Saturday, October 29, 2011

Preschool Co-op Lessons: Pumpkins

I taught for my daughter's preschool again. We lost one of the families in the co-op because they moved across town. We found a new family to join, but at the time I taught, we only had 4 kids in the class.

We did two days of pumpkin lessons. I checked out every book I could find on pumpkins from our public library. The children's favorite was Pumpkin Day by Nancy Elizabeth Wallace, a fiction book about a family of bunnies going to a pumkin patch. The other titles we read were The Pumkin Book by Gail Gibbons (non-fiction, hand illustrations), Pumkins by Ken Robbins (non-fiction, photo illustraited), and Pumpkin Jack by Will Hubbell (fiction). Songs we sang were Five Little Pumpkins and a Halloween version of Ring Around The Rosy, called Ring Around the Pumpkin.

Pumpkin Day talks a lot about cooking with pumpkin, and includes some recipes. The day we read that one, we made pumpkin muffins. I used this recipe from all recipies, but left out the raisins and walnuts and substituted some ginger and allspice for the cloves, because I couldn't find the ground cloves I know I have somewhere, and I thought it would be good with a variety of spices. I took all the ingredients to my kitchen table, along with a big bowl, and had the children all help dump flour, sugar, etc into the bowl. I had them all smell all of the spices as we were putting them in. They got to help crack the eggs (messy!) and stir the batter. They had a lot of fun with it. They came out perfect...

When I chose the recipe, I didn't look closely enough to realize that the yeild is 3 dozen muffins! I only have one muffin pan, so we had muffins our oven for much of the day! They made the house smell amazing, though! There were plenty to share some with friends and they all got eaten! After having our muffins for our snack, we decorated some mini pumpkins. The kids drew on them with markers and I helped them glue googly eyes on them. There were 4 orange pumpkins and 4 white ones. Only the youngest child chose a white one. The one with the eyes on the top of the pumpkin is the same child as the one who glued leaves on the trunk of her tree in the tree's and plants craft (she thinks outside of the box). The one in the back that has a mouth is my daughter's :)

On the second day, we made paper plate pumpkins. I adapted this craft by using pre-cut construction paper for the facial features instead of cutting them out of the paper plate itself and gluing crepe paper on the back (it sounded like it would be too much work for me to do in the middle of the craft). Our color of the week was black and our shape for the week was a diamond, so the black diamond eyes seemed appropriate. I didn't get a picture of all of them, but this is my daughters (she is one of the oldest in the class, so she had better paint coverage and more face-like arrangement than some of the others)

Yay for pumpkins! Have a great Halloween, everyone!

Monday, October 24, 2011

Raise Your Hand if You Have Prenatal Depression

I do. Or I think I did, anyway. I think it is gone now. And now I think I can finally talk about it.

Prenatal depression (also known as antenatal or antepartum depression) is the term for depression that occurs during pregnancy. According to ACOG, it occurs in 14-23% of pregnancies. That is common! Shockingly common, considering how little it is talked about. I think we need to be talking about it! I think a lot of women do what I used to do, and ignore anything we come across about prenatal depression, because we think it could never happen to us. Until it does.

Symptoms of prenatal depression include:
  • A sense that nothing feels enjoyable or fun anymore
  • Feeling blue, sad, or "empty" for most of the day, every day
  • It's harder to concentrate
  • Extreme irritability or agitation or excessive crying
  • Trouble sleeping or sleeping all the time
  • Extreme or never-ending fatigue
  • A desire to eat all the time or not wanting to eat at all
  • Inappropriate guilt or feelings of worthlessness or hopelessness

Guilt was a big part of it for me, as were appetite issues and fatigue, and lack of motivation. I experienced more "irritability" than "excessive crying," though at one point I was crying about once a week. I think that because I felt angry and overwhelmed and not always sad is part of why I wasn't sure I had it at first. It was when I read Sheridan's experience of her postpartum depression that I recognized that feeling irritable could be a symptom of depression. I felt like I wasn't myself, like I wasn't enjoying day-to-day life or motherhood, and a whole lot of guilt because of that.

Prenatal depression wreaked havoc on my marriage. My husband didn't understand why I was so unlike myself, and he took it personally as a rejection. When he feels rejected, he withdraws, which was the last thing I needed at the time. Thankfully, our marriage made it through, and is stronger for it.

If you think you might have prenatal depression, what can you do about it? Here are a few ideas:
  • Talk to someone. Someone who understands. I will talk to you if you need me! If you can't get what you need with peer support, seek therapy with a qualified provider. And if your depression causes thoughts of hurting yourself or others, get professional help immediately.
  • Take a vitamin D supplement. Vitamin D deficiency can cause depression, and the majority of the American population is deficient because of how little time we spend in the sun without sunscreen. My midwives routinely check Vitamin D levels as part of prenatal bloodwork, and mine was 28 (optimal levels are 50-80).
  • Take an Omega oils supplement. These fats are good for your developing baby and research suggests they can improve mood.
  • Eat healthy. I know how hard this is to do when you aren't feeling motivated, but obviously your body needs nutrients to feel well and grow a person at the same time.
  • Light or Moderate exercise. Find something you can do to get moving that you don't hate--walking with my kids in the stroller and dancing with my prenatal dance DVD have helped me when I've done them.
  • Establish routines. This happened because we started the preschool co-op. It helps tremendously to have a rhythm to the day and the week. I also feel a lot better when I am accomplishing things and when I am in an uplifting (read: organized) environment, but it is hard to clean when you a depressed. Having Hypnobabies classes in my home each week has given me a reason I have to keep my house clean. If cleaning routines are new to you, I recommend FlyLady.
  • If you are spiritual, pray or seek other spiritual help.
  • Recognize that it will get better. Feeling this way is a temporary thing. It is not your life from now on. You are not a bad mother and prenatal depression is not your fault.
Support Resources:
You are not alone: other women's expereinces:

Tuesday, October 18, 2011

Comparison of Midwifery Education in Different Developed Countries

A couple of months ago, Amber at Midwife{ology} wrote a post, Educational Standards of American Midwives: A Comparison, which compared the direct-entry midwifery education program she left to the nurse-midwifery education program she is currently pursing. She points out what she sees as a huge discrepancy in the training of these two different types of midwives, and concludes that CPM training is inadequate to prepare a midwife to be a competent birth attendant. Stephanie at Nurturing Hearts Birth Services (who I highly respect as a midwife and appreciate for the wonderful midwife's perspective on Hypnobabies she wrote) responded in her post CNM vs CPM by saying that she feels that the training of CNMs and CPMs are different because they have a different scope of practice: CPMs attend only out-of-hosptial births with low risk women who are not being medically induced or receiving drugs, while CNMs are trained to work with medical interventions in a hospital environment and do pretty much everything an OB can do except vacuum/forceps assisted births and cesareans. Training for CPMs is different because what they need to know is different. Good points on all sides.

I think that maybe comparing different midwife certifications in the U.S. is the wrong comparison, and we should be comparing American midwife training to midwife training in the rest of the developed world.

The United States: In the U.S., the types of midwives practicing fall into three basic categories:
  • Certified Nurse Midwives (CNMs): Those seeking this path must train as a Registered Nurse first and obtain a Bachelors of Science in Nursing (BSN) or the equivalent (usually through a "bridge" program), and then complete a midwifery program. CNM clinical training focuses mostly on hospital birth, and most CNMs attend hospital births, though some work in birth centers or have homebirth practices.
  • Credentialed Non-nurse Midwives: This path to midwifery is for those who do not have and are not seeking a nursing degree. These include those with the Certified Professional Midwife (CPM) credential obtained through the North American Registry of Midwives (NARM), the Certified Midwife (CM, which is only recognized in 3 states) credential from the American College of Nurse Midwives (ACNM), and various credentials bestowed by state licensing, such as Licensed Midwives (LM), Licensed Direct-Entry Midwives (LDM), or Registered Direct Entry Midwives. Different states have different requirements for their licenses. A midwife can obtain both her state license and a CPM (in some states a CPM is required to get a license, some states have requirements above what the CPM credential gives). There are multiple training paths for a CPM, including MEAC-accredited midwifery schools and apprenticeship options. All must pass the NARM exam. For more information, see the NARM website. These midwives practice almost exclusively out of the hospital and very rarely get training in hospital birth.
  • "Traditional" or Non-credentialed midwives: Licensure for non-nurse midwives is available in about half of the U.S. states. In the others, there are midwives who practice without licenses. Some do go through the training process with NARM, but they are still not legally allowed to practice. Some midwives in states that offer licenses choose to remain unlicensed, and do so illegally, except in Oregon and Utah, where it is currently legal to practice midwifery without a license. Training for these individuals varies widely.
United Kingdom: In the UK, there is one type of midwife training, done through a university. Training in nursing is not required, but those who have it have a head start in the program, so there must be overlap between basic nursing and early midwifery training. Midwives in the UK are qualified to attend births in all settings, home, hospital, and birth center. From the Nursing and Midwifery Counsel:
Education and training
In the UK midwifery education and training programmes are only run at NMC-approved educational institutions. Courses usually take a minimum of three years, unless you are already registered with the NMC as a level 1 (adult) nurse, in which case the training can be reduced to 18 months.
Midwifery training takes place at a university, with at least half of the programme based in clinical practice with direct contact with women, their babies and families. This can include the home, community and hospitals, and in other maternity services such as midwife-led units and birth centres.
Canada: Midwifery training in Canada is done through university education that prepares midwives to be able to attend both home and hospital births. From the Canadian Midwifery Registers Consortium
Midwifery education in Canada is offered at a university baccalaureate level. Education programs are “direct entry” (i.e. there is no nursing or other credential required for entry).
One example: The University of British Columbia Midwifery Education Program
The Midwifery Education Program at UBC is a four-year, direct entry, full time undergraduate program leading to a Bachelor of Midwifery degree. The curriculum combines broad-based knowledge and understanding in the humanities and the social and bio-medical sciences. . . .The first two years of study are located on the UBC campus and in the area of the Lower Mainland. The final two years, including the summer between years 3 and 4, consist of clinical courses. . . .Students are prepared for practice in both high tech and low resource settings (home, hospital, rural, international).
Australia: From the Australian College of Midwives - New South Wales
To become a midwife you need to complete either a Bachelor of Midwifery degree (direct entry) or a postgraduate program if you are already a registered nurse.
For an example of an undergraduate midwifery program in Australia, see Bachelor of Midwifery from the University of Technology, Sydney. This program takes 3 years of full time study to complete.

New Zealand: New Zealand also has a 3-year direct-entry program, where registered nurses can get advanced placement. From the New Zealand College of Midwives:

Each midwifery school offers an extended three year bachelor degree programme meaning that each year has a minimum of 45 programmed weeks rather than the more usual 36 programmed weeks. All students whether full time or part time must complete the programme within four years of commencement. This is the framework for all routes to midwifery registration. Each programme has a Recognition of Prior Learning Policy that enables those with appropriate previous qualifications and experience to receive credits or partial exemptions for aspects of the programme. Midwifery students who hold a previous nursing registration or those with other degrees or other relevant experience are likely to gain credit under these policies and complete a shorter programme. Registered nurses will usually complete at least two years of the full programme.

New Zealand midwifery training also includes mandatory hospital-based clinical experience:
Students work in a variety of settings over three years including family planning clinic, independent midwifery practices, neonatal intensive care units, maternity hospitals, laboratories, homebirth, and community. All students have a dedicated ‘block’ in base hospitals to achieve the experience necessary for competency in recognising deviations from the normal and working collaboratively with obstetricians in the provision of secondary care.
I was unable to find websites about midwifery in countries where English is not the first language, but according to reports from midwifery students on the forums, midwives in the Netherlands must complete a 4-year direct-entry program which qualifies them to attend both home and hospital births (and to allow women to choose to change her birth location up until the last minute without having to change providers), and midwifery school in Denmark takes 3 1/2 years to complete and midwives can do home or hospital births. Though it was a little difficult to decipher exactly what the French student midwife was saying with the language barrier, it appears that midwifery school in France is 4 years and may be part of medical school.

Okay, so, which one of these things is not like the others? All of these other developed countries train midwives to be qualified to attend births in both hospital and out-of-hospital environments and all of them require a university degree to practice midwifery. A class of midwives that deals exclusively with out-of-hospital births is unique to the United States. This raises some questions to me:
  • Would requiring midwives who practice out-of-hospital to receive hospital clinical experience (where they are much more likely to encounter rare complications), make them more qualified to handle rare emergencies when they occur in out-of-hospital births?
  • Would it benefit consumers for direct-entry midwives to be qualified to attend both home and hospital births and be able to obtain hospital privileges and attend the same types of hospital births certified nurse midwives currently do? Would this allow for better continuity of care when circumstances require a change in planned birth location?
  • Would standardized training and education for midwives similar to what other countries do give midwives who attend out-of-hospital births more respect in the medical community, allowing for better cooperation with obstetricians, nurses, and other hospital providers?
  • Would requiring more education for midwives, as some fear, "turn them into obstetricians"? Would training have less emphasis on skills needed to support normal birth with too much focus on pathology?
What do you think about how the training and scope of practice of midwives in the U.S. compares to the rest of the developed world?

Thursday, October 13, 2011

Preschool Co-op Lessons: Trees and Plants

On Thursday of my first week teaching preschool, our theme was trees and plants. I only had three in my class that day because one was out of town and one was sick. After doing puzzles and block and the calendar/weather/letter/color/shape routine, we sang our songs, In the Leafy Treetops (an LDS Primary Song), and Trees (to the tune of The Farmer in the Dell, which I found online). Then we read several books about threes, The Giving Tree by Shel Siverstein, Up, Down and Around by Katherine Ayres, and A Tree is A Plant by Clyde Robert Bulla. (I think only having three kids in the class probably allowed them to pay attention to reading books longer!)

Then, for a "sensory activity" we went outside, and my husband had these packets of sunflower seeds and little containers left over from something they did at his work, so each child got to fill a container with soil (which I had bought), put some seeds in it, and put more soil on top. Then we watered the seeds and the kids got to take them home. I put my daughter's in the windowsill above our kitchen sink, and five days later, the seeds sprouted!

Then, since we were already outside, we went on a short walk and looked at my neighbor's garden and talked about all of the vegetable plants she has growing there. By this time, it was already almost time for snack, but I let the kids play for a few minutes while I got it ready.

For our craft, I had prepared large pieces of paper each with a drawing of a tree (I just drew them myself) and I had some cut up some pieces of green tissue paper to be "leaves." The kids used glue sticks to glue the "leaves" on the trees. Most of the trees ended up being a bit sparse, and one child took creative license with the placement of the leaves (she put them on the trunk). I think they are very lovely trees!

We always close each day of preschool with the same set of songs:
Ring around the rosey
Pockets full of posies
Ashes, ashes, we all fall down!

Cows are in the meadow
Eating buttercups
Thunder, lightning, we all stand up!

Teddy bear, teddy bear
Turn Around
Teddy bear, teddy bear
Touch the ground
Teddy bear, teddy bear
Give a jump a try
Teddy bear, teddy bear
Wave bye-bye

Thank you for being our friends today
Come back again and we'll sing and we'll play!

Saturday, October 8, 2011

Preschool Co-op Lessons: The Farm

I recently taught for my daughter's co-op preschool for the fist time. We have five kids in the class, and we rotate it to each mom's home each week, so when it was my turn, I taught two lessons. Here is the structure of the day:

9:00-9:15 Structured Play
9:15-9:35 Circle Time
9:35-10:05 Sensory Activity and Free Play
10:05-10:20 Snack
10:20-10:40 Art Time
10:40-11:00 Outdoor/Indoor Play
11:00-11:15 Clean up and close

For both days, I did puzzles and blocks for the structured play. Circle time consists of a welcome song, which includes each of the children's names in the song, followed by updating the calendar and weather chart, and there is a song we sing for the weather, too. Then we go over the letter, color, and shape for the week. Our week we had the letter C, the color yellow, and triangle. We have a color book in the preschool box (which travels to each home, along with the calendar and weather chart) with pictures of things that are all one color on each page, so the kids get to point to one thing that the like on the yellow page that is yellow, and there is also a shape puzzle book where all of the pictures on a page are magnetic puzzle pieces that are the same shape, so the kids get to take a piece, say what thing they have that is a triangle, and then put it back. All of this is basically the same in every circle time, no matter whose house school is at for the day..

On Tuesday, our theme was The Farm. We sang some songs about farms: Old MacDonald Had A Farm (the children really enjoyed getting to choose what animal sound we were going to sing) and The Farmer in the Dell (I had one child be the farmer and let her choose who would be the wife, and she chose who would be the child, and so on, and as they were chosen, they got to stand up). Then we read the book Click, Clack, Moo: Cows That Type by Doreen Cronin, which is about a farm, but it is a bit of a higher level and their attention wasn't staying focused on it. I had some other farm-related books picked out, but I decided to skip them. We sang another song "This is the way we..." with farm chores for the actions, while I got out my laptop. I used this website to play real recordings of animal sounds and had the children listen and try to identify which animal it was. I think they got all of them except for the turkey.

For our craft on Tuesday, I printed pictures of a pig on pink cardstock and mixed some shaving cream with a little brown paint in a cup for each of the kids. I explained about how pigs need mud to protect their skin, and let them use their hands to smear the shaving cream "mud" on their pigs. It was really fun! They took a long time to dry, but I thought they looked kind of neat after they dried.

It was actually really cool for my daughter that we had just learned about farms in pre-school because we ended up going to a farm, Smallwood's Harvest Farm Park near Leavenworth, WA, as a family that weekend. She fed the animals, rode the cow train, and did other fun farm-related activities.