Tuesday, June 29, 2010

Question and answer

By true blessings: Heelo, I have a question. DO you believe homeschooling is meant for every child? or do you have to be led to do that? I would have loved to homeschool since my kids were little ,but my 2 oldest are 12 and 13 ,and they attend a very good school,as far as curriculum goes,their website is yesprep.org,can you tell me what you think about this?It is privately funded so it is not a public school.ANd I also feel that if I were to withdraw them ,that I would not be able to teach them like their school teachers..thank you

Yes, I do think that being taught by their parents is the ideal situation for all kids to be in. This goes for academics as well as general life skills, or a trade that the Dad may work in. Imparting an education is only part of homeschooling.

Other, equally important benefits of homeschooling include a close-knit family, siblings who learn to become best friends with their family members, and who see first hand every day how much work it takes to keep this ship called "family" afloat. They learn to pitch in from an early age, and they learn to teach their younger siblings.

Homeschooling is also as much about teaching and growing us as parents as it is about the kids. A homeschool mom is forced to constantly grow - academically, spiritually, and as a mother, as well as in every area of life that we could all use growth in but are all too often happy to be complacent. There is nothing like waking up to a house full of hungry, energetic little sinners that you know you will have to spend all day with teaching and training that will drive you to your knees and ask God for His help.

Mom is forced to spend large amounts of time with her kids, instead of the internet or TV. Our modern world often looks at large families and thinks that the kids in these situations are not getting enough individual attention, when just the opposite is true for those families who choose to homeschool. While the public elementary school kids on our street get picked up at 8 am and dropped off at 4:20 pm, my kids are usually sitting down to a hot cooked breakfast when the bus rolls around in the morning, and when it comes back around in the afternoon they have not only completed their school work, but also spent hours playing with each other, helping me, and running errands.

At home, there is no peer pressure to wear the latest fashions or labels. Nobody cares if you wear your brother's handed-down clothes. Our kids know nothing about any TV shows or current movies, or popular books such as Harry Potter or Twilight. If they went to school, they would either quickly become very wise in these worldly matters, or be social outcasts, neither of which we want for them.

Another (maybe fringe) benefit of homeschooling is that kids enjoy a much better diet than the average school child, especially if they are eating a school lunch. Private schools may offer better options, but what public schools serve is literally lower quality than fast food. Add to that vending machines with candy and sodas, and it's no wonder kids are acting crazy all day and get labeled as having "ADHD".

Finally, I really feel that I would miss out on so much of their childhood if they spent the majority of their awake time in the care of others. None of us knows how much time we will have with our children, and I don't want to have to look back regretting having given up precious time with them.

If you are unsure about whether or not homeschooling is the right option for your family, you should pray for God to show you His opinion on it from the Bible.

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By Kimmie: I have a question. I had my tubes tied four years ago during a c-section with my second set of twins. My husband and I are raising 5 little girls. I wasn't a Christian or even married when I had my tubes tied. I have HORRIBLE carpal tunnel during my pregnancies and decided I never wanted to get pregnant again.

Now, I'm so very sad about this decision. The cheapest I can find reversal surgery is in Tennessee with a female pro-life Christian Dr. It would cost us about $6000, we live on one small income and don't have this money. I am so discouraged. I feel extreme conviction to have this surgery done almost to the point of being depressed about not being able to conceive again. I've prayed for God to heal the tubes, but I have a feeling he wants me to save and have the surgery. My husband is not so sure he wants more children, but I want to fix myself and leave it up to God.

What do you think about reversing a tubal ligation? If it were your situation, would you save as long as you can to have it reversed.


I am sorry to hear you are in this situation. Sadly, it's all too common, and many ladies come to feel the same way you do.

While I do think that reversing a tubal ligation is a great idea for those who can afford this option, I do not think it would be a sin not to go through with it if you are not able to do so. The mistake/sin was to get one in the first place. Think of it like a tattoo - the Bible clearly says not to have one, but if someone got one ignorantly, they don't have to go and have it removed, just realize it was wrong and don't get any more.

I cannot say what I would do in your particular situation, but I imagine I would try to do what I could to be able to have it reversed, while at the same time trying not to be discontent and obsessed (not that you are either). Whenever I feel like I am in a hopeless situation like that, I pray about it. I tell God that if He wants me to be in such and so the position that I'd rather be in, to please help me get there, and if He doesn't want me to, to change my heart so I won't want it any more, either.

Also, not to scare you, but one common side effect of tubal ligation is an increased risk of ectopic pregnancy, although still very rare. It has to do with the fact that if the tubes are only tied (as opposed to tied into a loop and then cut), the man's seed could be small enough to make it through the tied part. If a child is conceived, it will have grown too large by the time it passes down the fallopian tube on its way to the uterus to pass through the same spot, thus leading to an ectopic pregnancy. I have personally known a lady who suffered this. I would guess that the risk of an ectopic pregnancy would also be higher in a tube that has again been restored, as there will probably be scar tissue in that spot.

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By anonymous: Just wondering, as I remember the Border Patrol video but didn't think much of it at the time, you have made some comments about a police state.... however, I noticed you have not commented on SB 1070 at all. I am not asking necessarily about the immigrants, but about the increased role ALL police officers will soon have (to charge you with a crime, detain you and fine you - basically deem you guilty and you must prove your innocence). Do you at all worry that you might get singled out as a possible illegal (they have no real parameters or qualifications for "illegal," it is just the officer's judgment as far the text of the bill goes)?

I don't doubt there are some amazing police officers out there (in fact, I have known some). But when I moved to the Phoenix area last year, I was shocked by all the police misconduct cases in the Arizona Republic. For some reason, there seems to be a disproportionately high number of police who enjoy abusing their power. SB 1070 could easily be carried out faithfully and without prejudice up north (or even by our fellow southern neighbors west of us), but in Arizona, I don't believe it can or will be done without incurring massive lawsuits from injustices like your husband's.


For many reasons, I am 100% against SB 1070. It will, and in fact already has been, used to violate the rights of civilians of all skin color, not just those who look like "illegals from Mexico". I think our nation's whole view of immigration as a negative thing is wrong. The Bible and the Founding Fathers agree that the more people we have, the better off we are. Unless, of course, people are coming here for a free handout, which we shouldn't be giving out in the first place, to immigrants or citizens.

My husband wrote an excellent article on this particular bill, you can read it here.


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By Narelle Nettelbeck: I'm a little late, but I'd be interested to hear your thoughts about depression - particularly Christian people who struggle in this area.

I think depression is real, and can affect Christians as much as non-Christians. However, I do disagree with the popular belief that all heaviness of spirit (what the Bible calls it) is negative. For example, we once had a lady in our church whose 1-year old son had died in a tragic accident. Her work made her go to counseling, who then prescribed her with antidepressants, as if she should not have been saddened by the fact that she had lost her beloved child. The Bible says in Ecclesiastes 7:3: Sorrow is better than laughter: for by the sadness of the countenance the heart is made better.

I also disagree with the proper treatment for depression. I do not think that medication is EVER the right course to pursue. To those who think that there are chemical imbalances that cause the depression, they are wrong because the Bible clearly tells us that the sadness is what causes those chemical imbalances, not the other way around.

Proverbs 12:25 - Heaviness in the heart of man maketh it stoop: but a good word maketh it glad.

Proverbs 17:22 - A merry heart doeth good like a medicine: but a broken spirit drieth the bones.

Other than in cases of obvious sadness like the lady I mentioned, I think that the true source of many people's depression stems from guilt they are feeling. Guilt about things they have done wrong, maybe even through ignorance. As Christians, we know we have forgiveness through Christ for all of our sins, but we may not feel forgiven, and thus still feel guilty, if we never confess our sins to ourselves and God. In other words, if we do wrong and never admit we did, we will feel guilty, maybe even without knowing that it is guilt that is making us "depressed".
I see this all the time in divorced people, who most often never come to admit that getting divorced was the wrong decision, and who as a result become different, bitter people. The same is true for people who did not go through the time and trouble to raise their kids right. The kids grow up to become adults who bring shame to their parents, something that would make any mother feel "depressed" to think that she has wasted her life's work, but the true source is a guilty feeling about not having done their part to ensure their kids' moral development.
We all make mistakes, and some people make mistakes that will have lasting consequences for the rest of their lives. In the end, we have to learn to ask for God's forgiveness, forgive ourselves, and then move on.
As far as counseling, I cannot condone being counseled by unbelievers or liberal Christians. Any true Christian would always point a fellow brother/sister in Christ back to seeking counsel from God through Bible reading and prayer.

While I have no personal experience with what would be defined as "depression", I do have emotional ups and downs simply due to the fact that I am a woman who is always lactating, gestating, or both, and these acts involve a lot of hormones. I have never suffered postpartum depression, but looking at our current maternity care system, I am surprised more women don't get it, particularly after a traumatic birth. I get particularly hormonal in the first few days after giving birth to a girl, but thankfully it never lasts past when my milk comes in and the pregnancy hormones have shifted gears to now supporting the little one outside my womb. The single best remedy for me to get in the right mindset during these times is to read the Bible.


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By Julie: I do have a question, and I am not trying to stir up controversy or question your beliefs - I am asking with respect, and if you don't feel that it's appropriate to answer that's fine too.

If you got to the stage where it would be medically inadvisable to have more children, would you take the decision to have your tubes tied or use contraception. I guess the root of the question is, as a Mum do you consider your first responsibility to be ensuring your own health so you are around to look after your family, or would you continue with further pregnancies despite medical advice? Again, NO disrespect, just curiosity from a mum of 4.


Good question, and not the least disrespectful. It's hard to answer, because there are so many unknowns. Would there be a real, significant risk to my life, or just a risk perceived by doctors who may think I have too many kids already? A second (and third) expert opinion would definitely be in order. Every time I have heard about a case where the mother's life was at risk if she had another pregnancy, it was something that could either have been prevented, or could be reversed/treated. I guess what I'm saying is that I can't imagine such a situation ever truly arising. It is also extremely important that moms learn all they can about maternity, natural childbirth, and healthy living in order to prevent such a situation rather than treating it.

What I do know is that even if I knew that another pregnancy meant certain death for me, I would not condone using hormonal methods at all, since these take the life of the child. If one of us has to die, it would be me, not the baby, just as I would gladly give my life if it meant saving that of any of my other children. I do not support using NFP as a method of birth control because I believe the abstinence during the most crucial parts of a woman's cycle are detrimental to the marriage bond, but I guess in a case of certain death (again, a hypothetical that I don't believe exists) abstinence for certain days would be better than no wife at all.

It's a personal decision that a couple in that situation would have to make, and since I have never been in such a case, I have no advice or recommendations, only speculation. It is possible to put oneself in a situation (even though maybe through ignorance) where any possible option to deal with the problem is wrong or sinful.


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By Elizabeth: Glad you're feeling better. Since you have now with carrying both boys and girls, do you have any inclination as to what you're having? I have one girl out of my 4 and it was so different with her. I was sick every single day until my 7th month. I was sick for only a few weeks with my boys. I also felt earlier movement with my girl, and later with my boys. Just wondering.
Italic

I'm about 90% sure it's a boy, although I'll have a better idea once it gets closer. My boy and girl pregnancies are very different. With the boys, I only crave hearty foods and lots of vegetables, and don't have any sweet cravings. I also gain less weight, in fact, I get to a point where I stop gaining or even start losing, even if I eat to my heart's content. After having gained almost 15 lbs during the first trimester (eating non-stop was the only way to combat the nausea at all), I first stopped gaining weight, and have now even lost almost 5 lbs even though I follow the Brewer Diet religiously and eat as much as I want. I do not recommend trying to lose or even maintain weight while pregnant, but what else can I do than eat when I'm hungry? I do like moving bulk from my hips and thighs (left there by my two last girl pregnancies) to my pregnant belly without gaining weight. Yay for boy pregnancies!!

There are other differences I notice. One is that the hair on my legs grows much faster, and I have to shave every time I shower. With girls, it almost doesn't grow at all. I have also noticed that when I am expecting a girl I enjoy being cuddled by my husband and kids a lot more than when I am pregnant with a boy. Must be the hormones!

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By Holly: Would you please comment on the following post? I am a non-Christian (but not hostile to religion, by any means, just agnostic).

http://fullofgraceseasonedwithsalt.blogspot.com/2010/06/wife-whisperer-is-back.html

I am very curious about how you feel about this post, given your previous statements about feminism.

Thank you!


I liked the article, although I can see why some women would be offended by being "compared" to a dog. Then again, the ones who would be offended are the ones to whom it probably applies, as the author herself pointed out.

Male leadership in every area of life is so lacking in our society. It extends beyond marriage into areas such as politics and the workforce. I think what is commonly referred to as "feminism" has done much to destroy families by abolishing God's line of authority: God - husband - wife - children. The current sorry state of our society, with all its broken marriages, dysfunctional homes, and rebellious children was only the logical next step.

I think the term "feminism" is a joke because it has nothing to do with being feminine. Feminism teaches that in order to have any value, women must act, dress, work, and otherwise behave like men. The Bible, viewed as archaic, patriarchal, and abusive exalts, honors and protects women as the weaker vessels that they are. Not weak as in having less worth, or being less important - just weaker as a fact of life, weaker in the sense of needing and deserving protection. Our kids are weaker than either one of us parents, which is why they are under our parental protection. That doesn't mean they have any less worth as human beings. The motto "Women and children first" was not born out of disrespect for either women or children, but out of utter respect for them, and valuing their safety and well-being above that of men, who are expected to give their all, even their life, protecting them.

Women in the workforce have to wear certain clothes, a name tag, have to give account of their every working minute, get limited breaks at certain times, are not free to come and go as they please, have to be courteous and respectful even when they don't feel like it, are often watched on camera, and generally have much less freedom than any woman who has decided that she will stay home and her husband is her boss. Few are the husbands who would require more of their wife than a boss would require of an employee. We think nothing wrong with the idea of an employee obeying their boss who does not even love them, yet we scoff at the idea that a husband should be the one to rule his own house which he is financing by his blood, sweat and tears.

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By Carrie: I know nothing about you and your husband, other than what you write, but I'm curious--it seems as if you work so hard and have so very much to do, does your husband pitch in at all? I'm sure, being a pastor with another job keeps him busy, but surely no busier than you!!??

Good question. I do work very hard, and I do have very much to do. On a typical day, I rarely ever sit down between 7 am and 9 pm. Thankfully, I was not thrown into this situation the minute we got married, because kids come one by one rather than in litters. The gradual increase has made it possible to grow into this workload, that if I were thrown into from being single and carefree would probably have sent me screaming the other direction.

My husband, likewise, has gone from working 40 to 50 hours per week, to working closer to 80 or 90 hours, not counting all the nights he spends out of town on business trips. It's the natural side effect of having a growing family on a single income in today's two income world. In addition, he is the one to bear all the emotional and mental stress of being responsible for providing for this large and growing family.

He does not help with the housework unless I ask him to, which I rarely do because I see it as my realm. I'm a lot better and more efficient at it, just as he is with his job. He does help with taking care of the kids a lot when he is home, often changing diapers, getting them in bed at night, or taking them with him to the office to get them off my hands for a bit. In addition, he obviously also spends a lot of time playing with them, reading to them, teaching them things like playing an instrument or boxing, etc.

I do think that if a husband expects his wife to work outside the home, he should pitch in with the housework to the same extent that she is pitching in with providing the finances to run the family. Sadly, most women who work outside the home still end up doing the majority of the housework.

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That's it for today! I am not claiming to have all the right answers on everything, only God/the Bible does. These answers are my opinions that I try to base on the Bible, but I am human and probably wrong on something I said.

My apologies if your question went unanswered - it was not intentional. There are two questions I have been asked repeatedly (disciplining children, and how I am so sure none of our kids will turn out sodomites) that are going to be answered in their own blog posts. Any other unanswered questions, please feel free to ask in the comments below.

Monday, June 28, 2010

Ways to help your kids keep their bedrooms clean

1. Garbage bag method: Go through their room and toss everything into big, black garbage bags. That way they won't see things peeking through the white bag and beg for this or that broken, junky toy that has been hidden under the bed for eons but suddenly they can't live without.

2. Donation method: Same as above, except as you go you sort between things that need to go in the trash because they are unusable, and things that can be given away. Hide donation bags in the trunk to prevent the kids from going through them treasure hunting.

3. Bonfire method: Round up all the toys and junk and make a nice bonfire. Don't roast marshmallows over it because the fumes from all the cheap plastic is probably highly carcinogenic.

All methods work equally well. Your goal is to leave the kids with nothing but a bed, blanket and pillow when you are done, plus two changes of clothes (one to wear, one to launder). I call this the "jail cell method", and it does wonders to help prevent cluttered, messy rooms.

Am I serious? Well, I wish I were. I finally dragged myself to go through John and Isaac's room this afternoon, which I had not done since getting pregnant. Now that the morning sickness is gone, there are just so many chores to get caught up with, it can be overwhelming. I literally pulled out at least 3 loads of clothes from under their bunk bed, and most of it had never even been worn but was now covered in thick dust. (For those of you who don't know, we have TERRIBLE dust in Arizona, because it never rains. I think it last rained in March.) Every toy box, shelf, and drawer was a total disaster. Three hours of work later, I was only done with half the room. Employing either of the above methods was very tempting, and would certainly have saved me a lot of time and trouble.

It was 7 pm before I started fixing dinner, and 9 before I finally had them all in bed. Only to discover that the two girls had completely taken my bedroom apart while I was busy cleaning the other room with all the boys. Now I still need to do dishes, clean the kitchen, get started on the huge mound of dirty laundry, mop half the house, clean bathrooms, and sometime tonight get some sleep. And to think that they will only turn it into a dirty pigsty again within a short amount of time!!!! In fact, they'll probably do so tomorrow while I clean my own bedroom up again! I feel like a hamster in a wheel sometimes. AAAAAARRRRRRRGGGGGHHHHHH!!!!

Did I mention I am super tired and have a splitting headache?

Friday, June 25, 2010

Enchilada casserole

Having grown up in Europe, I never learned how to cook Southwestern foods in spite of helping in the kitchen from a young age. When my husband, who is from California, and I got married, I soon came to love this particular type of cuisine.

This recipe is one of the first I ever tried making on my own, and over the years I have tweaked it here and added ingredients there to perfect it. I have also gone from making it in a deep pie pan to using a large casserole dish to accommodate our growing family... :)

Last week, I made this casserole with fresh homemade whole wheat tortillas and enchilada sauce made from scratch. For the meat, I used some leftover slow-cooked beef roast. My husband declared it to be the best meal he had ever had in his entire life. And you better know he eats like a king every day, so that was saying a lot.



12 Servings

Prep: 30 min. Cook: 50 min.

Ingredients

  • about 12 8-inch flour tortillas
  • 3 10-oz cans of red enchilada sauce
  • 1 1/2 cups shredded cooked beef or chicken
  • 1 1/2 cups cooked rice or 1 cup uncooked instant rice
  • 1 can kidney beans
  • 1 can pinto beans
  • 3 cups shredded Mexican cheese blend or Monterey Jack cheese
  • 2 cups frozen corn kernels
  • 1 cup prepared salsa

Directions

  • 1. Defrost corn by rinsing under water in a colander. Mix corn and salsa in a small bowl, set aside.
  • 2. In a large bowl, mix meat, beans, rice, 1 1/2 cups of enchilada sauce, and 1 cup of cheese.
  • 3. Preheat oven to 375 degrees.
  • 4. In a 13x9 inch casserole, assemble ingredients as follows: pour 1 cup of enchilada sauce in dish, then add a layer of tortillas (I cut 2 tortillas in half and put the cut sides of the halves against the four edges of the dish. Then I add cut strips to fill any gaps). Next, add half of the meat and bean mixture. Add another layer of tortillas. Next, add all the corn and salsa mixture in one single layer. Top with a layer of tortillas. Add the second half of the meat and bean mixture. Add a final layer of tortillas. Pour the remaining enchilada sauce over the tortillas, and top with remaining cheese.
  • 5. Bake in preheated oven for about 40 minutes.
  • 6. Turn heat up to 400 degrees, and bake another 10 minutes or until cheese is golden and casserole is bubbling.
  • 7. Allow to sit for 10 minutes before serving (if you can resist!).
  • 8. Enjoy!!
12 Servings

Prep: 30 min. Cook: 50 min.

Friday, June 11, 2010

Hair - It's What's For Dinner

Or: Everything you never wanted to know about L-cysteine


What’s in your morning bagel? If you get it from Noah’s Bagels, it contains either human hair or duck feathers, and it’s your guess as to which. The substance, called L-cysteine or cystine, is used as a dough conditioner to produce a specific consistency. While artificial cysteine is available, it is cost prohibitive and mostly used to create kosher and halal products.

L-Cysteine is used as a reducing agent in bakery products. It is used to:
  1. Reduce the mixing time of the flour dough.
  2. Stop shrinking of pizza crust after it is flattened.
  3. Help move the dough through various bakery processing equipments or dough conditioners.

L-Cystein is used in Bagels, Croissants, Hard Rolls, Cake Donuts (from human hair in Dunkin Donut's cake donuts only, Yeast raised donuts do not contain L-Cysteine), Pita Bread, some Crackers and Melba Toast. It is also used as a nutrient in baby milk formula and dietary supplements.



Many consumers are unaware they are eating hair additives everyday in popular products such as Lunchables, TasteyKakes, Cajun food maker Zatarian’s, as well as products like cigarettes and Emergen-C. Cereal maker Kellogg's no longer uses L-cys in Pop-Tarts, while Safeway said that they use "duck feathers" for in-house bakery goods.

The source of L-Cysteine is human hair, chicken feathers, cow horn, petroleum by-products and synthetic material. L-Cysteine is manufactured in Japan, China and Germany only. Human hair is the cheapest source for L-cysteine.

Mother Jones first brought large-scale attention to this situation in an article earlier this year.

You can read more about L-cysteine and other food additives here.

Read more about why Lunchables are anything but lunchable here.

If you have the time, you should really read all of the above articles. They are such an eye-opener. The more I look into perfectly legal and often "natural" food additives, the more bizarre and disgusting things I discover.

This issue yet again proves the need for feeding our family foods that are as close to the source as possible. Whenever you can, try to cook from scratch with such ingredients as meat and dairy produced by small local ranchers, fresh local produce, and whole grains that you yourself mill and process into your baked goods. Boxed, prepackaged, processed foods should be eliminated from our diets as much as possible. One figure I read said that average Americans spend approximately 90 percent of their food budget on processed foods.

Thursday, June 3, 2010

Chocolate-Drizzled Cherry Bars


Tonight, I got a hankering for a dessert that contained chocolate and cherries. I was thinking along the lines of Black Forest Cake, but that would have been much too complicated and time-consuming to whip up. Plus, I wanted to make something that could stand in for a special breakfast tomorrow morning.

I found the following recipe in one of my Taste of Home cookbooks, and thankfully, it's also on their website. It was very fast and easy to make on the side while doing the evening dishes and chores.

Chocolate-Drizzled Cherry Bars

Ingredients

  • 2 cups all-purpose flour (I used whole wheat pastry flour)
  • 2 cups quick-cooking oats
  • 1-1/2 cups sugar
  • 1-1/4 cups butter, softened
  • 1 can (21 ounces) cherry pie filling*
  • 1 teaspoon almond extract (I used vanilla)
  • 1/4 cup semisweet chocolate chips
  • 3/4 teaspoon shortening (I used coconut oil)
* Instead, I used a big jar of canned cherries with juice, which I cooked up with some sugar and corn starch to make it thick and sweet like pie filling.

Directions

  • In a bowl, combine flour, oats, sugar and butter until crumbly. Set aside 1-1/2 cups for topping. Press remaining crumb mixture into an ungreased 13-in. x 9-in. baking dish. Bake at 350° for 15-18 minutes or until edges begin to brown.
  • In a bowl, combine pie filling and extract; carefully spread over crust. Sprinkle with reserved crumb mixture.
  • Bake 20-25 minutes longer or until edges and topping are lightly browned. In a microwave or heavy saucepan, melt chocolate chips and shortening; stir until smooth. Drizzle over warm bars. Cool completely on a wire rack. Yield: 3 dozen.
It's too late to try this tonight, but it looks and smells absolutely delicious.

Tuesday, June 1, 2010

The dangers of repeat Cesarean deliveries

One of my biggest passions/obsessions is to advocate for natural birth, and the avoidance of unnecessary C-sections. Sadly, the rates of successfully achieving a natural delivery after a Cesarean (VBAC) have dropped into the single digits in recent years, while rates of surgical deliveries have now reached an all-time high of 1 in 3 births nationwide (with some cities/states/hospitals having rates as high as 70%).

These two factors combined mean that there are many ladies who will end up with a repeat Cesarean for no other reason than that she had one before. What many women may not realize fully is how the risks and dangers associated with that rise dramatically with each additional C-section.

For anyone interested in having a large family, or allowing God to determine the size of their family, this can be a serious health threat. So much so, that many OBs will strongly urge/pressure a lady having her third (or more) C-section to consent to having tubal ligation during the delivery, and medically speaking, I can certainly see their point. The mistake was to perform what was most likely an unnecessary surgery to begin with. I can right now think of probably a dozen or more ladies who all have three children after three C-sections, and who no longer can have kids although they would have loved to have more. It is such a sad state to be in.

I found the following article very shocking, but also informative.


Dangerous delivery shows peril of multiple C-sections

The worst surgical case of my residency came when we delivered my patient's baby by cesarean - her ninth cesarean birth.

The baby came out fine, but for the mother we suspected one of most feared complications in obstetrics - that her placenta had burrowed deep into the muscle of the uterus.

To get oxygen and nutrients to the fetus, the placenta needs to attach just a few millimeters deep into the uterus. We worried that hers had gone much farther and might eat through the entire thickness of the uterus, keeping it from shrinking back to its normal size after delivery and causing a massive hemorrhage.

We gave a gentle tug on the umbilical cord. Usually the placenta peels off with such gentle pulling, but hers remained stuck - an ominous sign.

The case points out a fundamental truth about surgical delivery: a first cesarean for most women leads to a cesarean with every pregnancy. And while a first section is quick, easy to perform, and rarely complicated, each repeat surgery carries greater risk.

More and more women are finding themselves on the C-section path. Almost one in three babies was delivered by cesarean in 2007, the most recent year for which data are available, an increase of more than 50 percent from a decade earlier.

At the same time, it's becoming harder for mothers to avoid repeat surgery. The number of vaginal births after a C-section fell by two-thirds, to fewer than 10 percent, over the same time period. This year, the National Institutes of Health estimated that since 1996, one-third of hospitals and one-half of doctors who offered vaginal births after a C-section no longer do so.

"There can be tremendous morbidity after three or four or five prior cesarean deliveries," said Gary Cunningham, an OB-GYN professor and former department chair at Southwestern Medical School in Dallas, who chaired the NIH panel.

"Women need to be counseled appropriately and accurately so that they can make an informed decision," Cunningham said. "But this doesn't do much good if she cannot find an obstetrician or hospital that will allow a trial of labor."

Repeat C-sections pose more risk than a first section for many reasons. One factor concerns anatomy. When a doctor performs a first cesarean, the layers of tissue look and feel very different from each other. These visual cues and textures guide the surgeon, indicating exactly where to cut.

The surgery is simple: the surgeon cuts, spreads, and pokes, layer by layer, until reaching the baby. The surgeon first opens the skin a few centimeters above the pubic bone. The fat underneath easily gives way until the connecting fascia is reached. The tough, fibrous fascia, which holds the intestines in the abdomen, is cut at the midline and opened in either direction. The beefy abdominal muscles beneath are spread.

Finally, the glossy peritoneum, the last layer of the abdomen, is entered, and only the uterus lies between the doctor and the baby. In a term patient, the maroon, swollen uterus, flanked by finger-size veins, fills almost the whole abdomen, pushing the intestines up. The surgeon moves the bladder out of the way, cuts the lower uterus open, and is met by a baby's foot, face, elbow, or behind, depending on how the baby is positioned.

The surgeon loses the advantage of good anatomy after the first section. The tissue undergoes scarring, toughens, and blends together as it heals. The variations in color and texture disappear. The intestines and bowel sometimes stick to the healing wound, putting them in harm's way the next time surgery is performed.

These changes increase the chances of an unexpected injury. "Her belly was cement," we'd say to one another during residency after a tough section.

A study from 2006 published in the journal Obstetrics and Gynecology compared C-section complications in more than 30,000 patients. Risks of requiring a large blood transfusion, incurring a bladder injury, needing to be on a ventilator, and ending up in intensive care all increased significantly with the number of sections after the first.

The study also showed greater risk for my patient's complication. Scarring on the inside of the uterus after a cesarean causes the placenta to attach abnormally in future pregnancies. During a first section, the risk of this complication was less than 1 in 400. After a sixth section, the risk ballooned to more than 1 in 15.

So we knew the risks my patient faced from her ninth cesarean and prepared the best we could. We matched extra blood, placed additional IV lines, and arranged for expert surgeons to back us up.

But with my patient's placenta stuck and bleeding, only one option remained: removing the entire uterus with the placenta still attached. Because the pregnant uterus is large, swollen, and filled with blood, a hysterectomy after a delivery is very dangerous and performed only as a last resort.

By the time we finished the surgery, blood covered the floor. Blood filled suction buckets, and saturated our sterile gowns and drapes. Blood-soaked sponges piled up in the corner.

My patient lost three times the entire blood volume of a normal person, sixteen liters in all. Only a massive transfusion kept her alive. Anesthesiologists pumped in 51 units of red blood cells and seven six-packs of platelets.

Vessels deep in her pelvis refused to stop bleeding, and instead of closing her, we packed her abdomen with surgical towels, hoping the pressure would stanch the slow, steady flow. She left the operating room and headed to the intensive-care unit with her abdomen still open.

After a reoperation the following morning and days in the ICU, she stabilized and slowly recovered.

With a first cesarean, the up-front costs - a few more days in the hospital, a longer recovery - may seem reasonable. Only in retrospect can the true costs become apparent.