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VBAC: What ACOG Really Says {Birth Without Fear}

VBAC: What ACOG Really Says {Birth Without Fear}

VBAC – Vaginal Birth After Cesarean.

The term and action is wrought with political and emotional meaning in the birth world. Can  you have a VBAC? Does your doctor or hospital “allow” a VBAC? Under what conditions can you have a VBAC? Should it be called a TOLAC (trial of labor after cesarean)? What sort of prior birth history is preferred? Once I have one successful VBAC, will I still have to jump through hoops in subsequent pregnancies?

All these questions and more come up when we start to discuss the mine field that is VBAC in today’s world. But I wanted to know what ACOG really says. I am not talking about the public statements – which you can read HERE. I want to know what ACOG is saying to the doctors, what they put out in their practice guidelines.

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The document I found is HERE. I encourage you to not only look at the document for yourself, but to also follow the many links I have scattered throughout this article.

At the opening of the document, ACOG has this to say:

Trial of labor after previous cesarean delivery (TOLAC)* provides women who desire a vaginal delivery with the possibility of achieving that goal––a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient’s preference for vaginal delivery, at an individual level VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies. At a population level, VBAC also is associated with a decrease in the overall cesarean delivery rate (1, 2). Although TOLAC is appropriate for many women with a history of a cesarean delivery, several factors increase the likelihood of a failed trial of labor, which compared with VBAC, is associated with increased maternal and perinatal morbidity (3–5). Assessment of individual risks and the likelihood of VBAC is, therefore, important in determining who are appropriate candidates for TOLAC. The purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and provide practical guidelines for managing and counseling patients who will give birth after a previous cesarean delivery.

Lets start with noticing that ACOG automatically terms all VBACs as TOLACs first. If you complete the trial with a vaginal birth, then it is a VBAC. The issue with this sort of wording (and thought process) is that it sets women up with doubt and it sets the doctor on the defense against the failure of the trial. I will use the term interchangeably only because the document that I am citing uses the term so often. But moving past this unfortunate wording we do see that they know VBACs are beneficial. They state that VBACs lower the maternal morbidity rate and risk of complications in future pregnancies and that as a whole they lower the cesarean rate. They do also point out that there are certain factors that make a TOLAC less likely to succeed, and that when they do “fail” you are more likely to have morbidity (which makes sense, as a major surgery is considered a morbidity to begin with).

In the “Background” section at the start of the Practice Bulletin we see several points that seem to be denied in the general obstetric community. First they state that the cesarean rate has increased rapidly since the 1970s, from 5% to more than 31% in 2007. They blame this increase on the introduction of electronic fetal monitoring, and the decrease in breech births and forceps births. I put emphasis on the EFM use, since we are often told that it is needed for a safe birth, even though research proves that it does not lower fetal morbidity or mortality. Again and again, research also shows that it increases the chances of a cesarean, which in turn increases the risks to mother and baby. Yet, ACOG still insists on the use of EFM as standard care.

They also state in this section that after the 1970’s VBACs gained popularity. By the mid 1990’s the rates of VBAC (28.3%) were such that it was actually reversing the cesarean rates. However, this increase in VBACs seemed to come with an increase in uterine rupture – though the literature does not state what sort of uterine scars were common (since certain types are known to have more risk, such as classical), whether induction was used, or what type of rupture occurred (most ruptures are not catastrophic but are instead considered a “dehiscence”). Due to this increase in ruptures, the case for VBACs was again set back to “once a cesarean, always a cesarean” in many practices. They finish this section by stating that it is known that liability is a large part of why VBAC is not offered to many women who are actually good candidates.

Now we get into the nitty-gritty of what they say about VBAC. I am going to take questions and statements from the document to break this down. All noted pages are from the Practice Bulletin unless otherwise stated or linked.

  • What are the risks and benefits associated with TOLAC? (p2)
    • Neither an Elective Repeat Cesarean (ERC) or a TOLAC are without risks.
    • Most maternal morbidity that occurs during TOLAC is related to a failed attempt when a cesarean becomes necessary.
    • VBAC is associated with fewer complications than an ERC.
    • Thus, the risk of a VBAC really comes down to whether it is achieved. If it is a “failed” TOLAC it has more risk than an ERC, but if it succeeds, it has lower risk than a ERC.
    • The main risk of TOLAC/VBAC is a uterine rupture. However, as stated in the background, some studies do not give background information about what type of ruptures are occurring nor on what type of prior incision or induction methods.
    • They include a chart of maternal risk in this section and it is interesting to note that maternal death risk can be almost double (0.2%-0.4%) with a ERC compared to a TOLAC after one prior cesarean (0.2%), and that TOLAC with more than one prior cesarean had no death risk within those studies. It is also noted that a ERC also comes with the risk of uterine rupture (0.4%-0.5%).
    • It is noted that for families wanting several children a successful VBAC takes away the risks of multiple surgeries which includes hysterectomy, bowel or bladder injury, transfusion, infection, and abnormal placentation such as previa and accreta.
    • They include a chart of neonatal risk factors when comparing ERC to TOLAC. It should be noted that there is no significant increase in neonatal death or neonatal admission (NICU admission). We see a much higher rate of respiratory distress (1%-5% vs. 0.1%-1.8%), transient tachypnea (too much fluid in the lungs which causes breathing issues) (6.2% vs. 3.5%) and hyperbillirubinemia (jaundice) (5.8% vs. 2.2%) in babies who go through an ERC.
  • What is the vaginal delivery rate of women who have a TOLAC? (p3)
    • Most studies show a 60-80% success rate.
    • Studies show a decrease in success if the same circumstances happen again, such as stalled labor, which lead to the first cesarean  (however, I will note that the definition of “stalled labor” is more likely the issue than anything else).
    • The chances of success are increased if the mother has spontaneous labor with no augmentation.
    • One VERY interesting note is that being “non-white ethnicity” lowers your chances of success. This speaks to the huge disparity in maternity care in ethnic groups in this country. Simply taking one look at the maternal mortality rate in non-whites gives a clear and horrible picture of this undercurrent in our maternity care system.
  • Who is a candidate for VBAC? (p4)
    • The best candidate is one in whom the risks and benefits balance out in a way acceptable to the client and care provider, this may be different for each woman and there is no specific “formula” to come to this answer.
    • Decisions about the first VBAC should be considered with future pregnancies in mind. This is due to each subsequent cesarean increasing the risk for future pregnancies, and the inability in some areas to find care providers to attend a VBAC after multiple cesareans.
    • For most women with one prior cesarean and a low transverse incision VBAC is a good option and they should be counseled and offered a TOLAC. Women with other incisions (T-incision or classical) or with prior ruptures and surgeries of other sorts to the uterus should be evaluated more.
    • Individual factors should be considered in all cases (i.e. – no hard and fast decisions to ruling mothers out of VBAC), and in the case of women presenting in labor, VBAC should be strongly considered as spontaneous labor increases the success rate of a TOLAC.
    • More than One Prior Cesarean:
      • Studies addressing TOLAC in women with more than one prior cesarean find rupture rates ranging from o.9% to 3.7% – again, without specifying the type of prior incision or level of rupture. They also have not consistently compared these findings directly to women with only one prior cesarean.
      • One large study in particular found no significant increase in rupture between VBAC and VBAMC (vaginal birth after multiple cesarean) – o.7% vs. 0.9%. A second large study only found a slight increase – 0.9% vs. 1.8%. They also found no significant increase in morbidity.
      • The chances of success are similar to that of a VBAC after only one cesarean.
    • Macrosomia (Big Baby):
      • Some studies show a decreased chance of success with a baby larger than 4,000g, and posibily higher rupture rates. However, these studies are based on actual birth weights, and not the estimates given before birth. This is significant given the inability to accurately predict birth weight before the birth.
      • Suspected macrosomia alone should not rule out TOLAC.
    • Gestation of more than 40 weeks, according to the largest study done which looked at this factor, does not increase risk. There is evidence that after 40 weeks chances of success decrease but we must consider that induction of some sort may be common at that point (given current practice trends) and that lowers the chance of VBAC in general. Gestation of more than 40 weeks should not rule out TOLAC.
    • Previous Low Vertical Incision:
      • Studies show similar rates of success compared to low transverse incisions (the most common).
      • Studies do not show increased risk of rupture or morbidity for mother or baby.
      • Studies are limited, but a low vertical incision should not rule out VBAC given the current information.
    • “Unknown” previous uterine incision should not rule out VBAC. The two large studies done at large tertiary hospitals show that there is no increase in rupture rates or morbidity, and success rates are similar. Unless there is a high clinical suspicion of a complicated previous uterine incision TOLAC should not be ruled out.
    • Twins Gestation:
      • In all studies available it is shown that in women with a previous low transverse incision there is no increase in risk to VBAC a twin gestation.
      • Success rates are similar to those of singleton mothers. Twin gestation should not rule out TOLAC.
  • How does management of labor differ in a VBAC? (p5)
    • Induction of labor for maternal or fetal factors remains an option for TOLAC. However, the increased risk of rupture that comes with any induction and the decrease in success rates should be discussed.
    • One large study of over 20,000 women found that rupture rates increased slightly with induction. Spontaneous labor had a 0.52% rupture rate, non-prostaglandins induction with a 0.77% rate, and with prostaglandins a rate of 2.24%. However, again the types of rupture were not specified and the context of the inductions are not known (unfavorable cervix, need for multiple induction methods, etc).
    • Another study of over 33,000 women found a slight increase in rupture (o.4% for spontaneous labor, 0.9% for augmented labor, 1.1% for oxytocin alone, and 1.4% with the use of prostaglandins). An analysis of this same study noted an increase in rupture rates when the highest levels of pitocin were reached, however no upper level of dosing has been decided for VBACs.
    • Studies done on the risks of misoprostol (cytotec) show an increase risk of rupture and should not be used for TOLAC. (Actually, it increases risk of rupture in ANY mother so it should not be used for induction, period.)
    • Due to the small absolute risk found in several studies, ACOG notes that use of pitocin for labor augmentation is not ruled out for VBAC.
    • Mechanical cervical ripening (such as the foley bulb) are also considered acceptable for labor augmentation/induction in VBAC.
    • ECV (External Cephalic Version), such as to turn a breech baby, are not contraindicated in a woman who wishes to VBAC.
    • Epidural/Analgesia use is not contraindicated and studies show it does not effect success rates. However, epidural use in general is shown to increase the chances of cesarean in all mothers. (to view that study, right click and select “copy link location” and input into google)
    • Electronic Fetal Monitoring is suggested since the main sign of uterine rupture is abnormal fetal heart rate (up to 70% of cases). It is noted that internal monitoring does not help in diagnosing ruptures.
  • How should future pregnancies be managed after uterine ruptures? (p7)
    • If the rupture is in the lower segment of the uterus, the chance of another rupture is 6%. In the upper sections of the uterus it is around 32%.
    • ACOG suggests an elective cesarean for births after a rupture.
  • How should women be counseled about TOLAC/VBAC?
    • Each woman will weight the risks and benefits differently. Therefore, the options should be discussed at length and documented.
    • Counseling should always consider the future plans for more children and discuss the risks of multiple uterine surgeries. Women should also consider that family plans can change or there may be unexpected pregnancies.
    • After counseling the ultimate decision should be made by the client. Global mandates (aka – hospital wide) should not be made as they do not consider the individual factors and wishes of each client.
  • What resources should be available at a facility where a woman will VBAC?
    • The previous suggestion of ACOG was that VBAC should only be offered in facilities with “immediate” access to surgical facilities and staff. However, this severely limits the locations where women could VBAC.
    • ACOG now suggests that care providers and clients consider the facilities available, their individual risk factors, and the availability of other locations where more resources are available.
    • Health care providers and insurance companies should do all they can to facilitate women in achieving VBAC through transfer of care or co-management of care.
    • If there is no way to transfer care, a woman’s autonomy should be respected. If a woman wishes to VBAC in a hospital without immediate access to surgical facilities steps should be taken early in care to develop a plan of action in case of rupture.
    • It should be noted that coercion into a repeat cesarean is not appropriate. A policy of not allowing TOLAC at a facility should not be used to deny care or force a woman into a repeat cesarean. If appropriate, transfer of care should be arranged to a facility and care provider who is better able to support TOLAC.

Now I would like to take a moment to talk about the notion of only “allowing” VBACs in facilities with immediate access to surgical teams and facilities. Lets compare the risk of rupture, 0.7% in most studies, which is not always catastrophic, to the risk of other obstetric emergencies. Cord prolapse, a very dangerous situation in which the cord proceeds the baby down the birth canal and gets pinched, occurs in about 0.28% of births. This situation requires immediate access to a cesarean in most cases. Placental abruption, another very serious complication, occurs in about 0.7% of pregnancies. This also requires immediate access to cesarean in almost all cases. Notice that the risk of abruption and the risk of rupture are the same. The rate of shoulder dystocia, which is considered an emergency that may necessitate a cesarean (or an instrumental birth) is around 1.29% though some studies report it at higher rates in the current birth climate.

Now looking at the rates of these complications, which are on par with the risk level of rupture, we have to wonder why ALL hospitals offering birth services are not required to have immediate access to a cesarean. After all, placental abruption happens with the same frequency and can happen in any pregnancy and ACOG does not seem to be concerned that EVERY pregnant mother does not have access to immediate surgical care. At the end of the day, the risk/benefit analysis needs to be decided by the mother and what she feels comfortable with since the rate of rupture is comparable to the risks of any pregnancy and birth.

The point of this article is not to suggest any particular course of action for every mother. This is about giving you the facts to make your own decision. This is about looking at what ACOG really says about VBAC/TOLAC and not just what your doctor tells you they suggest. Arm yourself with information and consider your own personal factors and Birth Without Fear, no matter how you choose to birth.

Breastfeeding Rights: On Being Asked to ‘Cover Up’ By a Home Depot Employee

Breastfeeding Rights: On Being Asked to ‘Cover Up’ By a Home Depot Employee

I noticed how polished she was. Flirting with a guy who was loitering around the taco truck and asking her again when she got off work. She said, “Nine.” I considered complimenting her on her perfect ankle boots.

I sat down on the gray wooden box that probably holds pylons or road salt (but wait – it’s California – no ice here) and put my shopping bags beside me. Baby Evie wasn’t in her carrier because we had taken the car. My husband and son had gone to Home Depot, and baby and I to my preferred big box store. It’s a craft emporium and sells such craft-making necessities as “Christmas scent” and “One hundred things you might need someday”.

I waited. We were supposed to meet at the Home Depot checkout but I needed to nurse Evie. She had been patiently smacking her lips and making occasional lowing noises since half-way down the Mod-podge aisle. In the thousands of square feet of the craft store, patronized mostly by women, there was nowhere to nurse her. Outside in the new evening there were some wire-frame benches at the bus stop but to reach them I would have had to cross a busy parking-lot street with a baby, a purse, and two full shopping bags in my arms. I’m always scared of being hit by a car anyway.

So I sat on that gray box outside the Home Depot exit and cuddled baby up. I wasn’t wearing a nursing top, just a v-neck sweater and a tank-top underneath. I pulled them both down and latched her on. She nursed contentedly. I found I couldn’t meet the eyes of the well-dressed security woman checking receipts at the door. I found I had already known she would disapprove. Much to my chagrin, I found that I cared. I didn’t want to, but I did.

She asked me to cover up.

In my two-and-a-half years of nursing I have breastfed in public places across Canada and in parts of the US. I have breastfed in front of friends, family, strangers, public officials, flight attendants, doctors, my husband’s boss, and at least one family pet. Nobody has ever asked me to cover up.

She said people were staring.

I asked who. I looked around. I saw no one. I shrugged. She rolled her eyes and huffed. Like, if I want to be a slut, that’s my problem. Which it is. I mean, which it would be.

My heart was pounding. But my baby is hungry. She has been so patient. She doesn’t nurse with a cover and would inevitably pull it off. Why would I have to cover, anyway? I’m not doing anything wrong. My right to do this is protected by law, dammit! And breastfeeding in public won’t become culturally accepted until women start breastfeeding in public. 

Kristie Robin I

As if on cue, Evie felt the (immense) milk letdown coming and pulled off. So now my nipple, spraying like a geyser, was exposed. I pulled her close so it would just spray onto her onesie (babies are supposed to smell like milk, right?). Under the stare of the security worker, I let her latch back on. We nursed for a few more minutes. I stopped it early and gathered my things, walking around to the entrance of the store so I could look for my husband. I just didn’t feel safe.

The moment of breastfeeding is more than just a soft, intimate act. It’s also a moment of vulnerability. It feels primal to me. No female ancestor could fight off a saber-toothed tiger while holding a baby to her breast.* While only I can decide whether or not I want to breastfeed, my success in breastfeeding requires consideration from other people. When I sit down to nurse Evie, I depend on other people not to insult me, ostracize me, sexualize my actions, or invade my space. You know, to take a turn battling those saber-toothed tigers – not to come running at me shouting caveman obscenities.

boobs gif

*It’s reflected in the biology of breastfeeding – for most women, stress inhibits their ejection reflex (instead, I have an ejection reflex like those bullet-shooting ta-tas in Austin Powers, but that’s another GIF altogether).

Because let’s face it: I’m human and if people told me to leave or cover up everywhere I went, I would stop nursing in public. If my husband acted grossed out or jealous when I nursed at home, I would stop nursing there, too (or just get a divorce, but then who would take our kids to Home Depot every week?).

In a culture that fetishizes female bodies, their exposure is not inert. Maybe some people were staring, just as they would stare at a woman wearing a revealing shirt. But I can’t imagine an employee asking a woman who was baring her breasts in that way to cover up. In fact, she might even receive better service. In any case, it’s up to me whether or not I am concerned about people ‘staring’ at me.

I don’t give a rat’s ass about people staring at me. I’m just that kind of gal. I do care about having society’s shame thrust upon me when I am feeding my baby. It was the Home Depot employee who felt uncomfortable and it was wrong for her to project her discomfort onto me. I’m starting a correspondence with the store manager the moment this post goes live. Stay tuned for a follow-up.

Home Depot, you messed with the wrong mama.

Kristie Robin II
Have you ever been told to cover up? What did you do? How did you feel about it?

**Images of breastfeeding at Home Depot by Kristie Robin of Kristie Robin Photography.

Grief And Guilt {The Birth Trauma Experience}

Grief And Guilt {The Birth Trauma Experience}

Trauma after the birth of a baby is a ‘special’ kind of trauma.

It’s a bittersweet kind of trauma. It’s a silent kind of trauma. It’s an invisible kind of trauma.

And if your baby is healthy, it is usually considered an unjustified kind of trauma.

I suffered from birth trauma. It was agonising, painful, and heartbreaking. I was alone, and misunderstood. It began the first night, a few short hours after the birth of my first daughter, from the moment my partner went home for the night. I was alone in the dark in my single room with this tiny little newborn. I held this chubby baby girl in my arms, and felt nothing but sadness at the experience we had gone through together to bring her into this world. I’d feel a stab of shame every now and then, and scold myself for being so ungrateful – my baby was here, wriggling in my arms, and I had the nerve to even consider mourning the experience that brought her to me. I would quickly go back to the sadness, mourning the loss of a dream – a beautiful and empowering birth experience. That night was the beginning of a four year battle with birth trauma.

My grief was deep, and some days I felt I was drowning in it. I floundered, being hit by waves of sadness, disappointment, and anger. I replayed the labour over and over in my head. I beat myself up with ‘what if’ and ‘if only’. I felt responsible; I blamed myself. I felt cheated, let down; I blamed my partner, I blamed the midwife, I blamed everyone. I tried to pinpoint where it went ‘wrong’, where I  went wrong. News about new babies had me sobbing, even watching birth scenes in movies was painful. A phone call from my sister, hours after the birth of her son, left me feeling like I’d been hit by a truck, and I hid behind shelves in the department store I was in and I just cried and cried. I bitterly wished for every woman to have a horrifying experience, and I felt an unimaginable hurt when I saw women emerging from birth empowered and ecstatic. It wasn’t that I wanted every woman to experience the pain of birth trauma, but I just wanted to them to know my pain.

 

I suffered terrible postnatal depression and post-traumatic stress disorder, even though my trauma largely went unacknowledged. Where it was acknowledged, it was usually deemed unwarranted. My experienced was pushed away and minimised by well-meaning but hurtful comments from others…

 “Years ago, you both would have died. Thank goodness for modern medicine.”

“It’s just one day in your life.”

“You were probably never going to give birth naturally anyway.”

“It’s probably because of your birth plan. You can’t control birth, you know. If you didn’t have such high expectations, you wouldn’t be so disappointed.”

“At least you are both alive and healthy, that’s what really matters.”

The comments were so hurtful. I felt like very few people understood. What about me? I would think. How can you say I am healthy? I feel like I am falling apart. Does my mental health not matter? I should have been overwhelmed with love for this tiny little bundle of joy, but instead I would hold her, look at her, and wish that I felt something. I was numb.

Sometimes I retold my birth story. I rarely came across anyone who had a story like mine, and people would cringe and exclaim “oh my goodness that’s terrible”, and then tell me their story. Sometimes they would have their own war story to tell, and I would listen and we would joke about never doing that again… But that wasn’t what I wanted.

I craved validation. I craved acknowledgement. I just wanted to tell someone my story, have them hold me as I cry, and look me in the eye and say: “I’m so sorry. You were cheated. You deserved better. You should have been able to birth the way you wanted. Your pain is justified. You have every right to grieve, without guilt.”

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Maybe your birth trauma hit you straight away, or maybe it slowly grew, beginning as a nagging feeling you didn’t quite understand and growing into a deeper pain. Maybe your plan for birth went way off course, or maybe you didn’t have a birth plan but you wished that you had. Maybe you sometimes think that you weren’t informed about your choices, or maybe you think your pain could have been eased if you knew, and expected, less.

Maybe you had a caesarean. Maybe you had an instrumental vaginal birth. Maybe you had an unmedicated birth. Maybe you birthed in a hospital. Maybe you didn’t make it to hospital. Maybe you birthed in a birth centre. Maybe you had a planned homebirth. Maybe you asked for pain medication, and didn’t get any. Maybe you asked for support in a drug-free birth but was pressured into using medication. Maybe you had an unexpectedly fast labour, or an unexpectedly slow labour. Maybe you refused a procedure, but it happened anyway. Maybe you wanted a certain procedure, but no one listened…

Or maybe, none of this happened. Maybe it’s not about how you birthed. Maybe you birthed exactly as planned – but your trauma relates to how the nurse spoke to you or looked at you or ignored you…

Maybe you feel unsupported, alone, unjustified, silly, or even selfish. Maybe you’re sad. Disappointed. Angry. Hurt. Jealous. Afraid. Ashamed. Guilty. Responsible. Maybe you don’t feel any of those things…

Birth trauma can happen to anyone, in any situation. Birth trauma can happen to you, and even to your partner. Your experience is totally unique, and it doesn’t matter how anyone else feels about their birth or what anyone else would have done. Birth trauma is about how YOU feel about YOUR birth. Birth trauma is about YOU and YOU alone.

But make no mistake, you aren’t alone. Right now, thousands are alongside you, silent in their trauma and suffering.

Birth trauma is real. And needs real support.

To the mothers out there, dealing with birth trauma, I want to offer you my empathy, and my deepest condolences. Birth trauma is real. Your pain is real. Your pain is justified. You deserved a wonderful birth experience, and it is unfair that you didn’t get that. You deserve support. You have the right to grieve without guilt.

To the partners, friends, family, midwives, doulas, doctors, nurses, acquaintances… offer your empathy, and your deepest condolences. Birth trauma is real. Their pain is real. Their pain is justified. They deserved a wonderful birth experience, and it is unfair that they didn’t get that. They deserve support. They have the right to grieve without guilt.

 

Circumcision Doesn’t Beget Circumcision {One of These Things is Not Like the Other}

Circumcision Doesn’t Beget Circumcision {One of These Things is Not Like the Other}

Yes, you read that right, we’re going to talk AGAIN about circumcision, but this post is a little different. I’m not writing this to try to tell you what to do. In fact, this post is actually going to start off with a confession; the day after my first baby was born I had him circumcised.

Whew. Okay. We got that part out of the way!

When I was pregnant with my oldest child, I must have read everything that I could get my hands on. I was very strict with myself and did everything that I could to maintain my weight, to avoid every item on that list of no-no foods (deli meats, sushi), and struggled through headaches and pains to avoid using medications like Tylenol even though my OB said it was fine. I started a pregnancy journal and had the baby’s full name picked out by 14 weeks along.

pregnancy second baby

When I got to the chapter in my pregnancy how-to book about circumcision, we had just found out that the baby was going to be a boy and I remember reading about the detailed procedure and cringing, picturing them doing this to my tiny, new baby. I had never really read anything about circumcision before, and not only that, but I literally knew NOTHING about foreskin. Like many new moms-to-be, I decided to leave that decision up to his father, figuring, “Well, Dad’s got a penis and I don’t, so he will know the correct decision to make here.”

Well, it turns out that my husband was reading FAR less about this baby than I was and without researching any part of it, or even reading the chapters I had so nicely bookmarked for him, he told me that we would have it done because “that’s just what you do” and “we don’t want him to look different.” Even though the description had made the hairs on the back of my neck stand up, I didn’t argue with him.

I ended up being (unnecessarily) induced and after 12 hours of Pitocin, our perfectly healthy baby boy came torpedoing into this world. The circumcision was performed the following day and we listened closely as all of the aftercare instructions were explained to us. They even sent us home with a whole packet of information about how to care for it and danger signs to look out for in case he got an infection. (Whoa, wait… an infection?? Isn’t that what we were trying to avoid? We’ll get back to that.)

Have you ever seen a freshly circumcised penis? It’s basically an open, raw wound that you smother with Vaseline and hope that it keeps it moist enough to not stick to the diaper. Have you ever skinned your knee open? Imagine the feeling of peeling a gauze bandage off of it when it gets stuck. Now imagine someone pouring warm, acidic liquid all over it; because that’s what’s happening to this brand new, little person every time they urinate. Then that wetness gets to just sit there. You ever wear a moist Band-Aid over a cut?

Every time our new baby wet his diaper we immediately had to change him because it hurt him so badly. And when he would poop, well, that was a whole different ball of wax! Cleaning poop off of a penis and a set of testicles (especially when it’s a learning experience with a less than one week old) is one thing, but having to do it while your child is screaming bloody murder in your face because he has feces covering his raw, sensitive glans is quite another.

Fast forward a few years and now he is almost five. We are constantly reminding him to clean himself and have had to teach him to be sure to tug on his “foreskin” (basically just the remaining bit of skin that was leftover) and pull it away from the glans because it is constantly trying to reattach itself. As our son has gotten older, we have had issues with the “foreskin” trying to reconnect and also teaching him how to keep himself clean.

So when we got pregnant with our second child, I was in a different spot with the medical side of birth. I had not had a good experience with my first delivery and therefore spent a lot of time reading more than just baby books and fear-mongering websites. I started to look into the facts about birth, the facts about induction, and even the facts about circumcision. We found out that we were having another boy and the decision of circumcision came up after a prompting from our care provider.

Like I have already stated, my husband was not into researching everything pregnancy like I was and so it wasn’t something that he was concerned with. He had automatically assumed that because we had circumcised the first boy that of course we would be doing the same with the second. All those complications involved with the first baby? Yeah, those weren’t necessarily complications at all! They were just snags that happened when you leave the glans open and raw like that. Those issues we had with our first baby in the first several weeks we were all learning how to be a family were totally “normal” and were all listed in our handy little info packet that was sent home with us.

In reading up about circumcision I was very surprised to learn that, with the exception of Israel, the United States has the highest rate of circumcision. Most countries don’t practice it, in fact many have had the procedure banned. In some cases, circumcisions are botched, leaving men with noticeable scarring or sexual dysfunctions – and that is in mild cases: baby boys sometimes die from the complications of circumcision.

I also took the time to learn about the many functions of the foreskin and how having one intact would benefit my child. It might be tough to think of it like this, but the foreskin can easily be likened to an eyelid or a pair of lips. One of its main functions is to protect the sensitive skin underneath and to keep that area clean and moist.

Along with keeping the area underneath clean and moist, the foreskin is actually adhered to the glans and won’t even start to detach until around age three! So all that stuff we had heard before about it being “cleaner” to cut that part off was total BS! It’s attached! That means when your baby has one of those really big poo-splosions and craps up the back of his onesie, you won’t have to also deal with carefully and calmly wiping poop off of a swollen and painful wound. With a baby who is NOT circumcised the foreskin does a fantastic job of keeping everything covered, so you don’t have to worry about it getting inside at all! You just clean it off like a finger (likely how you’ll clean up your own finger after checking for poop) and go about trying to remove said onesie without resorting to scissors.

Then there came the whole deal with him not only looking different from his Daddy, but also looking different from his older brother. Well, when you really get down to it, they’re already going to look different in so many more obvious ways, does it really matter? For instance, our oldest boy has green eyes and his younger brother ended up with blue ones. His older brother has light brown hair while his head is covered in pale, blonde locks. They are different heights, different weights, and have vastly different personalities, so why in the world would anyone be worried about their penises looking the same, which they probably wouldn’t anyway.

circumcision decision

I was asked about what we would do when he was teased about his foreskin in the locker room at school and I honestly had to laugh at that one. First of all, adolescent boys are going to tease one another about SOMETHING, so for me to be worried about that NOW seems a bit pointless. Secondly, the circumcision rate in America is going down every year, so chances are he will not be the only boy with foreskin. And lastly, because I will explain to him why we left him intact when he is old enough to understand, he will be able to educate his friends and tell them how when he’s older, having a foreskin will make sex feel better for both himself and his partner, allow him to masturbate without needing lotion, and add girth to his penis. What adolescent boy wouldn’t want that?

And while we’re on the topic of sex we may as well just get it all out there right now: “Anteater”, “turtleneck”, “Water Snake”; the list of horrible, sex-shaming nicknames goes on. It’s a disgrace that we would alter a baby’s body so drastically just to make it more aesthetically pleasing for ourselves. Yet if someone wanted to start trimming the labia from the genitals of baby girls I am positive that people would be totally up in arms. Has it ever occurred to anyone that the basic function should override the supposed aesthetics?

I have also been asked about what I will say to my oldest son if he should ever ask me why I decided to have his foreskin removed and not his brother. Well, I plan on telling him the truth. I thought that I had read all of the right information and, at the time, I thought I was doing what was in his best interest. However, if I am truly honest with myself, reading about the procedure made my stomach turn. That feeling was human instinct and I plum ignored it. I thought I knew what I was doing and I was wrong. I felt in my heart that going through with the procedure was a bad idea but did not feel like it was truly up to me to make that decision.

And truth be told, it wasn’t. It wasn’t up to me and it shouldn’t be up to the Daddy either “just because he has a penis”.

So, okay, they say that circumcision is “cleaner” and “healthier” and will keep your child from “being made fun of.” Well let’s just say you believe all of that (which is fine, and it might be what your care provider has told you); where does it say that this procedure HAS to be done within the first week of your child’s new life outside of the womb? Isn’t there already enough going on? Chances are you’ve got a birth you’re healing from, other children to care for, breastfeeding (which can be quite stressful for some) to learn, and you’re probably hungry and sleep deprived. WHY in the WORLD would you want to add in “caring for an open wound”?

Where does it say that the offer to be circumcised will expire after the first two days? Why can’t it just be left up to the person whose penis status is being questioned to decide? A lot of people will get a child’s foreskin removed because of the possible risk of infection. But what about tonsils? Appendix? TOENAILS? All of these things can become infected yet we make no mention about having them removed at birth. Many people will research more about their newest cell phone upgrade than they will about their own pregnancy and labor, and even fewer will research about circumcision.

brothers

If I were to wish one thing for you, it would be for you to read, read, read about circumcision. Don’t just read about it in the US, check out what they say about circumcision in other countries, where it is seen as a barbaric practice. Or do your baby a solid and watch the procedure being done on YouTube. Arm yourself with knowledge and if anything, wait until the child is old enough to be given proper pain management for such a painful procedure. Even better, leave them intact and allow them to decide it for themselves.

It makes me sad when I think about what I have taken from my oldest son by having him circumcised, but I feel like I have all the opportunity in the world to help make it better by passing on what I have learned to others. Hopefully, with the correct information, they will make better choices than I did. I have looked into the information on foreskin restoration so that I may pass it on to my son should he be interested in it one day.

Having circumcised one child does not mean that you have to circumcise them all. Even if you have FIVE boys that were circumcised you can TOTALLY leave the next intact! None of our children will be exactly like the next. Even if their genitals don’t match Daddy’s or each other’s they will always be brothers and that is what’s important. I leave you with a quote that has always resonated with me about our decisions regarding circumcision:

forgiveyourself

Forgive yourself for not knowing what you didn’t know before you learned it.” – Anonymous

Photography Credit: http://earthmamaphotography.com

Further reading:
http://www.thewholenetwork.org/index.html

http://www.cirp.org/library/

http://www.catholicsagainstcircumcision.org/

http://www.doctorsopposingcircumcision.org/

http://www.jewsagainstcircumcision.org/

http://www.mothersagainstcirc.org/

http://circumcisionresources.org/

http://uncutting.tumblr.com/compilation

http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e4/html_9

http://www.noharmm.org/anatomy.htm

http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in-us/

http://www.psychologytoday.com/blog/moral-landscapes/201109/myths-about-circumcision-you-likely-believe

Beautiful Breastfeeding while Pregnant Moment

Beautiful Breastfeeding while Pregnant Moment

Yes, it was removed from Facebook, but really we just want to share this gorgeous picture of a mother breastfeeding her child while pregnant with another. This is real life folks. #peaceloveboobs #normalizebreastfeeding.

IMG_7985

I had my first breastfeeding image removed from my personal FB page today.  This photo is so special to me because of 2 things, first, my son whom I never thought I would be able to breastfeed is 2.5 years old and going strong and second, because I am 26 weeks pregnant with my 4th son and am thrilled to have kept nursing through this pregnancy and really look forward to the amazing bond my kids will have through tandem nursing.  {Whitney Hempsey}

My Fearless Birth {Home birth turned hospital}

My Fearless Birth {Home birth turned hospital}

My wife, Jenny, and I tried for two years getting pregnant, so when we found out on our 2 year anniversary trip that I was pregnant we were more than excited! I had known since we started trying that I wanted a home birth. I educated myself as best I could. I started taking a Hypnobabies class, hired a midwife and a doula, and soaked in any and all information my fellow home birth moms had to offer.

Since the day we had come back home after finding out, spiritual things started happening in our home. We chalked it up to being my wife’s father, who passed away. Our midwife, Susan, and doula, April, were so very kind to hear us out and not make us sound crazy. Actually they helped us come to terms with it. After that things settled down until around November. We were all sitting there talking about the new things that were occurring in the house and new feelings surfacing when I started telling them that I had always had a feeling the baby was going to come early. Jenny kept saying the date December 5th kept sticking out in a big way. This so happened to be the same day her father died. We talked to the spirits (assuming it was her father) letting him know Dec. 5th was too early and we wouldn’t be able to have a home birth.

December 5th came around and sure enough I went into early labor. The only thing that kept me from going into full labor was that I put myself on bed rest for the next couple weeks. All was well.

Friday, January 4th at 3:00PM labor starts again (Due date was Janurary 3rd). Our 10 year old son, Quenton, came home from school and saw me practicing my Hypnobabies and getting super excited. It had been planed for him to be leaving that day for the weekend but he didn’t want to go. We told him it was OK, he had to go, but he was going to be a big brother when he got back. He went on his way. I tried keeping myself occupied by working on the baby book and a calendar project with friends and families guesses when they thought I’d have the baby. I was getting restless by the evening and we went and rented movies.

That night my sister came over to help out. I was stressing out with getting the room and bathroom ready since pressure waves (contractions) were getting closer and stronger. I was also obsessing about who was going to take pictures that I couldn’t focus on Hypnobabies. When she came things started progressing even more. We focused hard with Hypnobabies and used the yoga ball a lot. Later that night April and Susan came over after waves started getting closer. Jenny and I did very well through each wave. We were all very excited to meet our baby boy. We talked and laughed through each of my waves. I felt good. I felt on top of each one, progressing nicely. Since it seemed like it was going to be soon we all thought it’d be a good idea to get some rest. Even though I knew I needed the rest, once I laid down my waves slowed down. Around 8:00am (Jan. 5th) I asked Jenny to go make everyone some breakfast. I was upset and wanted to be alone for a little while. I was so sure this was going to happen and I felt bad for calling April and Susan over (since they lived 30 mins away and both had kids). They assured me it was OK but that they were both going to go home and to call them when things picked up again. I liked that idea because I was ready to do this on my own again and concentrate on what I was doing.

home birth

(Saturday, January 5th)
Jenny and I decided to go rent a couple more movies around 11:00am to help me relax again. I remember breaking down while in the aisle at the rental place because the waves were getting so strong. We took the day to work through the waves that were quickly intensifying again. I could tell they were getting stronger than the ones I had the day before but I did not want to call April and Susan until I felt like we were really ready (in my mind I wanted to call when I felt like I wanted to go to the hospital). I did not want to take the chance of calling them and labor slowing down again. My brother came over to borrow some stuff and I remember working through the waves with breathing techniques. He was surprised to see I was that calm while in labor (although I personally felt like I was going outta my mind). We used different techniques of Hypnobabies. I tried walking up and down the road which didn’t work too well for me because it was just hurting too much. I got in the bath a lot. I rolled around on the yoga ball, also. I couldn’t put my finger on it, but I was falling out of rhythm with Hypnobabies and I could feel EVERYTHING. I would cry and the hospital kept crossing my mind. We were so sleep deprived at this point. Even though we would rest, we would get woke up every 5-10 minutes by a strong wave.

Around 10:00pm we felt we were ready for April and Susan to come. It was like deja vu, yet waves were definitely longer and stronger than Friday nights. My mom was now there since we just “knew” this was it. I got in the tub with candles and my wife. She’d rub me down with oils and we had finally gotten back into a fabulous Hypnobabies rhythm. Jenny would chant the cue words in such calming and comforting ways that she ended up putting my mom to sleep. When my mom would wake up, the vibe around the room was so different. Like a warm blanket being put on you coming in from the cold. I’m still cold, but the comfort was there. She was so brave and strong for me. Always telling me how proud she was of me. That was a big moment in my life as we had not had a close relationship growing up.

Early morning came (Sunday) and when I laid down again waves slowed down. Again, April and Susan went home. I was so upset. I cried and cried and kept saying I just can’t keep doing this. I had been working so hard at this point to stay in the zone of Hypnobabies. I didn’t know how much more of this I could take.

(Sunday, January 6th)
First and foremost- I’m not above admitting that by this point I had gone through enough and was ready to go to the hospital. The thing that stopped me was the simple fact that I had went on and on about how much I wanted this home birth and I did not want to disappoint everyone who rooted me on.

Jenny and I were left alone again, and although the waves slowed down in length they, by no means, slowed down in intensity. To be perfectly blunt- I was pissed. I was annoyed. What the heck was I doing wrong? Why wasn’t this baby out? I was doing everything I learned, everything I was taught. I never read this in the books. I had never listened to anyone tell their story of being in labor for three days, dilating back and forth. What was going on? I was ashamed in thinking I was not giving birth the right way. I kept thinking to myself, “I’m so bad at this. April and Susan are so annoyed with me. Jenny probably thinks I’m not trying my best.” But no way would I voice these things out loud. I had to be strong. I had to put my game face on and not let anyone know how different this was becoming to me, how increasingly hard it was to keep it together.

It seemed like as soon as I started thinking all this April had arrived, and Susan soon followed after picking up our son. I put a brave smile on for my son, my sister Justice (who was the same age as my son), and my mom. Soon after, my father came downstairs to give me a huge hug. I remember this moment like it was yesterday. I didn’t want him to see how much pain I was in and I knew since the waves were really close together it’d have to be a quick hug and he would need to go. Once he got down there and I fell into his arms, I didn’t have a single wave. I felt so much peace. I wanted him to stay. He told me he loved me and off her went out of town for a job.

midwife birth story

My family stayed upstairs as I continued to moan, sway, and breathe through each wave. “I can’t give up now! I can’t give up now!” Susan and April insisted me sit on the toilet to help keep me dilating. I hated it. No- I LOATHED IT! They sure were right though. It wasn’t long after going to and from the toilet to the bed that my water broke. I remember I was on the bed with the yoga ball asking for the bed pads because with this next contraction I’m pretty sure I’m going to pee. There it went. “DeAnna- it’s not pee. Your water broke!” Another contraction. “I’m sorry guys I’m peeing again!” “DeAnna- I promise it would be OK if you were even peeing, but you’re not. It’s your water.” I was not convinced it was not my pee until it was prob the 10th time I had a contraction and was still feeling gushes come out. Once my water broke I could not stop the urges to push. Now it all seemed so surreal. It’s official. I’m about to have my baby! My mom, sister, and son came down and sat on our bed waiting for the cue to come in and watch little baby boy Sebastian come out. An hour of uncontrollable pushes came and went. Two hours. Three hours. They fell asleep on my bed. Four. Five. ‘OMG, WHY ISN’T THIS BABY COMING OUT! Stay strong, DeAnna. They’re all here for you. Ahhhhh! Please Lord help me!’

I couldn’t stand the water anymore. I sent my family away as I was to the point that I didn’t want them to hear me cuss, I didn’t want to scare my son any more than he had already been, I didn’t want to scare my sister into never wanting children. By this time though, laying in bed, I hated everyone. I felt like every birth story, birth movie, birth show I ever watched were all lies. Every time anyone would tell me I was close I didn’t believe them anymore. Everyone was a liar. I’m NOT close. I’m NOT doing a good job (otherwise the baby would be here by now). I’m NOT about to have my baby.

I kept being checked and told that I was close. I would cry and losing all faith in Hypnobabies. Although I felt like I wasn’t doing Hypnobabies anymore, I was told they would catch me not saying much and chanting through some tough waves without even giving it a second thought. I just wished I could get a break- just for an hour. I need sleep. But nope- those urges to push just wouldn’t let up.

(Monday, January 7th)
I pushed all night. Begging and pleading for someone to do something. Everyone was so encouraging. April tried so hard to keep me calm. I remember crying as she rubbed my head looking into her tear filled eyes. Jenny was so sick as this time- really feeling the effects of everything I was going through, still sticking by my side like the amazing wife she truly is. Susan was the perfect midwife, encouraging me that I was the toughest person she’d ever met.

April needed to get home to her little girl. Everyone thought a new person in the picture to help with the support would be a good idea. So they called up Megan- a close friend and our Hypnobabies instructor. She arrived around 9am. I cried in her arms allowing every fear and angry feeling come out. “I’m trying so hard Megan. I’m doing everything you told me to do. I’m doing everything everyone is telling me to do. I can’t do this anymore. They’re lying to me or something.” She smiled this beautiful, angelic smile and told me I was amazing. She helped me get back into the groove of Hypnobabies. She helped me back into the tub with Jenny. We began to breathe, chant, laugh, and chit chat. Susan insured us that this was great and would allow that last bit of cervix to move out of the way. I felt confident at this point.

About an hour later, after the water was cold and I was ready to try pushing him out, I got out and laid on the bed. Everything intensified again. I made it clear at this point that I was way too tired to do this anymore. I wasn’t going to push him out. I got hysterical all over again as these uncontrollable waves took over my body over and over. Susan said she was going to check me. Megan held my hand on one side as Jenny stroked my head and held my other hand. That’s when I let them know that if there is no change we have to go to the hospital. I saw the look on Susan’s face. No… no change. Still a 9. “NOOOOOOOOOOO,” I cried, “Ok. Let’s go. NOW! I want the epidural and I want it now! If you don’t take me right now I’m going to go out there half naked and make someone driving by take me.”

At that point my mother came down to try and calm me down because even though I had it set in my mind that I was going, I was even more hysterical because of how disappointed I was in myself. I couldn’t stop telling her that everyone who doubted me and was negative about my birth plan is going to say “I told you so.” Everyone was so comforting at that point telling me how great I had done and that they understand and think it’s a wise choice to go ahead and go in.

We pulled up to the ER entrance and I told my wife to please go in there and tell them to have me a room ready before I get in there because there was no way I was going to scream through my waves and pushes in the middle of a waiting room. I can laugh about it now, but it was so funny getting into the hospital. The look on their faces! Those people rushed around so fast. I felt like I was in one of those really dramatic movies. I mean, no joke, the guy pushing me in the wheelchair was swerving around corners so fast I thought I was going to tip over. The woman in front of him was running yelling for people to get out of the way. I couldn’t tell them to chill out because I was busy “hoooo-hooo-haaaa-haaa-ing” but inside I really felt like I was in a movie.

I was checked once I got situated in the room. I slipped back to a 6 from a 9 since we left home. (This is what was happened at home. I would go back and forth in dilation). Another mind boggling thing? My water broke… AGAIN! Right there in the bed. I had no idea this was possible… having your bag break multiple times? Yep- it’s a real thing.

It was a couple hours later that I finally got the epidural. Oh sweet loving Lord above. Thank you! At least now I can still have a vaginal birth. I’m not gonna lie- I see why women are so quick to get those things. My wife, son, mother, sister, and Hypnobabies instructor and friend, Megan, were all there. At 8:30p.m. it was time to push. I got scared because I could feel my legs. I THOUGHT I WASN’T SUPPOSE TO FEEL ANYTHING! It was too late. I was pushing. OMG I FEEL IT! WOW! I began feeling sick and started vomiting. This is was the BEST pushing tactic haha. As I was puking the force of it was really shooting him out.

home birth turned hospital birth

“Look down DeAnna! Look down!! Baby born at 8:57p.m.”

“OMG! Look at my baby. Is he not the most beautiful baby in the world,” I said with tears just rolling down my cheeks.  My wife went with the baby and my son instantly came from my feet (watching his baby brother come out) to my head. As he rubbed my head, grabbed my hand, bawling his eyes out he managed to give me a kiss on my forehead and said, “Oh mom I am so proud of you. I can’t believe you did it. You did such a good job. I can’t believe this baby isn’t dead and we finally get to take one home.” I had never known that the loss of one baby made him think that every failed attempt of trying to conceive meant it died too. I had never known he was crushed every time (for two years) we’d have to tell him, “Nope, bud. It didn’t work this time.” My big brave son finally let it out and he was proud. Proud of ME. What an emotion. An emotion I don’t think I will ever experience again. An emotion nothing else can replace. The bond that happened in that moment made me want to be the best mother in the world not only to him, but new baby Sebastian.

birth story

I look back at how hard this labor was. I had never had a kid before so I did not know that what I was going through was rare and not a typical birth. When everyone would tell me all that happened I started to realize how strong I was. I just went FOUR DAYS in labor! There was nothing in my life that made me feel so amazing. Nothing that made me feel so powerful. I wanted to yell, “I AM WOMAN! HEAR ME ROAR!” Even though this was a very hard birth, there is no doubt in my mind I would do it all over again. In fact, I can’t wait to get pregnant again because I will try the home birth without a second thought. It’s funny because I actually hear myself thinking, “You can do even better next time!”

hospital birth

Food Budgets and Meal Planning {Challenges of Motherhood}

Food Budgets and Meal Planning {Challenges of Motherhood}

Food. It’s important (just a little) and we all have to buy it. Most of us have to cook it as well (or at least make sure someone in the house cooks it). But when a family sits down to budget – or figure out where the money went – we can usually plan on a large sum going to food. How do we keep this spending controlled and purposeful? [Side Note – click the photos in this post for more recipes!]

Meal Planning.

Why plan meals? One of the main reasons is that it keeps you from playing the “What’s for dinner?” game each night. That game can lead to ordering out or going out which means more money spent. Lets look at an example – ordering pizza. For most families, ordering pizza is going to be around $30 – possibly much more depending on family size. That same $30 can buy my family breakfast foods for at least 2 weeks (including farm-fresh eggs from a local farmer), especially if I pay attention to sales and coupons. When you start to break down your budget in these terms, you may be shocked at how the math plays out.

Another good reason is that you spend less time running to the store. This saves you money in a couple ways – less gas used in the car and fewer chances for impulse buys (those $1 here and $3 there purchases really add up). It also helps your home run more smoothly. Everyone knows what is for dinner and there is less chance for arguing.

Meal planning at first can seem daunting. I remember when I decided to start and I got bogged down in the details. Many blogs and books are dedicated to this subject and include everything from freezer options (cooking once or twice a month and freezing it all) to spending a whole month in your crock pot. Then you add in couponing (which I totally don’t understand by the way, at least not the extreme couponing) and it can feel like too much to consider.

I promise, you can make this simple! First you want to look at your situation with your “reality glasses” on. I am not talking about your ideal life and cooking situation. I mean look at your cooking and meal time plans as they actually tend to happen. Do you and your partner both work long days, leaving little prep time when you get home? Do you stay at home and have time to prep and cook each day? Would crock pot or freezer meals work better for your time management? Do you have sports activities for the kids that require being gone around dinner time?

Chicken Teriyaki

With those answers in mind, here are the steps you want to take:

  • Make a pantry list. What is in your dry goods area and spice cabinet? This list will be important when planning and shopping.
  • Make a list of items you have to buy each week – milk, eggs, bread – the essentials for your house.
  • Call a family meeting and make a master list of favorite meals.
  • Decide on the method that would work for you – a larger portion of freezer meals or crock pot meals, cooking fresh each day, or a mixture.
  • Decide how far in advance you want to plan. Start with at least a week at a time. Some families plan the whole month at once.

Now for the really fun part! You get to make your plan for the week or whatever period of time you decided on. This is where you get out some paper (I use a cheap spiral notebook) and start digging through your ideas. My meal ideas come from several places in any given week. Pinterest is a favorite now, and most people have a recipe or food board – so actually put all those pins to work! I work from family recipes – meals I have made for years and are a hit every single time. I check out cook books from the library – you would be amazed at how many cook books libraries usually have. This is very cost effective – you can get endless recipes without buying a book yourself (and I am sure others can relate to how frustrating it is to buy a cookbook and find you only like a few recipes in it). We even have a post of quick meal ideas here.

You start with dinner for each day and go from there, writing down each recipe name. Some families plan every meal and snack, some don’t. I personally do not. I write down breakfast and lunch ideas for the week at the bottom of my dinner plan list though, especially for my husband who takes his lunch to work each day (a huge money saver by the way). I also plan that my son and I will most likely eat left-overs for some lunches.

Chicken Enchiladas

Then you take this list and look at the recipes for needed ingredients. Make your grocery list, while also checking your pantry list. By checking your pantry list you can avoid buying something for a meal when you already have it at home. You can also avoid that moment where you think you have a certain spice in the cabinet only to find you don’t…while in the middle of cooking!

Then head to the store! If you make your list in sections – produce, meats, spices, pastas, canned goods, etc – you will save time at the store.

Let me do a short example (just a few days). I find examples to be much more helpful than descriptions!

Now I take this list and check my recipes and make my grocery list.

  • 1 bag baby spinach
  • 1 green bell pepper
  • 1 sweet potato
  • 1 onion
  • 5lbs bag potatoes
  • 3 ears corn
  • Apples (check sales)
  • Grapefruit
  • 2 lbs ground turkey (I am replacing the ground chicken in the chili with ground turkey – I like the texture better)
  • 2lbs chicken breasts OR rotisserie chicken (I check prices and get the cheaper of the two!)
  • 1lbs ground beef
  • large tortillas
  • mild salsa
  • 2 cans fire roasted tomatoes
  • 1 can kidney beans
  • 1 can white beans
  • 2 blocks Monterrey Jack cheese
  • Lunch Meat (check sales/deli)
  • Oatmeal
  • Bread
  • Granola Bars
  • Almond Milk
  • Yogurt
  • Chicken Nuggets
  • ***Pick up eggs

Some things I have left off my list. For instance, I didn’t include rice b/c I have it in bulk at home. I didn’t include the tapioca from the chili recipe because I will serve it with rice instead. I have the ingredients for cornbread at home, so I left those items off. This is when your pantry list/inventory comes in handy! And I actually do make notes to myself on my list about checking sales since I tend to forget when I am in a rush to get my toddler out before his “timer” is up. Now I am able to walk into the store and get everything I need in one trip!

Chicken Parm

Some tips I have learned over my time meal planning:

Keep it organized. Have one notebook or binder and develop your system. There are a ton of “printables” online for meal planning with different set ups to suit each family. You can simply fill these in and stick them on your fridge for the family to see. Try to pick one grocery day a week if you can. Mine is Saturday during nap time most weeks so that I can go without my toddler. I plan our week out that morning and then shop that afternoon.

Create a recipe binder for your family. I am currently working on ours, and I am having a ton of fun with it! Personally, I am typing up my recipes, and then I will put them in a binder with dividers (breakfast, chicken, beef, party, holiday, etc). Some families just write them down (or cut them out/print them off) as they go and stick them in a new page protector. This will not only build up a collection of tried and true recipes for your family, but is a great bit of history to pass down one day.

Plan meals based on “extras” or “left overs”. For instance, if I find a great deal on whole chickens I will get one or two of those for the meals that week that need chicken. I will boil them or bake them one morning and then pick off all the meat. That meat can then be used for anything needing pulled or diced chicken for the rest of the week. Or I make chicken salad for sandwiches, or freeze the extra for meals another week. You can save a lot of money doing this if you plan accordingly.

Give yourself the nights off that you need! I know that Fridays are usually days we don’t cook, and typically I skip this on our meal plan. Some Fridays we still stay in and just make sandwiches or something easy. Some Fridays we go out to McDonald’s and let our son play in the play area, or do something similar at the mall where they also have a play area. If you have busy nights in your week, plan for them! Your meal plan should not make you feel like you have to cook every single night. This is about making your life easier and more on budget, not stressing you out!

Check your grocery sales and coupons. I will admit I am not an avid couponer, but I am working on it. But everyone can check the grocery sales. For instance, if they are having an amazing sale on whole chickens, pick a meal that can use it that week. If they have eggplant on sale, make some eggplant parmesan or ratatouille that week.

Create a learning experience. If your children are toddlers or older, you can use your meal plan to educate. For instance, pick a week and make regional foods – this could be from your area (maybe visit some local landmarks that week too), your heritage, or pick a country or region. Perhaps you could have a week of Italian food or Chinese foods? Does your family have an Irish heritage? Pick a week to learn about and cook the foods from Ireland. You could also pick themes like colors or letters for little ones. Maybe one night have all “orange” foods – mac-n-cheese, steamed carrots, and orange cupcakes. Or have all “B” foods one morning – blueberry pancakes and bacon anyone?

Get creative! Meal planning can really expand your menu choices and cooking skills. When you play the “what’s for dinner?” game, you usually fall back on the same things again and again. When you plan in advance you are giving yourself time to plan to try new things. This makes dinner exciting and may just get you interested in cooking if you never have been before now. I try to make an effort to cook one new meal a week, at least. It is also fun to try one new ingredient a week. Have you never used barley? Find a recipe one week and try it! Have you always wanted to learn to make lasagna? Do it!

Stay on budget. When you meal plan, you have a great chance to lower your food costs. Not only by watching sales but simply by keeping your plans within your budget for the week or month. If you know your budget can’t handle steak every other night, then don’t plan for it! But you can look for alternatives like grilled chicken if you are craving some grilling time. I have learned over time how to “cheapen” recipes as well. I know when I can sub out expensive cheeses for cheap ones, or more expensive cuts of meat for cheaper ones (your crock pot is a great way to make cheaper cuts of meat just as delicious). I have also found that taking the time to grate a block of cheese versus buying shredded cheese saves me about $2 each time – and we use a LOT of cheese around this house!

Bonus! I am going to add a couple recipes from my collection just for you! These are simple recipes I turn to again and again.

No-Rise Pizza Dough – Fast, easy, and cheap and you won’t want to order out again!

  • 3 cups flour
  • 1 cup warm water
  • 1 tbsp honey, heaping
  • 1 tbsp olive oil, heaping
  • 1 tbsp dry active yeast
  • 1 tsp garlic salt
  1. Combine water, honey, oil, yeast, and garlic salt. Stir to dissolve honey.
  2. Add 3 cups flour, stir until combined.
  3. Knead dough a few times, roll out into large pizza size. Top however you like.
  4. Bake on cookie sheet for 12 minutes at 475*F or for 8 minutes on a preheated pizza stone.

**You can also use this recipe for calzones (longer baking time at 350*F – about 20 minutes) or personal size pizzas. Be sure to use a liquid measuring cup for the water, it really makes a difference for this recipe.

Baked Oatmeal with Raisins and Pecans – you can add whatever fruit/nuts you want in this

  • 2 cups rolled oats
  • 1 tsp ground cinnamon
  • 1/4 tsp ground nutmeg
  • 1/2 tsp salt
  • 1/4 cup sugar
  • 2 1/2 cups milk
  • 1 cup raisins
  • 1/2 cup pecans
  • brown sugar for serving
  1. Preheat oven to 350, lightly grease 9×9 baking dish.
  2. Combine all ingredients except brown sugar. Pour into dish and bake 20-25 minutes or until liquid is absorbed.
  3. Serve hot. Enjoy your homemade and delicious oatmeal!

 

Community Support and Breastfeeding {Make a Difference}

Community Support and Breastfeeding {Make a Difference}

I would like to start this post with a story.

Imagine a mother – a fresh new mother – with a baby just barely 24 hours old. She drives to another city the day after her birth for her first post-birth checkup with her midwife. After leaving the appointment she and her husband decide to stop for lunch. It is late afternoon, so they have their pick of places as none are crowded. A Red Lobster is calling mom’s name – she is famished after the long work of labor the day before and seafood just sounds heavenly. And maybe a little indulgent too!

Mom, Dad, and newborn are seated right away and order their food. Mom orders crab legs (her favorite!) since baby is sleeping peacefully in his wrap against her chest. Surely he will stay asleep long enough for her to shell the crab and eat. (More experienced moms are probably giggling right now!)

The food comes out, hot and steaming. On cue, baby wakes up and wants to nurse. Mom stares longingly at her plate, knowing she can’t bother with it right now because it takes two hands to get this newborn latched and stable for the whole feed. Dad offers to help her but mom declines – at least one of them should get a hot meal after all.

The server comes out to check that everything is going well. She sees mom’s predicament and says she will be right back. She comes back, with gloves on, and starts to shell all of the mother’s crab legs for her. All the while she talks to the couple about her children, her nursing experiences, and how great it is to see a young mother breastfeeding. She also shares stories of many cold meals because of the uncanny ability of babies to wake just when dinner comes out.

She finishes shelling the still steaming crab and gives the plate to mom. Mom figures out how to support baby’s head with the wrap so she can slide one hand out to eat her still hot dinner! Mom and dad get full bellies with hot food, and so does baby. What could have ended in mom sadly eating stone-cold crab legs instead has a happy ending.

That mother was me. I have *never* forgotten that server’s support and love in that moment, and I never will. One mother, reaching out to another giving simple and practical support. That one encounter gave me the pride and hope and confidence to nurse in public in the years that followed. That one encounter helped my husband to feel 100% comfortable with nursing in public as well – knowing that people would not always be rude to his wife. While we have had rude encounters, I can always look back to this first one and radiate with joy.

The support of the community can make a huge difference for mothers who take the journey through breastfeeding. In fact, in studies and interviews women tend to rate social support as more important than professional support on the duration of their breastfeeding experience 5. Why is this?

The answer is simple – we spend far more time in the world at large than sitting in a professional’s office. We need support from our partners, family, and community at large. We need to feel supported by other mothers. When a person feels like they are doing something alone – no matter what it is – they are far less likely to succeed or meet goals. Emotionally, we feel more able to succeed with social support.

The United States has some of the lowest rates of breastfeeding in the world among developed nations, and when you look at the rates of exclusive breastfeeding it becomes especially dismal. While about 75% of woman initiate breastfeeding – this is a very large category and a bit misleading. This includes one attempt in the first days of life. While this is great (so many mothers attempting to breastfeed!), it gives false hope as the total rates of breastfeeding. In 2007, at 6 months of age the rate of exclusive breastfeeding was only 13% 1. Lets keep in mind that six months of nothing but breastmilk is the current recommendation from every major group with an interest in infant health (this includes the AAP and WHO). What is happening to cause a drop from 75% of women attempting to breastfeed, to only 13% succeeding at 6 months?

The simple answer for most cases – lack of proper support. Study after study shows that our support network is vital to breastfeeding success. For most women, one caring and helpful IBCLC cannot undo the “work” of a society that does not really support breastfeeding. While it is possible for a woman to physically or psychologically be unable to breastfeed that sub-section of woman is statistically small – most certainly not 87% of woman or the human race would not have made it very far.

The Surgeon General put out a “Call to Action” in 2011, urging America to support breastfeeding. Much of the document focuses on increasing community support across the board – from the family unit, to the care provider, to society as a whole. Some highlights from the document include:

“Women with friends who have breastfed successfully are more likely to choose to breastfeed. On the other hand, negative attitudes of family and friends can pose a barrier to breastfeeding. Some mothers say that they do not ask for help from their family and friends because of the contradictory information they receive from these sources.” (pg 22)

What this little gem tells us is that mother’s who DO succeed in breastfeeding need to talk about it. We need to share our wonderful experience – it actually encourages other mother’s to more seriously consider breastfeeding in the first place. This also tells us that hearing conflicting and outdated information from “well meaning” family and friends is NOT helpful. (Big surprise there, right?)

Now, there is a whole section on Embarrassment. Yes, in the great nation of America, the Surgeon General actually has to address embarrassment as a barrier to breastfeeding.

“A study that analyzed data from a national public opinion survey conducted in 2001 found that only 43% of U.S. adults believed that women should have the right to breastfeed in public places. Restaurant and shopping center managers have reported that they would either discourage breastfeeding anywhere in their facilities or would suggest that breastfeeding mothers move to an area that was more secluded. When they have breastfed in public places, many mothers have been asked to stop breastfeeding or to leave. Such situations make women feel embarrassed and fearful of being stigmatized by people around them when they breastfeed. Embarrassment remains a formidable barrier to breastfeeding in the United States and closely related to the disapproval of breastfeeding in public. Embarrassment about breastfeeding is not limited to public settings however. Women may find themselves excluded from social interactions when they are breastfeeding because others are reluctant to be in the same room while they breastfeed. For many women, the feeling of embarrassment restricts their activites and is cited as a reason for choosing to feed supplementary formula or to give up breastfeeding altogether.” (pg 23)

This section goes on more but let me pause here. No matter how you choose to feed your child, I hope that above statement leaves a bad taste in your mouth. Only 43% of adults feel that a mother should feed her baby in public. Lets not even give the cop out of breastfeeding and “modesty”. This statistic literally translates to mean that 57% of Americans are uncomfortable with a baby being fed in public in a normal way. Only 28% in this particular study believed that breastfeeding should be portrayed on television 4.

Then we see proof that managers and business owners do ask women to leave if they breastfeed and refuse to move or stop. We see this in the news from time to time, but many people think it is rare. Is it really going to be a rare occurrence when over half of all Americans are uncomfortable seeing normal infant feeding? It also goes on to say that we are not just talking about public situations, that last section literally means that within their own homes and social units, women are being made to feel uncomfortable because they breastfeed. What woman is likely to keep breastfeeding if she doesn’t even have acceptance in her own home or social group?

To continue with the “Embarrassment” section:

” In American culture, breasts have often been regarded primarily as sexual objects, while their nurturing function is downplayed. Although focusing on the sexuality of female breasts is common in mass media, visual images of breastfeeding are rare, and a mother may never have seen a woman breastfeeding. As shown in both quantitative and qualitative studies, the perception of breasts as sexual objects may lead women to feel uncomfortable about breastfeeding in public. As a result, women may feel the need to conceal breastfeeding, but they have difficulty finding comfortable and accessible breastfeeding facilities in public places.” (pg 23)

This section speaks to how our breasts are viewed. First and foremost in our culture they are viewed as sexual. This context of breasts as primarily sexual is actually not the predominate view in the world as a whole by the way 3. This portion also speaks to an issue that comes up more and more with social media – the posting and viewing of breastfeeding photos. These studies and surveys prove that women need to see breastfeeding. The more you see it, the more normal it becomes.

Our sexual view of breasts did not just evolve from thin air – it evolved through a constant presence of sexual images of breasts in our culture. Simply put, the more we can promote and share the non-sexual view of breasts, the less sexual our breasts will become in the culture as a whole. I, for one, would be very happy to see that happen – not only for breastfeeding rates but also for the self-worth of women in general.

In the last sentence, the Surgeon General notes that even though women may feel compelled to hide breastfeeding because of these pressures, there is no where to hide! Our society seems to insist that we breastfeed “somewhere else” but where exactly is this wonderful place we are supposed to hide? Very few places, especially outside of large cities, have breastfeeding spaces. When was the last time you saw a breastfeeding room at your local grocery?

In the section of the document about ways to help increase breastfeeding rates, special attention is given to educating the fathers/partners and grandmothers. Studies show that lack of support from those two sources can lead to shortened breastfeeding (or never starting). There is also special attention given to strengthening and supporting woman-to-woman support groups, such as local La Leche Leagues or other community breastfeeding groups. Those two actions in our communities would be especially helpful to low-income women, where studies show that social support and acceptance are paramount to breastfeeding success 2.

Now I would like to switch gears. We know that community support can make a difference, but we hear little about it. Normally, we only see stories of mothers being harrassed for feeding their babies. If positive stories and experiences with breastfeeding can make a difference in breastfeeding rates, then we need to share them. I reached out to our support group and got many stories and photos, all about positive experiences with nursing in public!

“The first time I ever breastfed in public was last summer when my daughter was 8 months old. My family and I were on vacation in Austin, TX and we were on a tour in some underground natural caverns.  We were at a resting area and I chose a rock to sit on and started nursing her.  I was so nervous that someone would give me a dirty look or say something rude, but a woman came up to me and thanked me for nursing my baby.  That one little comment gave me the confidence I needed to keep nursing her in public and I have been doing so ever since.” – Jennifer

breastfeeding

“Over Memorial Day weekend there is a big festival by the beach where we live, so my husband and I invited our folks to join us and our 2 month old daughter. It was HOT with very little shade! My daughter was getting fussy so I sat down on a bench behind one of the vender’s who had an umbrella up. My mom, who is easily embarrassed, kept trying to give me a cover but I told her no and proceeded to nurse my baby. The vender turns around to see me nursing my daughter and says, “Good for you! Not enough mother’s breastfeed any more! Keep doing what’s best for your kid.”‘ – Beverly

breastfeeding

“We took a vacation to Vegas with our daughter. We had just finished a limousine ride, and walked back into our hotel. I sat in the lobby and started to breastfeed my little girl. A lady came by and told me breastfeeding is the most beautiful thing in the world! I wish I had taken a picture with her. It was such a positive experience for me.” – Krystal

Below is Brianna nursing at Disneyland. Just a fun fact, from a former Cast Member – Disney Cast Members are instructed specifically in training about the importance of nursing in public and that it is 100% legal and acceptable for women to do so anywhere in the parks or property. Some companies do care!

breastfeeding at Disneyland

Below is Katelyn nursing her son at the aquarium, her supportive husband at her side!

breastfeeding

If you have a positive nursing in public experience, please share it with us! And remember that the “other person” in these stories is someone just like you. Just one person reaching out to another and saying “Good Job” – it can literally change a mother’s whole outlook on breastfeeding. Next time you see a mother nursing in public – no matter how she chooses to do it – give her a smile or even better, a kind word.

References

  1. U.S Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S Department of Health and Human Services, Office of Surgeon General; 2011.
  2. Pugh, L., Milligan, R., Frick, K., Spatz, D., & Bronner, Y. (2002). Breastfeeding Duration, Costs, and Benefits of a Support Program for Low-Income Breastfeeding Women. Birth: Issues In Perinatal Care, 29(2), 95-100. doi:10.1046/j.1523-536X.2002.00169.x
  3. Wolf, J. H. (2008). Got milk? Not in public!. International Breastfeeding Journal, 31-3. doi:10.1186/1746-4358-3-11
  4. Pettis, C. T., & Miller, M. K. (2007). PROMOTING BREAST-FEEDING THROUGH SOCIAL CHANGE. Women’s Policy Journal Of Harvard, 439-47.
  5. McInnes RJ, Chambers JA. (2008). Supporting Breastfeeding Mothers: Qualitative Synthesis. J Adv Nurs. 2008 May; 62(4):407-27. doi: 10.1111/j.1365-2648.2008.04618.x.

Staying Ahead of the Mess {Challenges of Motherhood}

Staying Ahead of the Mess {Challenges of Motherhood}

Let me start with a big fat disclaimer. I am not a perfect housewife. Pretty far from it actually! But, as time goes on (7 years cohabitation, almost 5 years of marriage, 2 years as a mom) I am finding what helps me keep a “groove” so that the housework does not drown me. Because lets face it – most moms are in serious danger of getting taken down by mountains of laundry that seem to spring up from nowhere. I am even going to include pictures of my own house – without cleaning any more than normal.

Kitchen

So how how do I keep up? Schedule, organization, and learning to let go.

My first step is a schedule. At one time I thought that housekeeping schedules were just a bit much. After all, it is the same things over and over again and I should be able to remember them. Right? Wrong. I started to realize that my “clusters” of mess were created by forgetting the small chores many times over. Then you end up with much bigger mess. After looking at many different “systems” on the internet, I sort of mashed them into my own that works for my family.

  • Create a list of tasks that need to be done each day. For our home that would be dishes, vacuuming downstairs, picking up laundry (it never makes it in the basket), toy clean up, and wiping down tables/counters.
  • Create a list of tasks that need to be done once a week. This might include changing/washing all the bed sheets, washing towels, and cleaning toilets and tubs.
  • Create a list of tasks that need to be done once or twice a month. My list includes vacuuming all of the upstairs, cleaning the fridge, and reorganizing spaces such as the diaper changing area and toy space.

Some systems also go into tasks you do once or twice a year, but I don’t include those. One big reason is that we are renters and many of those type tasks are more on the home maintenance level. If you have tasks that need to be done a couple times a year or in certain seasons, feel free to make a list of those too. A good way to keep these lists is in a house management binder. I will admit, I don’t have one of these yet – but one day Pinterest will show me a cool printable one and I will do it.

Now look at your lists and daily/weekly schedule. How can you fit in your daily tasks into your daily routine? Think about how often you need to do dishes (do you have enough that they must be done at each meal throughout the day?). Think about how often toy pickup needs to happen to make your space livable. When is the best time to vacuum? Jot these down in schedule format – not so much with actual times but more like “before nap” or “after lunch”.

Now we need to fit our weekly tasks in. These are the tasks that tend to really get away from us. Changing sheets on all the beds once a week keeps us sleeping soundly and cleanly (just google how much the average person sweats at night and you will see what I mean). Pick one day a week to do this task – change sheets, wash the dirty ones, fold and put away. For my family this task is done on Monday. Towel washing day is Wednesday. On those two days, I don’t do any other laundry usually unless I need to throw in some cloth diapers (which is easy laundry anyway).

Closet

Now fit in your monthly or bi-monthly tasks, and you are set to go. These I usually have to mark on the wall calender to remind myself. I have even created a “Magic Eraser Day”. On that day, I bust out that life saver and attack scuffs and scrapes and marks all over the house. This cuts down on the general grime (like the floor boards, corners where little hands touch often, and fridge handles). You know, the grimy spots that you suddenly see one day and go “OH MY GOSH” and irrationally feel like you live in a garbage pit? Yeah, no more of that if you attack that stuff once a month.

Now put your daily and weekly rotation (two separate sheets) on the fridge. Write your monthly tasks on the calender. You are ready to go!

You will notice I didn’t focus on clothes laundry. I left this out because everyone has a different laundry volume. My family of 3 (almost 4) is going to have a lot less laundry than a family of 7. You know your volume of laundry, so decide how often you need to wash to stay on top of it. Do you need to do at least one load a day? Two? Every other day? Figure that out, and fit it into your schedule. (*Just a side note on the picture below – those things hanging over the washer/dryer are the “lost socks”. If I keep them right there in front of me, I find the matches much faster!)

laundry room

Here is our basic schedule for the day:

Daily Schedule

Of course some days this changes. For instance, on Mondays instead of loading clothes in the wash, I strip the beds and wash the sheets. Sometimes we pick up toys before bath instead of after; it depends on the time. In the evening we also do some things at the same time – for instance bath/dishes are on the same line because whoever is not doing the bath is doing the dishes. This way we kill two birds with one stone and our evening is basically open after that. The point is that you have a basic guide to your day.

Eventually this all becomes second nature and you don’t have to look at your schedules. That is when you have hit your “groove”. You will also learn what you can fit in during other tasks. For instance – bathroom cleaning doesn’t make my list anymore, because I clean the bathroom during bath time.

My second step was organization. This is pretty self-explanatory. The more organized you are, the easier it is to clean. Some basic things to implement are really going to have to do with the kids in your home.

  • PURGE the toys. Watch your kids for a few days and see what they play with again and again. See what they are just making a mess with (for instance, just dumping a basket of small toys but not playing with them for long). Then get rid of toys – lots of toys. The less you have, the less you have to clean up. The less you have, the more creatively your kids will play with what they have.
  • Create a place for everything. Cars go in a car bin, blocks go in a block bin, books go on a book shelf. Puzzles are put away with all pieces in place (and if they don’t have all the pieces, toss them). Not only will this help your home look more orderly, but it helps your kids clean up and play more efficiently. For instance, if they are looking for a car, they don’t have to dump a whole toy box – they just go to the car bin and get that car.
  • Create play zones. Set up a small table just for coloring and keep those supplies there. Buy (or make!) a car rug and store the cars near it. Again – organized toys and supplies makes for less clean up.

Living Room

Now, my last tip. Learn to let go.

Not everything will get done every day. Some days you will be tired. Some days your child will be sick. Some days you won’t be home. This is when we need to take a deep breath and realize that we have not failed and our home will most likely not explode. Forgive yourself if the clothes pile up – they will eventually get done.

There is a fine line between keeping your schedule and going crazy because of it. This is why I have kept my schedule basic and flexible. Some home organization and cleaning systems have so many steps and so many rules…and it was just too much. Create enough structure to keep you on track, but not so much that you feel guilt.

Learn what is most important to you. Are dirty dishes the one thing that really makes you nuts? Then make sure those are at least done before bed, even if you let other things go. If you really need a made up bed, make sure that gets done for *your* sanity. Everyone has that one thing that makes them feel like they have a clean home. Figure out what that is for you.

Now I want to hear from you! What do you do to keep up with the mess of life? Do your older children help, and if so how did you instill those helpful habits? What is your “one thing” that makes you feel like you have a clean house? Share your tips and hints in the comments.

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