birth experiences for hours!

• Firstborn son: 3-4 weeks premature. At five weeks [before my due date], began labor and they stopped the labor with an alcohol drip. I’m serious. An alcohol drip. I’m lucky/he’s lucky he didn’t have FAS (fetal alcohol syndrome). A week later, my water broke and at the hospital, my blood pressure shot up to 240/210. I found out years later I was lucky I wasn’t dead or had a stroke. He was 4 pounds 10 ounces and quite healthy, but the hospital policy at the time was to not release them until they were 5 pounds, so he stayed in hospital for two and a half weeks. This really damaged my ability to nurse because although I would bring them my breastmilk and go down every day to nurse him at least once, it just wasn’t enough. They were giving him formula or glucose water instead even though I’d instructed them not to and told them to use my milk.
  Also, this was 1974, and in that final push on the delivery table, I closed my eyes and the doctor grabbed a pair of forceps and yanked him out with them – wholly unnecessary. I didn’t know about it until some days later when I kept asking about the cuts on the side of his head that were getting worse and looking like they were infected. Some nurse said, “was he a forceps birth?” I said no because he was small enough, there really wasn’t a problem but she looked it up on his chart and confirmed that he had been. They had to put him on antibiotics because the cuts developed a staph infection. 
• Second child. My blood pressure had begun to “creep up” and a routine exam showed I was dilated to 2 cm so my OB decided that I should go to the hospital “right away” and be induced. I was two weeks away from the due date. I didn’t know then that this was not all that unusual and I could have kept her in me for another two weeks and let her brain and lungs finish developing. But OBs are always in a such a hurry and I believed it was necessary because he said so. Then at the hospital, I wasn’t “progressing fast enough” for his taste, so he turned up the IV on the Pitocin because I was still only dilated to 2cm. I had a single contraction that made me feel like I was going to just die and I thought if I have seven more hours of this, I won’t make it. It was horrible. So I let the OB talk me into a spinal block which I didn’t want (first child was without drugs). So, he tries to give me the block and missed and hit a nerve and I screamed again and he asked what I was doing and I said pushing. He checked and I was now dilated to 10cm and she was crowning. Basically, that first contraction put me from 2cm to 10cm and through transition in one contraction. No wonder it hurt so bad. Everyone went nuts trying to get me in the delivery room on time. I delivered her in 3 contractions total and only 45 minutes from start to finish. And all his, “let’s induce” because it will minimize my blood pressure which was only 140/90 at the time, was for nothing because my BP shot up and I spent the next 36 hours in intensive care anyway. 
• Third child. Did a lot of reading on theories of pre-eclampsia. Discovered it used to be a disease of the poor and then became a condition of the middle and upper classes and had everything to do with eating enough fats and not worrying about weight gain (poor can’t afford to eat right, upper/middle doctors tell clients to restrict weight gain) so I wouldn’t let my doctor tell me how much weight I’d gained. Spent a great deal of time telling him that no matter how much I begged, don’t give me drugs and don’t even try to do that spinal block thing! I started to go into labor on the 4th of July. Got all the way to the hospital and found out my OB was out of town for the weekend and freaked out. Suddenly my labor stopped. Scared me out of it I suppose. A week later, I lost the mucus plug, so he wanted to check me in and induce if I hadn’t started soon, which he did. That one was about 3 hours from start to finish and I lost a lot of blood but all was okay and he was term and a happy plump little boy. 
• Fourth child. BP [blood pressure] issues again. Jerk Woman OB made a nasty comment when I told her I was tired all the time and she said that I was “a little old” to be having a baby (I was 39 at the time). Then we did a routine ultrasound in which she told me that there was no doubt that my baby was a Down’s Syndrome child. Higher level tests later and we discover she wasn’t and isn’t. I changed doctors and got a male OB who understood that pregnant women shouldn’t be working if they can help it because, after all, I’m pregnant. So he wrote a note to my firm and I got to take the last two months off from work with full pay. A week before she was born, my doc wanted me in the hospital full time. I spent a day there and said I’m going home because I only saw nurses about three times a day and not only was I bored stiff but I was also starving! At home a week later, I started labor around 10 p.m. and we rushed as fast as possible to the hospital. They wanted me to hang out while they “checked” until I told them it was my fourth child and I had a history of short labor. We got upstairs and the doctor showed up while the Pediatric Trauma Team gathered in the back of the room (since she was premature by three weeks). I had a birthing bed/table. A really nice environment to be in. I never dilated completely and she got stuck on the “cervical lip”or something. The doctor wanted to do an emergency C-Section but the pediatric nurse just sort of shoved him aside, waited for me to push again and just “held” me open with one hand and reached inside with the other until her head came out. My vaginal muscles have never recovered from that but the baby came out fine and never lost any oxygen. When she popped out, the doc’s hands slipped and she (the baby) screamed at him. The six members of the pediatric EMT team in the back all cheered and clapped. It was awesome having the applause! I can still hear it!
  This becomes important . . . She was fine, I was more or less fine but doc was worried about my BP possibly shooting up. (With pre-eclampsia and eclampsia, it can shoot up to a stroke anytime in the 24 hours after delivery). He put me on an IV drip of the same magnesium sulfate drug which made my arm hurt so bad that I told the nurses to take it out (It’s a very painful drug going in). They said they couldn’t take out the IV unless the doctor ordered it and he was asleep (it was about 3 a.m.). I told them to wake him up and they said they weren’t “authorized.” So I said wake him up or I’m taking it out myself and reached up to pull the IV out (it’s not rocket science). They scrambled, he finally came in, said I might die if he took it out and I signed some papers and they took it out.
• Okay, this is the really important part and as I write this on the evening of the 29th of February 2012, I am thinking about the latest news regarding Douglas Kennedy, youngest son of Robert F. Kennedy, and the “scandal” when he tried to take his newborn baby out for some fresh air. There are two issues that came up with the last baby (born in 1996). The first was that, as is normal, my milk had not yet “come in” in those first hours. I naturally nursed my new girl so she could get the colostrum, but she was a truly hungry baby. She didn’t want to sleep, she wanted to eat. So I asked for some formula. The nurses wouldn’t give it to me. I’m not kidding. They said, “the chart says you’re nursing.” I said, “yeah, but there’s no milk yet and she’s hungry.” They replied that I should just “be patient” – okay, well patient in my case, I don’t know about others, is that it might take three days before my milk comes in. That’s not all that unusual and has been the case with me before and in the meantime, she’s awake and she’s hungry so could I please get some formula (my other kids weren’t interested in the first 2-3 days and slept most of the time – this one was just downright hungry). They absolutely refused to give it to me! I had to go into the nursery and steal it when they weren’t looking! Unbelievable. Then later on, she got a little restless, so I wanted to walk her up and down the hall. The nurses said I couldn’t. I wasn’t “allowed” to walk her/rock her in my arms. I had to push her in the little pushcart basinnette and I could only do that in my room! You weren’t “allowed” to walk your baby up and down the halls. I called my husband and told him to come get me and I checked out before 24 hours was up after she was born. 
• The interesting part to me is that with a gap of just 22 years, in the first case with my first child, I tried to get them NOT to give him formula and I couldn’t stop them. With the last one, I just wanted a bottle to tide her over and they refused. Who are these health care professionals anyway? And I wasn’t allowed to carry her out of the hospital. I was wheeled out and some other nurse carried the baby. 

SB-V: Can you share with us some of your tricks and tips about staying sane as a new mother?

GS: I think the biggest tip is just don’t expect to get enough sleep or feel normal for the first two years and next to none in the first weeks and months. Remind yourself that it WILL get better and it WILL get easier (because it does!). It’s like that last contraction as they go through transition. When that one happens, that’s usually when you think you just can’t do it anymore (someone shoot me please!), but if you’ve been through it once, you remember that this is the one that signals that it’s almost over. So, if you know going into motherhood that you will not get sleep, you will not feel normal for a while, then it makes it easier to cope because you know that this IS normal. Can’t remember how many times I had to choose between shower, eating or sleeping. As a nursing mother, I generally had to eat like it or not or I wouldn’t have enough milk the next time, so showers just didn’t happen often. But I learned to take the baby in the bathroom with me and just let him/her roll on the floor if you need a shower or a bath. Usually the sound of the running water will soothe them anyway. My kids still make fun of me because I spent so many years going into the bathroom and leaving the door open that even today, sometimes I forget to close it! But the big thing is don’t “expect” anything. Do what you can and if you can’t then don’t. If you have other kids, even if they are little, let them help as much as possible. I still feel I made a mistake with my son when I wouldn’t let him “help” with the baby because he was only five. I could have. He wanted to but I was too busy “doing it all” and not being patient enough with him to let him be a part of it which in the end made him not only uninterested but I think it really increased his jealousy level higher than it should have been.

SB-V: What kind of sleeping arrangements did you have?

GS: First two kids had their own nursery and a crib although they did spend a lot of time in the bed with me because I was nursing so I’d just fall asleep with them in my arms (and, no, you are not going to suffocate them! Prop yourself up on a pillow, pillow under the arm and then nurse!). The third one slept with us until he was five or so. Had to actually lay down with him to get him to go to sleep and after that, no point in moving in because he’d wake up and cry until he got put back in the bed with us. The fourth had a crib initially but again, slept with me a lot because of the nursing. Then there were times when I was single and very broke that both of them shared the bed with me out of necessity. I don’t think it’s “damaged” them at all, in fact I think they have no doubt in their minds that I love them and that can only be a good thing.

SB-V: Can you talk a bit about your experiences breastfeeding?

GS: I breastfed all my children. But with three of them, I always had difficulty and it didn’t last long – three months tops. But then with the first two, I had some serious pre-eclampsia and premature birth plus they gave me Magnesium Sulfate shots which I learned in a class I was taking with Dr. C. Everett Koop that this could have interfered not only with my breastmilk supply but also could have caused some serious damage to the children. The third child was the only one born at term and I nursed him until he was nearly 9 months old. The only reason I stopped was because he got all eight of his front teeth in (four top, four bottom) all at once and he fell asleep and then clamped down so hard I had bruises and almost couldn’t nurse him after that. I tried to teach him not to bite (I may be a human bottle but I’m not a human teething ring!) and he wouldn’t get it, so I quit nursing. With the other older two children, I substituted the bottle for the breast when my milk supply gave out – as in I made it the same “ritual” and NEVER gave them the bottle without me holding it for them and then just went bottle to cup when they were old enough to sit up and hold it and they were eating babyfood by then. The bottle was gone immediately and they were both out of diapers by the time they were not quite two – even at night. I think that had a lot to do with it (no bottle) because I certainly wasn’t fanatical about toilet training or night time diaper issues.

With my last child, I had to go back to work when she was 10 weeks old. No choice. She was about 3 weeks premature and she had difficulty latching on so basically the milk she got was what started if it decided to – or not. Turns out that in later years, she really had some difficulty with her tongue and had articulation problems in the early days of speech. Then she also had a completely erratic sleep schedule. She’d sleep for two hours, wake up, nurse, sleep for three hours, wake up, nurse, then sleep for seven hours before she’d wake up again. When I noticed that this was interfering with my milk getting established, I tried waking her, but it just wasn’t happening. So, I’d try to pump at the 3rd or 4th hour just to keep the supply going and almost like she knew I was doing it, she’d wake up 5 minutes after I’d done that! It was really tough. Her schedule was what she wanted it to be. Even after I went back to work, I tried pumping – not much success – so I tried going home at “lunch time” but that didn’t always coincide with her wake schedule. By the time she was three and half months old, I gave up.

SB-V: What was your experience with having over-supply of milk? How do you wish people had responded to your offers to donate? 

GS: With the third child, he nursed every two hours around the clock for the first two months. When he eased up, he just went to every three hours. I had so much milk, easily an excess of 12-24 ounces in a 24 hour period. I called local hospitals. I called not so local hospitals. I called the La Leche League. I called everywhere and I got the same answer and that was that they weren’t interested. They might get sued. They had no way of guaranteeing that the milk was not contaminated. All I could think about was mothers of the seriously premature babies who weren’t getting breast milk because they can’t quite suckle yet and their mothers were never able to establish the milk supply. What a difference that might have made! But no one wanted it. I still don’t have an answer to that. It’s so cultural and specific to our western society.


SB-V: What mistakes did you make as the mother of small children?

GS: Really? That’s a question? Lots. You’ll have to read my book! But we can’t all be perfect and I did the best I could with what I had and what I could do always making sure to tell them and show them with affection that I love them.

Sunday Brunch: Interview with Diana, creator of Onya Baby

You all should know by now that there's nothing I like more than a sexy babycarrier. Oh, unless it's a sexy babycarrier that also transforms into something else. Yup. And here it is: The Onya Baby Carrier, designed by Diana R Coote, transforms from a cute and practical babycarrier into... a highchair! (well, let's be accurate: it hooks onto a chair to create a harness. The chair is not particularly higher. The point is: it keeps baby safe and brunch-participatory). Yes, lots of wrap and sling babycarriers can also serve this function (see below, Sweet Baby James sitting on top of a booster seat and tied to the back of a chair at a restaurant in Vancouver) but something makes me nervous about those ad-hoc sling uses. What if the booster seat slips? What if Mister Bister throws his weight to the left without warning? I like how comfy and safe the Onya baby looks. Like, it has straps and stuff.

Sweet Baby James, moderately safely restrained.

Diana, mama, designer, business owner

I've never actually seen one of these Onyas in real life but I heard about them in a babywearing discussion on mothering.com, a natural parenting forum I was recommended by someone I met on transit who pointedly told me I should enter their contest so I could win a real babycarrier (I was mildly offended: Like, WTF is wrong with my green ring sling which is actually just a fraying piece of old cotton? If I want to carry my mid-sized-dog-sized baby on one shoulder that's my business!). The forum was discussing ways to get papas to wear their babies, a topic for which I have very little patience. I'm going to start printing  'Don't be a douche, wear your baby' T-shirts anyway now. Really. Anyway, someone recommended the Onya as a gender-neutral carrier that might appeal to those of the masculine persuasion. Its design is simple and functional, though the mamas in their promotional material look pretty darn gorgeous. Kind of like the founder herself. She's a SAHM whose product facilitates not only Attachment Parenting, but Mamactivism (the radical philosophy that mothers are people with the right to get out of the house), and is 'going pro' with her design, selling it in boutiques across America. But what's it like to break into this female-dominated business as a full-time mama? Is it easy and welcoming, with everyone nursing their babies and swapping diaper stories in the boardroom, or is it red in tooth and claw? And what kind of person willingly goes into business with not only their husband... but also their in-laws?

I contacted Diana Coote to ask her these questions and more. In this week's Sunday Brunch she discusses the joys and challenges of running a family business, how she came up with the convertible carrier-chair idea, what baby wearing means to her, and her dreams for the future.

Enjoy!


Svea Boyda-Vikander
__________________________________________


SB-V: What got you started in making baby-carriers?


DRC: I’ve been into babywearing since 2006, when my first child was born…I actually joined TheBabyWearer while I was pregnant! One of the very few baby items my husband and I purchased prior to her birth was a simple pouch sling, which I fortunately knew how to measure for correct size. That worked well for us for a while. But my babies have a way of chunking up fast, so I had an onbu made for me by a dear friend…that’s what got me into the two-shouldered carriers. I’ve always been really crafty, sewing, painting, knitting, kind of compulsively, so when I started finding my onbu pulling on my shoulders, I decided to add a waist belt. That’s what started this train rolling…


SB-V: The Onya's dual function strikes me as particularly relevant to babywearing, since women who wear their babies usually find it easier to get around and seem to be 'on the go' a lot more. How did this design come to you?


DRC: When my daughter, who is now 5 ½, was around 7 or 8 months old, I went out for lunch with a group of friends. It was fun…who doesn’t love meeting up with their girlfriends? But – hoo-boy – did we leave a mess behind! There was only one high chair at the restaurant and there were six of us…all with babies. So, you can imagine the food and utensil grabbing going on as we tried to eat our lunches. The first thing I came up with was actually a chair cover that worked as a secure seat for your baby. But alas, as I started looking into it, I saw that there were already several options of this exact thing already on the market. So I decided that I’d combine the seat with a carrier. I don’t like lugging a ton of stuff around and already wore my baby, so…voila! I suppose it was a gradual development of an idea. It’s just easier to carry less stuff around and yes, I agree with you, I think that babywearers seem to get out more.


SB-V: Onya Baby is a family company. What does that look like?


DRC: Onya Baby, at its core, is me, Diana Rickard Coote, my sister-in-law, Aleshia Rickard, and my brother, Billy Rickard. We also have my husband, Jon Coote, as our IT guy, and Aleshia’s sister, Silvia, as our graphic designer. Our mom, Billy’s and mine, is our accountant. We all have loads to do and it’s been a wonderful opportunity for us to all become closer.


SB-V: What are the challenges of working with family, and what are the rewards?


DRC: Working with family is both a challenge and a reward. Because we live so far apart (Billy and Aleshia live outside Santa Cruz, CA, Jon and I live in Ottawa ON, and Silvia lives in San Francisco) the company has been such a great opportunity to get together more, both online and in person. It’s given Billy and Aleshia more opportunities to see the children (Jon’s and mine) on a regular basis, something that wouldn’t have happened, in all likelihood, were we not on regular Skype calls. Another reward has been our strengthened relationships. I have to say that this last point would probably qualify as both a challenge and reward. It’s not always easy to handle disagreements within families, and I think that people often tend to fall into old patterns. This isn’t always a productive thing to do. But when you’re starting and running a business, you can’t do that or the business suffers. We’ve all worked much too hard to allow that to happen, so it’s forced us all to “grow up,” in a sense, to handle disagreement, conflict and other friction in a much more productive and objective way. We have to often compromise, or step back and trust another, and it’s been to the real benefit of our relationships and our company.


SB-V: It seems that there are a few big name carriers that have 'cornered' the market if you will (Ergo, Bjorn, etc.). What's it been like to break into the market with a new design?


DRC: It’s a challenge, for sure. We’re so tiny and new and very few people have heard about us yet. We just figure that we’ll keep plugging away and hopefully the carrier will speak for itself and people will love it because it’s a high-quality, comfortable, useful thing to have in their parenting tool kit. We hope word will spread and we’ll gain traction in the competitive marketplace.

SB-V: Given that this industry caters mostly to natural and attachment parenting mothers, do you find it to be more woman-friendly or child-friendly than others?


DRC: I think it probably is, though I can’t really speak from a place of a ton of experience on this. Prior to having children and starting Onya Baby, I worked in the field of Social Work. That’s a field highly dominated by women, so it’s not a big change for me in that sense. I think you’re right, though, the babywearing industry is largely comprised of women-owned, mother-owned businesses, and you can really see that at industry events. The Baby Carrier Industry Alliance annual meeting, for instance, which takes place at the same time as the ABC Kids Expo, has children present. The women who bring them are business owners and their babies are too young for them to not have them along, so there they are. They nurse and babywear during the meeting and everyone’s totally cool with it. Not sure you’d see that at, say, the auto maker’s yearly meeting.


SB-V: That sounds great. What has babywearing meant to you as a mother? How did you come to it?


DRC: Babywearing has simply made my life as a mother easier. It’s allowed me to care for my babies, my children, and still get things done. I truly don’t know how I’d parent without it.

SB-V: Me neither. I keep asking older women I meet how they did it without baby carriers. I've gotten all kinds of responses, from "My arms were very strong" to "He just had to lie in his playpen while I did the housework." How has having this family business impacted your children?

DRC: I think it’s shown them that it’s possible to work really hard, to be creative, to be persistent, and create and build something where there once was nothing. It’s been hard, too, at times. I struggle with the guilt of sometimes feeling like I’m not giving them enough attention because I have work to do. There are days when they watch more TV than I’m comfortable with, I’m admitting it. I try to keep those days few and far between, but they do happen. But then I step back and see how well they play together…most of the time! I see how co-operative they are with each other, with me and Jon, with others, and I think it’s all good. I had both of them home with me full-time until they were each over two, so I really do think I’m giving them what they need when they’re really tiny. They have a strong foundation.


SB-V: If you could, by force of imagination, will one fantasy product into existence, what would that be?

DRC: It would be genius for someone to come up with something that could clean our house, cook our food, do our laundry and possibly walk the dog. But I don’t want a nanny. I’ll take care of that!


SB-V: Nice one. I like a woman who dreams big! Is there anything else you would like to add?

DRC: Just that it’s been an amazing journey so far and I’m so unbelievably grateful that we’re where we are. It’s been a labor of love of mine for four years and to see it actually come to fruition is amazing. I couldn’t have done it without the whole Onya Baby team. We really do need each other. If we could grow this into a self-sustaining family business I would be over the moon. We shall see, eh?

Sunday Brunch: James Adomian Knocks You Up

James Adomian is a NYC-based comedian who performs standup and characters at festivals, gay bars, party schools and radical political events across North America. He likes wrestling, wrestling other men, and pretending to be Jesse Ventura. He recently appeared on NBC's Last Comic Standing as a top 10 finalist...

 And has had a long and illustrious career impersonating a certain Texan president:

He's also a frequent guest on Comedy Bang Bang, has appeared on Sklarbro Country and makes funny voices (including those of dead, curmudgeonly atheists like Christopher Hitchens) for the Onion Radio. So what does a gay, wrestling-loving comic without kids have to say to the mamas of the world? Lots, apparently. After all, women are more fertile when they're amused. And Adomian is one damn funny guy.

For this week's Sunday Brunch, Adomian answers some of our readers' most frequently asked questions. Want to hear more about handling your SO's lactation fetish? You can catch Adomian at his Valentine's Day show at Milk in SF, starting at 8pm (tickets are $12, and that's a little cheaper than in vitro). Guaranteed to make your ovaries ache.

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Dear James,

I wanted my son to be just like you but he's depressingly unfunny at eleven years old. Plus, he's totally got a hard-on for Disney princesses. What can I do?

Yours truly,

Hipster Mama Wants to be a Fag Hag

Dear HMWTBAFH, 

You might worry if your son was cheerfully unfunny, but if he's depressingly unfunny, he's got a good shot at making it in comedy later on. Give him a mic and see if he instinctively has a meltdown -- you could have a pro! And if he's really into the princesses, stay open to the glorious alternate path of drag shows a few years from now.

Dear James, I have a problem. Since I got pregnant, my husband doesn't want to have sex. He says it used to be like making love to a cored zucchini and now it's like carving a pumpkin -- and plus he's scared of hurting the baby. But between you and I, his 'knife' is only three inches long. What should I do? 

Yours truly, Desperately Seeking Orgasms

Dear DSO, you're in a tough spot, but one with a great opportunity. Turns out you're in the perfect position for a little backdoor action. Smaller makes it easy on the other side, plus the baby will think it's a dance party.

Dear James, my husband has a lactation fetish. Now that I've had the baby he's pressuring me to breastfeed (him!). He says he's been waiting for it all his life (though when I pointed out that I'm pretty sure he was breastfed he said that wasn't any of my business) and if I don't do it he'll be forced to seek out an Adult Nursing Relationship. I'm just not into this. What do I do?

Sincerely, Milk is for Babies, in Baltimore

Dear MIFB, I'd go bottled breastmilk. That way, he gets off but and you don't have to referee daddy vs. baby at dinnertime -- win/win. Plus you can always wean your man over to a sexy powdered formula!

Dear James, 

Circumcision: what's your opinion?

At a Fore(s)k(in) in the Road

Dear FITR, this is the question of the ages. Why pick a side now? Take your time and let him make the call when he's older. Trust that when it's up to him, he'll make the right decision.

Dear James,

My mom's an OB-GYN. My mother-in-law is an obstetrics nurse. They both want to deliver the baby. HELP.

Yours truly, 

Deliver Me in Montreal

Dear DMIM, I would, but it sounds like you have enough hands on deck for this one.

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Now wasn't that informative? Adomian performs live this Valentine's Day. He also has a tumblr called High Noon in the Garden of Good & Evil. You can ask him anything (anything!) here.

Sunday Brunch: First Interview with Mica Vincent, Speech-Language Pathologist

Language development is the most amazing thing. Watching (hearing) 'drop-sheesh' turn to 'wa-wagh' turn to 'gar-bage' is what I looked forward to most when I was eight months pregnant and feeling like, as Sylvia Plath puts it, 'a melon strolling on two tendrils'. But what happens when language doesn't seem to be developing quite right? If your baby doesn't babble, your toddler isn't saying "me do it!", or your young child can't express herself, you're bound to be worried.
Enter the Speech-Language Pathologist, a healthcare provider who will work with your child to assess and treat their language and speech communication difficulties. And then, we all rest easy, right? Not so fast. Speech therapy, as our Sunday Brunch guest Mica Vincent tells us, is more than just correcting lisps. It's like that line in The King's Speech. The movie was a completely inaccurate view of speech therapy, and also of the history of the British monarchy as relates to Nazism. But I'm sure you remember the part where the king describes his cruel early childhood nanny: "she-she wouldn't feed me". Difficult stuff. Sometimes a speech therapist needs to be all things: responsible, empathetic, knowledgeable, insightful, professional.

Mica Vincent with sweet pea

Enter Mica Vincent, Msc RSLP. I have known Mica since we were self-serious vegetarian teenage girls who were going to become developmental psychologists and open a clinic for troubled children together. As with so many impetuous adolescent dreams, the Vincent-Vikander clinic has not come to pass. Mica has since become a Speech-Language Pathologist, and I've become a basket weaver mommy-blogger.
Mica is one of those really outstanding people who seems to effortlessly think of the greater good and then make her decisions based on it. I would trust Mica with the care of my child; I would give her power of attorney over my estate (if I had one), and hire her as my Life Coach if I thought she would do it.
Mica recently graduated from the University of British Columbia's Msc programme in Audiology and Speech Sciences. She works with kids in a number of environments, including clinics, community and school settings. She's seen a lot of parents make a lot of mistakes; and she's seen a lot of beautiful things, too.
In this two-part Sunday Brunch interview she fills us in on the most important parts of child language and speech development -- letting us know what we should look for and when we should just chill the fuck out. It's all, she says, about helping our children to become great communicators.

Happy Sunday Brunch. Bon appetit!


 - Svea Boyda-Vikander

________________________________________

SV: So I thought we'd start out by finding out just what an SLP does. What do you, as a Speech-Language Pathologist, spend most of your time doing?

MV: It's pretty wide-ranging. An SLP works with children and adults with communication and swallowing difficulties and disorders. With some children it's obvious from birth, typically with a significant developmental disorder, that an SLP should get involved with their feeding and swallowing as well as communication skills as they develop. For other kids it's usually around one year or 18 months that parents start to have concerns because their children aren't learning to talk at the time that their peers are. But there are also more subtle delays or difficulties that don't show up until children are school-aged and have diffficulty in the classroom.

SV: So what are the most common speech/language difficulties you come across?

MV: I would say that language difficulties are probably more common than speech difficulties, but it's the speech that people notice. So you get a lot of parents coming in because they're concerned about the fact that their kids can't make specific sounds, but when you look further you see that there is actually an underlying language problem.

SV: What do you mean by that? What's a 'language' problem?

MV: A language problem is a more general difficulty beyond just not being able to make a 'th' sound. One of the misunderstandings about SLPs is that they're speech therapists and they only work on speech sounds like lisps and that kind of thing. But the language component is huge, and probably makes the biggest difference for the kids we work with. There are expressive and receptive language disorders; the expressive ones concern the ability to use words, put them into syntactically correct sentences, communicate in appropriate ways, that kind of thing. Children with receptive language delay or disorder have trouble understanding what is said to them -- so, for example, they wouldn't understand what to do when someone said, "Point to your toes." This can be quite subtle and not show up until after the first few grades of the school system, when the language in the classroom becomes increasingly complex, and students are expected to listen not only to understand what is being said, but to learn new information. It's more than following directions -- without comprehension children will have difficulty learning. And that can have far reaching effects.

SV: I think the 'subtle' element is the part that worries most parents. How is a parent supposed to distinguish between normal language development and disordered? Can you tell us some of the obvious early signs of disordered language development?

MV: First of all, if there's a child at increased risk for a speech-language disorder, for example, premature infants, if there were complications during pregnancy or birth or indication of genetic or neurological disorder...

SV: OK, but in an otherwise healthy child?

MV: Otherwise, you're looking for social interaction skills: imitating others, maintaining eye gaze, following a point with the eyes, and babbling (vocal play, making raspberries, those kind of noises, cooing). Reacting to sounds in the environment, understanding simple games and routines like patty-cake or tickle. If it's young infants who don't have speech yet you're looking for those skills of showing you in some way what they need and responding to you. Being 'tuned in' to their parent.

SV: That's interesting -- we always think about the parents being tuned into the kids.

MV: Right, it's a reciprocal thing. And it's important to remember that kids have different communication styles. So some kids are very sort of active and engaged, and some are more on their own agenda -- the kid sitting their playing with his toys and making noises to himself.

SV: So when should a parent contact somebody?

MV: Well here are some barebones milestones. You should contact someone if: a) there's no babbling within the first year, b) there's no social interaction skills emerging in the first year, c) isn't starting to use any words in the first year, or has a very limited vocabulary by 18 months old, and d) they aren't starting to combine words at around two years. Those are the earliest stages... With older kids, a lot of parents worry about their kids' speech sounds so there are milestones for that as well.

SV: You don't seem as concerned about that.

MV: I think being able to communicate is your first priority, developing language skills is second. My third would be the clarity of speech, and of course --

(Ed: At this point Sweet Baby James came into the kitchen with a mouthful of styrofoam. I fished around in his mouth but he swallowed most of it. Should I make him throw it up? I asked Mica. Probably not, she said.) NB: I didn't, and it came out the other end within 12 hours. Amazing.

SV: Now where were we... Yes, what kind of parenting style best helps a child's language development?

MV: In general I would say, just being engaged. Some of the suggestions that I would make for parents are... getting down to your child's level, literally. Playing on the floor with them, involving yourself with their play. So if they're banging a spoon, you're banging a spoon. Responding to how they communicate, without judgment. For a shy or reluctant child, you could try playing alongside them so rather than forcing interaction from them your'e just kind of cultivating that with less pressure.

(Sweet Baby James playing with his Aunt Emily)

SV: Interesting. What abut people who decide their child is shy -- I think that can be stigmatizing (it was for me). What do you think about that?

MV: It's important to recognise your chld has a communication style and it might not be the same as others you know. But recognise that even a quiet child is communicating so maybe tune into the more subtle ways they're doing it -- maybe it's eye connection, gesture, body-language. You could encourage your child to imitate you by imitating them.

SV: What are the most common mistakes you see parents making?

MV: Asking testing questions like "What's this?", "Where's the ball?" I think it comes from parents wanting their children to be ready for school so they get focused on things like their child learning all the names of the colours. But for me, my priority is more that they are able to communicate in order to interact with other people. And so maybe the most important word for them to know isn't all the colours of the rainbow but the sort of vocabulary that's going to be useful in their daily life. Things like potty, bathtime, hungry, thirsty. They're not the most glamorous words, but they're really important.

SV: So are those kind of testing questions ever good?

MV: Well, it's not to be confused with you know, helping your child to learn vocabulary, but to have the emphasis on the communication and the interaction rather than being focused on them giving you the right answer.

SV: Can you relate a beautiful or funny experience you had while working with a family?

I was working with one immigrant family, a mother and her daughter. She had a lot of anxiety around her child sort developing as she expected her to. We just went over some language facilitating strategies, like getting down to the kid's level. She was used to a more directive parent role so she was uncomfortable with it. We set it up so she would have her special playtime with her daughter where she wasn't being a directive parent, she was being engaged with her child. And when she came back she was so happy. Like she had found the freedom to just play and be with her kid instead of always 'parenting'...

There was this other little kindergartener. His speech was unintelligible but he would try so hard. He wanted to do more and more repetitions when we worked together -- and this is the kind of therapy that's not really that fun because you have to do drills, basically. But he just loved it. We were working on /s/ and /sh/, and also s+, like star, sw, and those kinds of sounds. One day we were playing an ocean game and he decided he was going to say 'starfish' which was pretty much the hardest word he could possibly have conceived of, given his difficulties. And he tried it like five or six times and his little face was all scrunched up and then he got it! And he started jumping around and running around the room. Everyone there was ecstatic. That he said 'starfish'.

(some poor little kid being harassed into saying starfish by his mama)


SV: That sounds so lovely. (though actually that video sounds really annoying) What from your own childhood do you bring to your work with kids?

MV: I've been told by supervisors that my style is very gentle and I think that benefits me. It's important to first establish a good rapport and build trust and understanding and have open communication. The speech therapist might be with the family or child maybe once a week, maybe once a month, depending on the context. For an hour. But the parent is with the child all the time so the most powerful thing I think for a speech therapist is to share their knowledge, their experience, their problem-solving skills in order to help support and empower the parent to help their child develop. So if I were to relate that to my own experience... it would just be about recognising that parents have their own lives and their own challenges and finding ways to work with their children in a way that works for them, in their own life. I didn't grow up with any developmental difficulties but I can recognize that it's important to get support for parents.

SV: So it's not just the child in isolation, there's a whole family dynamic.

MV: Yes, and I think that a lot of practice these days is moving more towards family-centred community service, which sort of aims to create the optimal environment for the child. Then the SLP can help assess what that might look like for each child.

SV: What are the greatest challenges you face in your work?

For me, the biggest challenge is also what keeps it so interesting: every child is so different, every family is so different. Speech and language is probably the most complex cognitive function that humans have and there can be so many interacting factors. It's like a crazy thousand-piece jigsaw puzzle with no picture [laughs] so it can be certainly very challenging. But I like puzzles.

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Mica Vincent, MSC RSLP, graduated from the Speech-Language Pathology programme at the University of British Columbia in 2011. She encourages concerned parents to contact their local health authority as most speech and language disorders improve with early intervention, but there's often a year-long wait list. Most school boards also employ Speech-Language Pathologists to assess and treat children. If you have further questions or comments, Mica can be contacted at micav.slp@gmail.com.

This was part one of a two-part interview. Stay tuned for our further discussion of the impact of Attachment Parenting on speech development. We'll also give Mica the floor to answer some of your own questions.