Hypnobabies Certified!

I received word a few days ago that my certification as a Hypnobabies Childbirth Hypnosis Instructor (HCHI) and Hypnobabies Certified Hypno-Doula (HCHD) is official! Yesterday, my information was posted on the Hypnobabies Instructor listing. If you are local and interested in joining my first class (most likely stating in late September or early October) please contact me here or through my website (link on sidebar). If you are not local, check out the link above for an instructor in your area.

I &hearts Dancing for Birth&trade!

The Dancing for Birth™ training was awesome! I learned so much! I am currently planning on finishing up certification and teaching the classes, in addition to my Hypnobabies courses, but we will see if it works out.

In a nutshell, Dancing for Birth™ is a prenatal and postpartum fitness class and a birth and new motherhood support circle, with bits of birth empowerment and childbirth education incorporated into it. There is a basic flow to the structure of the classes, but the content is flexible--instructors can choose what to include each week based on the needs of their students. There is a huge list of benefits to dancing during pregnancy, birthing itself, and the postpartum time. Not to mention it is a whole lot of fun!

I had a wonderful time bonding with all of the other women who were at the training. It was a very passionate group, and the nature of the workshop allowed us all to become close very fast. Most of the other trainees were doulas, but we also had some midwives and belly dancers. One thing I really liked about the workshop was the opportunity to practice some comfort techniques, including the double hip-squeeze and several rebozo techniques.

I found that the vast majority of what was taught was very compatible with Hypnobabies. We talked about how having "sensation" is necessary to follow your instincts in childbirth, but there was not talk of "preparing for pain." There was some of the idea that "you don't birth in your brain, you birth in your body," which is not what we teach in Hypnobabies, because we teach that you most definitely do use your mind during birth--it is where your birthing hormones come from. However, I think "birthing in your body," it is just different wording for a concept that is taught in Hypnobabies--birthing in a state where our conscious, analytical thinking is pushed aside, a state we call hypnosis, but other people have different words for it. Dancing is a naturally hypnotic activity, so it makes sense that dancing during your birthing time would promote the ideal mental state.

We also did a game where music plays and everyone dances, then the music fades and people pretend to be having pressure waves (most people chose to stop dancing and lean forward onto something, which would work with using the Hypnobabies lighswitch), then the music fades back in and everyone gets up and dances again. This exercise reminded me a lot of something we do in Hypnobabies called a "birth rehearsal," and I could see how the techniques of both programs could work together as we did it.

We did another exercise where we compared the measurements of the pelvic outlet (from pubic bone to tail bone) in a deep squat (with hips below knees) versus a standing squat (hips above knees, pelvis tilted back, upper body leaning forward). I recommend trying this yourself--you may be surprised at what you find!

All instructor training workshop participants take home a copy of the Dancing for Birth™ DVD, and I have been practicing with it every other day since I got back. I have difficulty sticking to exercise routines, but since dancing is so fun, I'm more likely to do it (plus, I'm trying to get a good grasp on the moves for teaching it, if that works out) I am looking forward to having dance to use along with my hypnosis during this baby's birth!

The Trap of Idealizing the Intervention-free Birth

Sometimes we get caught in a trap of holding up a spontaneous, drug-free vaginal birth as an ideal, because, well, most women should be able to give birth without interventions, right? Then, we end up comparing an individual birth to this standard. I doubt anyone would actually say this out loud, but I think something like the following happens in some women's minds, though it is probably not this specific.

• Completely intervention-free vaginal birth? A+! Great job!
  
• Vaginal birth with IV and artificial rupture of membranes? B. Good effort!
  
• Induction and epidural? C. Mediocre.
  
• Epidural, episiotomy and vacuum extractor? D. It could have been worse.
  
• Cesarean? F. Better luck next time.
  

But this is not how it works. Your childbirth educator isn't going to give you a grade, because your baby's birth is not an exam! You are not "most women" and every birth is different. It is not your responsibility to prove that birth with minimal interventions is best. As a wise woman once said, "that's a pretty freakin' huge burden to put on one vagina." Interventions are sometimes needed. You can't know in advance that you won't need medical help, so it doesn't do any good to believe that getting it is a negative reflection on you.

After my first birth, I did feel like a C student. I felt like I hadn't done a good enough job at practicing tools for reducing or coping with pain. I thought that if I had prepared better, I possibly could have avoided the epidural. But how in the world can a woman expect to know how to prepare for something she has never done, having no real way of really knowing what it is going to be like for her? Can someone who has never given birth before really prepare for a long, slow, sleep-depriving early labor? An intense, lightening-fast, precipitous labor? Constant pain in her lower back that gives her no break? An emergency cesarean? How can we expect a first time mother to predict what techniques might be helpful for her so that she can practice them? How is she to know how much time she needs to put into practicing so as not to forget everything she practiced immediately when her birthing starts? And how is she supposed to devote any time at all to it when society tells her to "just enjoy the pregnancy" and "don't worry about the birth" until it is less than three months away?

I wish we could irradiate the word "failure" from our vocabulary in conversations about childbirth. I do not call doing something differently from what you wrote on your birth plan failure, I call that a change of plans. Changes of plans can be in response to medical necessity (because intervention sometimes does save lives and improve outcomes), or they can be for psychological reasons. If a woman who wanted a natural childbirth has crossed over from "coping" to "suffering," and nothing is working to bring her back, the decision to use pain medication is not failure. In that kind of situation, medication is probably the best choice to avoid trauma and allow the birth to be a good experience for the mom. As many have pointed out, a traumatized mom is not a "healthy mom."

If a woman had interventions in her birth she wouldn't have chosen with more information or if her options had been presented in a different way, it is not her fault. I hear a lot that a woman has a responsibility to inform herself, but the problem with not knowing is that we don't know what we don't know. Can we really expect a woman to be responsible for understanding all of the situations that may come up in her pregnancy and birth and all of the benefits and risks of available medical procedures? In an ideal world, her care provider (whose job it is to know these things) would present the facts about her choices as objectively as possible, and leave the decision to the woman. In most cases, reality is pretty far from this ideal, but I don't believe in blaming women for not finding out for themselves what their doctors should have told them. (Though getting angry about what doctors should do doesn't do us any good--Felice recently posted about this here.)

As always, the language we use is important. We have to pay attention to the implications of what we say--what a woman may read between the lines of our words. The phrase"sucessful VBAC," implies that a planned-VBAC-turned-repeat-cesarean is a "failed VBAC." Criticizing high rates of medical intervention by saying things like "I find it hard to believe that X percent of women's bodies are broken" implies that the body of a woman who has an honest medical need for that intervention is broken, and "Your body is broken" is not an empowering message. Besides, we don't consider it failure for our bodies to not function optimally all the time in life--I don't usually think my immune system failed me if I get a cold or stomach virus--I usually attribute that to bad luck. I think sometimes birth is the same way. Preparation plays a role in whether or not you get the birth you planned for, but so does chance.

Maybe those of us who have had that idealized birth shouldn't get cocky and maybe need to recognize that it didn't happen all because of what we did, and hopefully those of us who had a birth other than that one can recognize that it didn't happen all because of what we did either. At the same time, I do not wish to invalidate other women's feelings. If "failure" is the word you choose to describe how you feel, then that is your reality. If reading my thoughts on this does not bring you any healing, I wish you healing wherever you find it.

Stay tuned for the next post in the series!

Blurry Lines

Focus by Tomasz Sienicki

A few months ago, I read the collection of midwife stories, Sisters on a Journey: Portraits of American Midwives by Penfield Chester. I mentioned it in a previous post. I wanted to go into a little more detail about the lessons I learned from this book, most specifically about the various roles that are all part of midwifery.

Midwife as Childbirth Educator

Ideally, the role of a midwife is not just to provide medical care that is less technological than the medical model, while still being the "birth expert." The role of a midwife is to foster independence in the woman. This is evidenced by the practice of showing the woman how to dip her own urine strips and read the results herself. The midwifery practice I went to for my first couple of appointments when pregnant with my son, before we moved here, used this method. Midwifery is supposed to be about teaching the woman how to take responsibility for her own health. A good midwife will help prepare her clients for childbirth. In some respects, a midwife is a childbirth educator.

As I have read blogs by midwives discussing unassisted birth, I find it interesting that some midwives feel that having a midwife teach a UCer how to perform assessments on herself makes it not "unassisted" anymore. But where is the line between "childbirth education" and "midwifery"? If a UC mom takes a childbirth class, that wouldn't be considered "having a midwife." What if a childbirth educator taught women how to do their own prenatal and birth health care?

Midwife as Doula

Midwifery care is holistic--midwives treat the entire patient, body and mind. They believe that a woman's emotions can have a direct impact on her body's processes, and works to help her feel emotionally supported during pregnancy and birth. A good midwife is skilled in natural pain relief techniques and helps her clients use them during labor. A doula's role is said to be "mothering the mother," but isn't this also what midwives do? A midwife is also a doula.

When I wrote my post on Doulas and Hombirth, I realized that line between midwife and doula becomes blurry when you consider the possibility of a doula attending a UC. How is a doula-attended planned UC different from a planned homebirth with an unlicensed midwife? On paper, they are virtually the same thing.

Midwife as Healthcare Provider

The other role of a midwife is to observe the mother and baby for signs of problems and treat them if treatment is in her scope of practice or refer to another healthcare provider. This part of a midwife's role is similar to a physician, though her perspective on how to go about providing this healthcare is usually different than that of an obstetrician (though I would think a family practice physician might have a more midwife-like approach). And because midwives practice low intervention care and treat low-risk patients, the healthcare provider part of her role is a small part, though a very important one.

The professions of "childbirth educator" and "doula" are both relatively new because their roles were performed by midwives and their partners or apprentices before birth moved to the hospital and began being attended by physicians. The majority of physicians view the practice of medicine as dealing only with the body, not the mind, and those who are specialists like OB/GYNs are only concerned with the specific parts of the body they specialize in. Women have invented our own systems for filling the holes left in our healthcare by modern medicine, and have created the childbirth educator and the doula--and thus, the "team" of physician, childbirth educator, and doula together does all the jobs of midwifery.

Me, a Midwife?

I have recently been seriously considering the possibility of becoming a midwife someday. I have been considering the pros and cons of various paths to midwifery--ideally, I'd like to train as a midwife in another country, but I'm not sure that would work for my family. It won't happen until our own family is complete, and I feel that I won't know it is time for that until it happens. I want to be a midwife, but as I've said before, I'm quite intimidated by it. I realize, though, that what I am doing now allows women to have all aspects of their maternity care needs address (just not all by one person), so I am already helping women have care that is as close to midwifery care as they can get without actually having a midwife--to some extent, I might consider that being "part of midwifery."

Giveaways for moms and birth workers

Sheridan at Enjoybirth is doing two giveaways on her blog. One is for birth workers and one is for moms. (Since I am both, I'm entering both giveaways).

For Moms: Tag*a*Long Giveaway

The Tag*a*Long is a handle you can attach to a stroller for a child to hold on to while you push the stroller. I think this is a great idea. We don't own a double stroller because when my son was smaller, I'd wear him in my wrap and my daughter would ride in the stroller. Now that they are bigger, I like to put my son in the stroller and have my daughter walk, but she needs something to hold on to so she doesn't wander and the Tag*a*Long would be perfect because if she holds onto the stroller itself she is in my way.

For Birth Workers: $25 Injoy Gift Certificate Giveaway

Injoy supplies birth and parenting educational materials, including videos and web-enhanced booklets. Many of the materials would be a great supplement to any childbirth education program or could be used as an informative resource for doulas or for healthcare providers.

If you are interested in either giveaway, check them out today!

The Myth of "Early Labor"

Expecting Mother By Petercantfail at en.wikipedia [Public domain], from Wikimedia Commons

As a science, medicine seeks to define things in specific terms. As a natural process, childbirth doesn't always fit into perfect little boxes. Childbirth education often uses the explanations from medicine in attempts to help women understand the birth process. However, based on my own observations, the "textbook labor" does not apply to the experiences of a very large proportion of birthing women, and I wonder if we are, by using it, doing women a disservice by creating false expectations.

The general model that is taught is that there are three stages of birth: dilation, pushing, and birth of the placenta. Within the dilation stage, three phases are taught: the early/latent phase, active phase, and "transition."

• Early phase is usually defined the time when the cervix is going from 0-3 cm dilation, and is characterized by pressure waves that are spaced far apart and my be irregular.
• Active phase is defined as cervical dilation from about 4-7 cm, and is when the waves get regular and increase in intensity and frequency and cause measurable cervical change.
• "Transition" is when the cervix goes from 8-10 cm, and is usually explained by its physical and emotional intensity and the presence of symptoms such as shaking, nausea, and vomiting.

There are a few problems with this construction.

• If this is the "normal" birthing women whose births do not fit this pattern may consider what they experience as "abnormal."
  
• It relies very heavily on measuring the cervix as a basis for knowing how far along a woman is.
• Some women's cervices will be reach dilations where thy should be in "active phase" but stay there for days or weeks before the baby is born, and there is nothing pathological going on
  
• I specifically disagree with the way "early/latent phase" is characterized.

The impression that this model gives is that from "not in labor" to "in labor" is a one way street; once "labor" begins, you are "in labor" until your baby is born. I feel that this construct, together with unrealistic media portrayals of childbirth (where it always seems like a woman is going along minding her own business, suddenly her water breaks, chaos and rushing ensues, as well as some screaming, and then someone is handing her a "newborn" the size of a 3 month old), encourages women to head to the hospital as soon as they have contracting sensations that they can tell are more intense than the Braxton Hick's they have been having.

I have been participating in an online support forum for women who are planning natural births for about 3 years now. On our group, we have a fun tradition called Lodges, which are a sort of journal for pregnant women that lasts from 36 weeks to about 1 month postpartum. I have followed many lodges in the past three years, so I have read updates from women as they are nearing the births of their babies. From my own informal observations, it appears to me that a majority of women experience periods of regular and intense pressure waves (not Braxton Hicks, but the same kind you have during birthing) on and off for days, weeks, and in some cases months, before giving birth. They will go long periods with no pressure waves, then have them start again for a few hours, then they'll go away. So, does early labor stop? Can early labor last for two weeks? Or is our idea of "early labor" a myth?

Some people would call the off-and on periods of pressure waves "false labor," but I really dislike that language because it implies that the woman doesn't know what she's feeling. In many cases, the only way to tell the difference is in retrospect: sometimes they go away and sometimes they continue to the birth of a baby, they usually don't really feel much different from each other, contrary to what some will tell you. "False labor" also implies that it is not doing anything, and I am of the opinion all pressure waves do something, even if it is not causing measurable dilation. It could be effacing the cervix or encouraging the baby to rotate into a better position. In some cases, dilation is occurring, just not quickly enough for it to be measurable. For women who have "false labor," it may just be that their body does the "early labor" work incrementally, with long periods of rest.

The problem is that I suspect that the majority of women don't know how common start-stop labor (as I like to call it) really is. I recently read a blog post by a nurse (shared on facebook by The Deranged Housewife) who blamed the "need" for hospitals to use pitocin on women going to the hosptial and getting epidurals too early. Comments on the facebook link suggested that the problem is not the patients themselves, but that someone is failing to adequately inform them what the end of pregnancy is really like. The nurse's post really made me wonder how many women are getting pitocin for "stalled labor" when actually they were having an episode of pressure waves that would have gone away? How many of these babies would actually have come days or weeks later without the pitocin?

(On a similar note, I also love this post by midwife Stephanie of Vita Mutari questioning the logic that it is "safe" to "labor at home as long as possible" in order to avoid crowding the labor and delivery floor and avoid interventions, yet "unsafe" to plan a homebirth with a midwife.)

The concept of "early labor" is misleading because it is so easy to mistake start-stop labor for "early labor," and if women assume "this is it"and run to the hospital at the first sign of a pressure wave, they are guaranteed to either be sent home disappointed or have a whole lot of interventions, and neither of those is a desirable thing. I know I fell into the "early labor" trap myself with my first birth--I remember thinking "I've been in early labor for two days and I'm only 1 centimeter?"

For real, human women, not mythical "textbook" ones, the onset of the birthing time is a fluid process that they may move in and out of at their own unique pace. The last few weeks of pregnancy are the orchestra tuning up before the concerto, the engines revving before the race.

I'm in!

It's official! I got the e-mail today saying I've been accepted into the Hypnobabies Instructor training program! Now I have to register, do book reviews, and do the Introduction to Hypnosis Course, as well as finish my doula training. If all goes according to my plans, in about 10 months, I will have both CD(CBI) and HCHI after my name.

Hypnobabies Instructor Training Info & FAQ Webinar Today!

The Hypnobabies Instructor Trainign Info & FAQ Webinar is today from 11:00 a.m-12:00 pm Pacific Time. There is still time to sign up, if you are interested in becoming an instructor. If you can't make it, you'll be able to listen to a recording of it afterwards.

I will be listening live. I am so excited to start this process!

How Midwifery Care Can Reduce Racial Disparities In Birth Outcomes

At the request of Courtroom Mama posting at The Unnecessarean, I watched the documentary Crisis in the Crib: Saving Our Nations Babies. I think the film does a great job of raising awareness on the issue of racial disparities in birth outcomes and infant mortality in the United States. It really got me thinking about what factors contribute to this disparity. I think it is a very complex problem, and it can be difficult to pinpoint all of the causes. Poor nutrition, lack of exercise, and lack of access to care are all factors, but they don't explain why there is still a disparity for babies of college educated black women. The film suggests higher stress levels and the lack of presence of a supportive partner as possible additional factors that could influence middle class populations. There are also some life-course factors.

As I was considering these factors and trying to decide what to write this blog post about, I remembered this video from last year's The Big Push for Midwives Issue Briefing for members of Congress showing Jennie Joseph, LM, CPM talking about her birth center, The Birth Place, in Orlando, Florida.

It's pretty clear that The Birth Place has drastically fewer racial disparities than her area's average. She attributes the difference to their care being more accessible to the uninsured, but I think that is only part of the story. I believe that the obstetric model of care, which is the norm in the U.S., is failing black women. Here are some components of the midwifery model that I believe may better meet their needs:

• Focus on Preventing Complications with Healthy Lifestyle - While obstetric practices generally focus mostly on screening for pathology, midwifery care includes extensive counseling on nutrition and exercise during pregnancy. This approach integrates prevention of problems.

• Individualized Care - Midwives strive to make their care specific to the needs of individual women instead of providing one-size-fits-all care that may be more suited to one race than another.

• Holistic Treatment - Midwifery care treats the whole woman, not just her body. Prenatal care that is only a medical check up is a missed opportunity to resolve other issues that could contribute to disparities, including social and emotional stresses in the woman's life.

• Longer Prenatal Visits - The average length of a midwife visit is significantly longer than one with a physician. This allows more time to focus on these issues and develop a trusting caregiver/client relationship.
  

• Relaxation Practice - Birth centers do not offer epidurals, so midwives at a birth center would encourage women to prepare for a natural birth. In fact, State of Florida Law requires that birth centers counsel their clients to receive appropriate childbirth education. This preparation usually involves relaxation practice, which can be helpful for dealing with stress.

• Empowering Education - Midwifery supports women in being educated and involved in decisions about their care instead of letting the birth professional make most of the choices for them. This can help them learn to take responsibility for themselves and their babies, both during and after the childbearing cycle.

I believe that the caring, sensitive, woman-centered model of midwifery care may be exactly what is needed to reverse the terrible trends we see in maternity care today and make great bounds in resolving the disparity we see between races in maternity care in the U.S.

The Fear Problem

Fear of the Unknown

It is normal to fear the unknown. For most first time pregnant women, birth is a huge unknown. Not only have we never done it, we may not even have ever seen it done. In North America today, I think it's highly unlikely that the average woman has ever been at a birth before giving birth. She also won't see uncensored images of vaginal birth in any public media. So, unless her school showed birth films in health class (mine didn't) or she takes a childbirth education class, seeks out birth videos on the internet, or watches a birth documentary such as The Business of Being Born, she may not even have seen a baby birthed before she is expected to do it. As I discussed in a prior post, some women seem to think that viewing a birth would disturb them, so they don't seek out any birth videos.

Add this that the fact that virtually every pregnant woman reaches a point in her pregnancy where, looking at her much-changed body, she realizes her baby is going to have to come out, but to her it just seems impossible that it could. It really is an unbelievable thing, even for those who have seen it and done it. That's kind of the miracle of it. Much of the medical system, however, seems to believe that it really is impossible without their help, and they are also afraid of the rare and very scary things they've seen or heard of going wrong, and they pass that fear on to women to add to their fear of never having done it and thinking there is no way her body can do something that seems impossible. Medicalization of birth also increases the "unknown" factor--it is something for educated doctors and nurses to know about, not average women.

Fear of Pain

It is also normal to fear pain, because pain is usually an indication that something is wrong, and we find it unpleasant. Our young pregnant women has heard others talk about how birth was painful for them and that they would never think about doing it without medication (or they did and it was a bad experience), and this just compounds the fear. She has probably seen birth shows on cable TV, which edit birth footage in ways that focus on the dramatic, because they are in the business of making exciting television, not of educating women about what birth is and can be. She probably has also heard a few stories of births where there were complications--maybe a vacuum delivery or an unplanned cesarean. She may fear something going wrong or having something strange done to her. Many women also feel fearful when they are in an unfamiliar place, surrounded by strangers, as is often the case with birth today.

Effects of Fear on Birth

We know that fear causes the body to release chemicals that can stop the birth process. This makes sense from an evolutionary perspective--a tribal woman wouldn't want to give birth if a tiger was chasing her, but as is explained in the book Birthing From Within (not a hypno-friendly book, by the way), the body doesn't know how to distinguish between real and imaginary tigers, it only knows fear. Fear also increases our perception of pain and prevents us from enjoying birth.

So, what is our average (and now thoroughly terrified) first-time pregnant woman to do?

Most likely, she'll figure that she has a highly-skilled doctor and well-equipped hospital that will keep her and her baby safe because they're the experts, and she'll decide she will get an epidural, so she won't need to worry about pain. It is likely that her preparation won't go much beyond this. She will still have other fears to deal with, though. For example, what if she's afraid of needles?

Fear of Needles

Fear of needles is pretty common. I see nothing unreasonable about having a fear about a sharp object penetrating one's skin to introduce foreign substances into one's body. I realize that needles do a lot of good in medicine, but the idea of them is just disturbing to me. It is sometimes fear of needles that leads women to seek out natural childbirth.

My Answer?

The best answer to the fear problem is childbirth education. And by childbirth education I don't mean most hospital-sponsored classes where the woman learns a little (but usually not enough) about what is going on in her body, what routine medical procedures to expect (without letting her know she has the right to refuse all of them), and that epidurals are usually safe and not anything to worry about. I mean childbirth education that is free to tell you what the hospital doesn't want you to know.

Most natural childbirth classes address fear in two ways. They tell women that they can give birth without medication, just like women did before medication existed, and teach them pain coping techniques which helps increase their confidence and overcome their fears about pain. Some of these techniques rely on freedom of movement, so these classes usually encourage women to consider declining unnecessary routine medical procedures that interfere with movement (such as IV fluids and continuous monitoring). They also address fear of the unknown by teaching about the natural process of birth, as well as explaining how medical interventions might affect the process and giving information about the risks and benefits of these procedures and encouraging women to choose for themselves whether to accept them or not. Feeling like they are involved in decisions about birth helps women feel less afraid.

Fear of Medical Interventions

However, the downside to teaching about medical interventions (both in classes and other places such as books/films/internet groups) is that sometimes this education has the unfortunate side effect of creating fear of medical interventions. So, fear of pain, birth, and the unknown, are replaced by fear of hospitals, pitocin, and iatrogenic complications. Remember, fear interferes with birth, no matter what the source or intention. Going into birthing with any kind of fear is not healthy. And there is always a possibility that a woman will need medical intervention in her birth, and if that happens, we don't want her to be afraid of it. I recognize that fear of pitocin had negative effects in my own first birth.

I want women to be able to make birth decisions without fear. The presence of fear makes it difficult to use the other things we need to make decisions--our logic and our intuition. Sometimes natural childbirth sources are guilty of some of the same fallacies as the medical side of things. Those who believe in liberal use of medical technology in birth will focus on a few rare complications as reason why a woman shouldn't choose a homebirth, a VBAC, minimal monitoring, no IV or heplock, etc, while ignoring the majority of births that go right. Natural birth advocates sometimes focus on the rare scary complications of epidurals and cesareans, without mentioning that the majority of women who choose an epidural or need a cesarean have no major problems. It is important for women to understand the risks of interventions, while at the same time understanding that there are times when the benefits of these interventions clearly outweigh the risks.

Overcoming Fear

I feel that the best type of childbirth education would present information in a way that doesn't scare women, but provides them with unbiased information that allows them to make informed, and not fearful, choices. Good childbirth education also has ways of helping women overcome their fears. Hypnobabies includes a fear-clearing exercise that works very well for this. Some other ideas can be found in this post by Felice at The Gift of Giving Life.