Wednesday, April 25, 2012

Guest Post: A Family-Centered Cesarean Birth by Stacy S. Hirsch

A few years ago I had the honor to work with a friend on her birth story. I asked Stacy if I could post her story on my blog, with the hope that it might inspire some of you to write your own stories. A version of Stacy's story was also published in Midwifery Today

A Family-Centered Cesarean Birth
by Stacy Hirsch
I was 34 weeks pregnant when we learned our little one was breech. An ultrasound confirmed the positioning and showed a nuchal cord (a cord around the neck). I had never worried about the possibility of a breech baby and in that moment the nuchal cord sounded more alarming to me. Our midwife assured me that many babies have the cord around their neck at some point during the pregnancy and this typically does not present any complications. The larger, more pertinent issue didn’t register for me immediately; I didn’t know enough to know that if our baby didn’t flip we were unlikely to have a vaginal birth.  
     We had chosen a midwife for our prenatal care and we had always planned to have a home birth. For me, home is where I reconnect with myself. It is the place where I can easily let my mind rest and where I can feel my body vibrate at a softer frequency. Having a home birth meant being surrounded by warmth, history, familiarity and love. It meant having our child born into an environment full of intention. The idea of not having a home birth was at first devastating. It seemed so unfair. To feel the vision I held for our birth slip away was incredibly painful. Unpeeling the layers of this disappointment took time.  
     I had already purchased a majority of my home birth supplies and they were neatly organized and labeled in brown paper bags. I was beginning to envision myself giving birth in our home and I eagerly began designing each detail for the event. The birth tub was ordered and I even planned the snacks I would have for our midwife and her assistant: hummus, herbed cheeses, hearty breads, fruit and vegetables slices, olives, nuts and seeds. All of my favorite finger foods that could easily be prepared ahead of time without a lot of fretting. The home would be warm, inviting and full of welcoming hearts, and the nourishing food would ensure my supportive team would have the strength to go the distance with me.
     I soon learned that in our region, as in many other parts of the United States, there really weren't many options for vaginal breech delivery. Providers typically view a breech presentation as having a great enough risk to necessitate a cesarean birth. Our midwife knew that it was possible and safe to deliver a breech baby vaginally but did not have the expertise to do so. We considered trying to find someone trained in breech delivery, even if we needed to travel to another state. It wasn’t difficult to find stories on the internet of women delivering their breech babies vaginally. I imagined these women as strong, rebellious, heroic, articulate and confident. They lived their lives with a silent certainty and they always achieved their goals no matter how big the fight. I envied these women.  
     My life is full of blessings, yet I am also a worrier. At times I posses all of the attributes I imagined these other women having but I often need a little extra support to overcome the fear that passes through my mind. I wanted my doctor or midwife to have training in breech vaginal delivery. I wanted the system to agree that it was a safe and sane choice. I wanted to know I was doing everything I could to give our daughter the very best start in life. I wanted to eliminate doubt and worry. The idea of choosing a vaginal breech delivery and then having a negative outcome was difficult for me to consider. It seemed like a choice with too much risk and not enough support.  
     We were concerned about the breech presentation but optimistic that with a little more time our baby would flip. We did our research and tried everything to gently encourage her to make the journey 'head down'. Our efforts included chiropractic techniques, homeopathy, acupuncture with needles and moxabustion, craniosacral therapy, hypnosis, counseling, swimming, biking, inversions/pelvic tilt, Rebozo, coaxing, vibrations and a bright light low on the pelvis, online prayer groups of various denominations, laughter, tears and finally an external cephalic version (ECV) performed under medical supervision at a hospital thirty miles from our home. An ECV is a procedure where the obstetrician manually attempts to rotate the fetus into the proper position while the mom and baby’s vitals are monitored. It is a relatively short procedure and, in our case, was unsuccessful.  
     We tried to hold it all lightly as we ultimately put our trust in our daughter, knowing that birth was a natural process and if she could flip, she would. With each appointment or technique I would go through a range of emotions. Part of me felt certain whatever I was doing in that moment was going to work and another part of me was slightly afraid of how it would feel to have this little creature flip-flop 180 degrees in my belly. Each day was a dance. Some days I felt I was the lead partner but on most days all I could do was follow.  
     Trying all of these techniques and connecting with all of these wonderful healers had a secondary effect. They were all women, all mothers and they all became an important part of our birth. They helped me to see that birth was not a single act. They reminded me that our birth experience began many months prior to finding out our daughter was breech. They opened my eyes to the larger process of birth. They also helped me to realize that this was my baby’s birth as much as mine. This was the first but it would likely not be the last time my daughter and I would have differing opinions about how to proceed through a life event. I could give up and settle for what the system had to offer us or I could let go, regroup and create the birth we wanted for our daughter within the system. 
     As the weeks disappeared, and our due date rapidly approached, a medically necessary cesarean seemed unavoidable. I had heard stories of women traumatized by their birth experience, and I was determined that this would not be me no matter what obstacles we faced. We needed to be informed. We decided to research our options for creating a cesarean birth that would honor both mother and child and allow us to not stray too far from our original intention. Our midwife was very supportive and helped us sort through all of the new information. She connected us with a midwife-friendly obstetrician in our region and a facility that would allow us some latitude in our birth choices. She also encouraged us to draft a birth plan. We went online and found a white paper on family-centered cesarean birth from the International Cesarean Awareness Network. Using the paper as guidance, along with other resources, we crafted a birth plan that offered us the best chance of giving our daughter the gentlest birth possible given the circumstances.    
     Version one of the birth plan sounded something like this: “I really wanted a home birth and I am only here because the system says this is where I need to be but there is a chance she will flip once we arrive at the hospital, and if that is the case, I want to leave so we can birth our daughter naturally in our home.” Version one also outlined a plan for a vaginal hospital birth and included a smaller section for a non-emergency cesarean due to the breech presentation. I was still struggling to let go. I didn’t fully identify with women who choose cesarean or even hospital births but I also had to let go of identifying myself as someone who was having a home birth. I felt very alone. I saw these sides and I didn’t belong to either.
     A few days after we drafted version one, and after a few more days of processing, I was ready to revise the plan and mostly let go of the hope we would have a vaginal home birth. As I began to accept the cesarean, I was able to see more clearly what was possible. Our requests became more specific and I was able to differentiate which pieces I could and could not create. It began to feel I could still have most of what I wanted for our baby: gentle hands to welcome her into the world, being surrounded by loved ones, never leaving our side, nursing soon after delivery, no shots or pokes or vaccines, not even a bath. It was all possible if we used our imagination. I, on the other hand, would be undergoing major surgery. I was worried a bit but I was a mother now and mothers do whatever they need to in order to ensure the health and well-being of their child. I was healthy and fortunate to have lots of support. I would be fine. 
     Our next step was to discuss our plan with the birth team. My husband called the obstetrician, anesthesiologist, and charge nurse. With each conversation we carefully reviewed the details of our plan, learned more about what to expect from the upcoming process and made compromises as needed. Success! We had a green light for those items most important to us. In addition to the father being in the operating room we were granted permission to have our midwife present. I was to be administered an epidural, but requested not to have additional antibiotics or pain medications. I wanted to be awake and coherent so I could fully experience the birth of my baby. We were allowed to take pictures and video, my arms were not to be tied down, and we asked that extraneous conversation be limited during the birth. Initially, we also asked to have the lights lowered at the time of birth so the environment would feel a little warmer and less shocking for our new baby. But in the end we let this go when it seemed their version of dim was not much different from regular lighting. We had also hoped that our baby might be delivered onto my chest and even begin nursing while the sutures were being placed, but with the surgical drape and the protocols for keeping the environment clean and sterile this was not possible.  
     Picking a date for the cesarean birth was a bit surreal. How do you choose a date for your baby to arrive when you want to honor the natural process? From our research we knew that contractions, and subsequent labor, induced a release of stress hormones in mother and baby.  This was seen as beneficial to the new baby as an early survival technique and impetus into the external world. It was our hope that the little one would experience some of the benefits of those contractions. After conferring with our midwife, our obstetrician was amenable to a 42 week gestation. Knowing we couldn’t go too much past 42 weeks helped us to narrow the window and we selected a date, July ninth. Although I never went into labor, the last week was full of gentle contractions.  
     On the day we went to the hospital my contractions were more frequent and more intense. Our daughter seemed to be letting us know she was ready. I don’t remember much about the actual drive to the hospital. We arranged for my mother to stay at a nearby hotel and we prepared food for her to bring to us for each meal. The three of us arrived at the hospital and completed the necessary paperwork. Shortly after they showed me to the pre-op room, our midwife arrived. Our delivery team came to our room and we reviewed the birth plan one last time to ensure all voices had been heard. The stage was set and our little one was about to make her big debut.  
     As I lay in the operating room, life simplified for a moment. My husband and I had been on a rollercoaster for the past eight weeks. Now our only job was to welcome our daughter into the world. Time had been our friend, allowing us to lay the groundwork for the type of birth we both wanted when our original plans were no longer an option. All of my awareness was focused on being present; I didn’t want to miss a moment of this life-changing event. I was nervous, excited and deeply grateful for the support of my husband. He would be the one to first touch and hold our baby. He would be our advocate if necessary. I needed him to be where I couldn’t. I trusted him to take care of us as we navigated this new territory. 
     As the obstetrician gently guided our baby into the world, the anesthesiologist held my head up so that I could watch her little red bottom emerge from me. Once our baby’s head was out the doctor quickly unwrapped the umbilical cord from around her neck and body and gently held her upside down for the natural removal of mucus from her air passages. (Typically, this piece is done with suctioning.) Within moments there was a tiny cry followed by several more substantial cries. She was here, she was healthy and we were all happy. The cord pulsed while the proud papa held our baby and the Apgar scores were assessed. The nurse brought warm blankets and a hat. My husband cut the cord once it stopped pulsing and carried our baby to me and placed her next to my face. She gently suckled on our fingers and on my husband’s nose while the doctor stitched me up. She was so at peace in our arms, patiently waiting to nurse. Our midwife took beautiful pictures and video of our first moments as a family. Forty minutes later we were in our hospital room and our daughter was latched to my breast. The charge nurse for the neonatal nursery said to our midwife, “You know, there really isn’t any reason why all cesarean births couldn’t be like this one.” Hearing this made us feel something even larger could come from our daughter’s birth.
     We stayed at the hospital for two days. As part of our birth plan we also drafted a section on infant care. We requested our baby never leave our side and, that all routine exams be delayed until after we had time to bond with our child; we did not give permission to bathe her, use eye ointments, vaccinations or injections of any kind; and we informed them that our baby was only to receive breast milk and no formula. We brought a small lamp from home so our room could remain dimly lit and my mother brought us nutritious food for each meal. We asked for our privacy and did not consent to examinations that had more to do with hospital policy than with our health. The staff was very accommodating even when it seemed we had taken them out of their comfort zone.  
     I am filled with gratitude when I recall our amazing journey and everything it took to bring our daughter into this world. I will never forget the intention and care provided by everyone involved. I thank our midwife for supporting us and the vision we held for our birth through lots of change and uncertainty. Having been through this experience I strongly believe that every parent should have access to resources that empower them to create the type of birth they want for themselves and their child no matter what circumstances. I believe that those who facilitate birth —midwives, physicians, nurses —play a critical role in making this happen by cultivating trust and meaningful working relationships with one another at every level.  At 34 weeks we didn’t have time to change the system for our birth. We didn’t have time to advocate that every obstetrician and midwife have training in delivering breech babies vaginally. What we did have time to do was to work with our team to create the most beautiful experience possible for our family.  

Bio:

Stacy Hirsch lives in Olympia, WA with her beautifully curious 3-year old, talented husband and overly indulgent cat that never passes up a warm sauna. She is an Integrative Health Coach, Founder of Two the Root and Co-owner of Beyond Medicine, An Integrative Wellness Clinic. Check out more of her work at TwotheRoot.com.

Here's what Stacy had to say about her writing process:

"I knew early on that I wanted to write the story of my birth. I wanted it for myself, for my daughter and to connect with expecting moms who might face a similar experience in their pregnancy and birth. Writing gave me a way to process the disconnects of my journey and create a fluid, seamless understanding of my experience. It gave me closure and at the same time opened a whole new world of possibilities.

Working with Anne was a tremendous gift. 
She skillfully stepped into one of the most intimate moments of my life and held it with tenderness and integrity. Anne's insight offered me the opportunity to try on new perspectives that I may not have seen without her help. She was a sounding board - a mirror to reflect my own thoughts, feelings and words so I could go deeper. Even now, years later, I am filled with warmth and gratitude for the experience. It changed me as a person and I believe it changed me as a mother."

Sunday, April 8, 2012

Writing Your Birth Story: June Online Workshop


Have you always wanted to write your child’s birth story, but are worried that too much time has passed or that you won’t be able to do it justice? Or have you simply lacked the time or focus to sit down and write it?

Procrastinate no more! In this four-week workshop, you will gather online with a small group of women and support each other in writing your birth stories. Maybe you simply want to remember and preserve the story of what happened for yourself; maybe you have lingering questions or layers of understanding that you still need to unearth and process about your experience; or maybe you want to create a polished personal essay that you can share with others. Whatever your intentions are, whatever your experience with writing is, and whether you gave birth five months or five years ago, this workshop is for you!

First we will read about and discuss the process of writing, and more specifically how this applies to the process of writing your birth story. Then we will free-write from prompts about our birthing experiences to help us stir up our memories and explore the different layers, themes, and questions that may reside within our stories. By week three, you will have written and submitted a draft of your birth story to the group. Anne will respond with extensive feedback for each person, asking questions and providing suggestions for ways in which you could further explore your story if you should so choose. Workshop participants will also be required to read and respond to at least one other woman’s birth story, following Anne's guidelines for ways to give respectful and constructive feedback.

By the end of our time together, you will have: written and received feedback on a draft of your birth story; gained insight into stages of the writing process from free-writing to revision; and emerged with a deeper understanding of your birthing experience’s significance to you. 

DETAILS:

When: Sunday, June 3rd – Sunday, July 1st, 2012.
Cost: $120 Sliding scale available- please inquire.
To Register: Please email Anne at: alkellor@gmail.com and confirm how you would like to pay. (Personal check, cash, or Paypal.) Receipt of payment necessary to hold your spot.
Format: We will use googlegroups to post our documents and manage our discussion threads. Group size will range from 3 – 6 women.
Questions: Please don’t hesitate to ask! Email Anne: alkellor@gmail.com


Here's what one mother had to say about working with Anne on her birth story:


"I knew early on that I wanted to write the story of my birth. I wanted it for myself, for my daughter and to connect with expecting moms who might face a similar experience in their pregnancy and birth. Writing gave me a way to process the disconnects of my journey and create a fluid, seamless understanding of my experience. It gave me closure and at the same time opened a whole new world of possibilities.

Working with Anne was a tremendous gift. 
She skillfully stepped into one of the most intimate moments of my life and held it with tenderness and integrity. Anne's insight offered me the opportunity to try on new perspectives that I may not have seen without her help. She was a sounding board - a mirror to reflect my own thoughts, feelings and words so I could go deeper. Even now, years later, I am filled with warmth and gratitude for the experience. It changed me as a person and I believe it changed me as a mother." - Stacy Hirsch

Unsure whether you want to write your birth story, or what kind of story you might have to tell? Check out my old blog post that reflects on how many different versions of one person's birth story exist. So much depends on when we tell our story (how much distance and perspective we have); how we tell it (what aspect of the story might we choose to focus on), and what our intentions are for telling it (What is our ultimate purpose here? Who is our audience? What do we seek to understand?).

Sunday, April 1, 2012

On Toddler Ear Infections, Trusting Doctors, and Trusting Your Gut


It’s been a bit of a rough week around here. Nothing unmanageable, just a runny nose that turned into an ear infection. A trip to the doctor’s, some muddied advice about it being up to me whether we “watch and wait” a couple days to see if it gets better on its own before starting antibiotics, or whether we start them right away.

Well, of course, if you leave it up to me, and you tell me about the potentially adverse side effects of antibiotics like allergic reactions and diarrhea, and then I get online and find out that since 2006 the AAP has actually recommended the ‘watch and wait’ approach, since many ear infections do get better on their own, and since a tendency to over-prescribe antibiotics can lead towards increased resistance to antibiotics, then I’m going to choose to wait and see. After all, I’m someone who doesn’t even like to give my child Tylenol too often, especially with all that high fructose corn syrup. You might think this sounds silly, but my child gets itchy and rashy when he has too much processed GMO corn.

Anyway, so I waited on the antibiotics, and meanwhile started giving Cedar Ibuprofen around the clock, and he seemed to be feeling better. But, of course, that was probably because of the Ibuprofen. So how am I supposed to tell if he’s truly getting better if I’m suppressing all the symptoms (fever, fussiness, etc.)? He seemed better and hadn’t been pulling at his ear anymore, but he was still sleeping poorly and he still had a temperature (although it was hard to know if I was getting an accurate reading with a squirmy toddler and the under the arm approach). So two days after going to the doctor, I called the consulting nurse. She took notes on everything I told her, consulted with the doctor, and advised me to wait one more day, then call back. She also made some remark about antibiotics to the effect of, “Well, and you don’t even know if they’ll work for sure. And over-prescribing antibiotics has led to cases of resistance to Merca.” Or something like that. So, okay, let’s wait one more day. I’m all for natural healing if that’s a likely option.

That said, I’m also someone who ultimately errs in favor of Western medicine—especially when something seems bad enough that I want immediate results. So I still drove to the pharmacy that afternoon to pick up the antibiotics just in case things took a decided turn for the worse. I wouldn’t have much time the next day to deal with the pharmacy, and maybe my gut was already telling me that we were going to need them in the end.

On the following day, Friday, Cedar was still following the same pattern of being okay, but increasingly fussy once the Ibuprofen wore off and still sleeping poorly. We were on day three of Ibuprofen, and although Cedar didn’t seem worse, he also didn’t seem better. His temperature had gone down a degree—or so I thought, until I called the consulting nurse one more time, and was reminded that you needed to add a degree to the reading when doing the under the arm approach. Oh, right. I knew that, once upon a time. Cedar has never had a fever before, so I’ve only taken his temperature once since he was a baby!

In any case, I was pretty much thinking we should start antibiotics that night, but like a dutiful patient I was calling one more time as advised. Well, the nurse this time clearly though that I had already waited too long and that I had some irrational fear of antibiotics. “Is there some reason why you don’t want to give it to him?” she asked in a slightly exasperated tone.
“Well, just because of the various side effects that the doctor told me about and that the articles I read online mentioned.”
“Well, I don’t know what to tell you. Is there some specific question you want to ask the doctor?”
“No, I just wanted to call and tell you his symptoms since I was advised to do so by the nurse.”
“Let me see who was on yesterday when you called. Oh… Dr. X.” she said, with a clear note of disdain. “Well, it certainly doesn’t sound like he’s getting better. I’d say you’ve certainly waited long enough. It says here in the notes that you were told to wait 24-48 hours and to start antibiotics if things did not improve or got worse.”
Yes but, I think to myself, it says on my notes from the doctor to wait two or more days. “Yes, well, it’s hard to tell if he’s really getting better or not because we’re suppressing the symptoms with Ibuprofen, but I agree that it seems like time to start. I thought his temperature had gone down, but now I realize it hasn’t. He doesn’t seem worse, though. And I just don’t know how long it typically takes for these things to clear up when you are supposed to wait.”

Anyway, suffice it to say that the nurse I talked to that day was of a different persuasion than the one I talked to the day before. And the doctor I saw? He seemed pretty neutral on the matter, but I trusted that if it had seemed like a bad enough case, he’d have told me to start antibiotics right away.

Some quick research online also revealed that this is a source of debate in the medical community. Recent research that came out in early 2011 shows that toddlers may recover sooner and have less chance of having reoccurring infections when treated right away, so the current AAP advice or the general sentiments amongst doctors may likely swing back towards advocating immediate antibiotic treatment. But other previous studies have also shown that the problem may lie in diagnosis— “Doctors vary in their opinion of what defines an ear infection when looking at the ear drum. The enlightenment in this new research is the use of strict criteria for diagnosis: bulging eardrum, redness on the drum, pain, and an inventory of acute symptoms. The study highlights the essential challenge with ear infections–make a good diagnosis.” says Seattle pediatrician and blogger, Wendy Sue Swanson in this article

She goes on to say that parents should thus question the doctor about the nature of what they see in the eardrum to make sure it indeed looks like an infection. “When the pediatrician diagnoses an infection, push them on the appearance of the eardrum. It’s always okay to ask what it looks like! Ask if the eardrum is bulging, if it has pus behind it, or is red in color. It’s okay to ask the pediatrician to clarify and explain the difference between fluid in the ear and an ear infection. In combination with your child’s symptoms, it will be important for making a plan.” But who in reality does this? Or who has the forethought to read such articles before taking their child in to the doctor? Not me. My first response is always: go to the doctor. Second response: question what they say from the comfort of your couch and with Internet access.

It seems that the more you read and learn about your own health or children’s health, the more it teaches you to not blindly trust your doctor’s word or sometimes pithy statements of reassurance. We all want to just be able to trust and get on with it, to not have to play detective and doctor ourselves. And most of the time, this is probably okay if we have good doctors and fairly normal diagnosis. But unfortunately, this is not always the case. I have been given questionable information by my child’s doctor a number of times. And when Cedar was having so many problems with his body rashes and intestinal pain, it was ultimately through seeking out the advice of naturopaths that I was able to find any answers—with clear, tangible results—as opposed to the treat the symptom, not the cause (“We don’t know what the cause is”) approach of the Western pediatric dermatologist I saw.

Like I said, I still err towards Western approaches. I am fully immunizing my child (also after much reading and considerations towards alternate schedules, etc.). But we have also been relatively healthy and not been placed in situations in which your willingness to do your own research, seek second opinions, and make your own decisions might make the difference between life and death. 

Don’t get me wrong: I’m not trying to make it sound like Cedar’s ear infection is THAT big of a deal. But these recent interactions have just brought up for me these thoughts and feelings. And we are approaching 48 hours of Cedar on his antibiotics, and unfortunately, he does not yet seem to be getting better as he should. But again, this is hard to say because, after calling the consulting nurse one more time to see if it was okay, I started giving him some Ibuprofen again to help him in the meantime before the antibiotics take full effect. I guess if he’s not feeling better by tomorrow, I’ll need to bring him back in. Sigh.

The last two nights he’s been sleeping terribly, only seeming to find rest when attached to my boob or lying on top of me, and then waking up in 30, 60, or at most two hour increments. This has meant I have gotten very poor sleep myself. I would not be functioning, much less sitting here writing, if my dear husband did not let me catch up by sleeping in. I slept an extra three hours this morning until eleven, when I was brought a tired toddler to nurse back to sleep for his nap. I had just enough time to put on my robe, drink a cup of tea and have some cereal before said toddler woke up again. I tried to get him to go back down, seeing how tired he still was, but his nose was all stuffy and when he tried to nurse he was uncomfortable, and this—plus who knows what other discomfort—set him into a tizzy of screaming, which turned into a full-blown tantrum that lasted a full 30 minutes.

I usually am able to calm him down from a tantrum within a few minutes. This time, nothing helped. He did not want cuddling or soothing. He did not want to get up and look out the window. He did not want more milk. He did not want to watch Thomas the Train. Instead, he violently flung his body about, banging his head on the bed, and trying to bang it elsewhere—on the wall, even on the bookshelf. I’ve read that head-banging falls within the realm of normal toddler tantrum behavior, but it sure is scary to think of how he could hurt himself if he’d succeeded in hitting his head on the corner of the bookshelf. Finally, after 30 minutes, he decided he would try to have some milk again, and his nose had cleared enough for him to do this, and so we lay there for another half an hour, allowing our heart rates to go down and breathing to return to normal, before he finally decided to get up, a happy and perky little two year old again.

Big sigh. In the meantime, this was supposed to have been my morning to steal away and write, but I finally got out the door at 2:30 p.m. Thank God I was able to get away at all. A week of terrible sleep + worrying about your sick child + long days staying at home with him = one exhausted mama.

I also carry a slight trace of guilt knowing that Cedar might already have been feeling better by now if I’d started him on antibiotics right away, even though I know that I made the best decisions I could given the information I was given. This whole process has just been a reminder to me that you need to take everything any doctor or nurse tells you with a grain of salt, and remember that even though they are the “experts” their personal biases and training can and will slant the advice they give you in distinct ways. During this process, I’ve talked so far to three nurses and one doctor. They each have given me slight, yet still significantly different takes on what I should do. It was only the last nurse I talked to whose voice reached out to me with a tone of mothering compassion, who listened closely to what I told her, and who did not seem like she was scolding me for being “that type of paranoid parent” or whatever the previous nurse had been thinking.

Anyway. I have other things I’d rather be writing about, but I feel all pent up and angsty and sad, so I needed to get this off my chest. Access to the Internet and too much information can sometimes feel like a curse in our modern age where everyone can self-diagnose and prescribe if they wish.  And yet. I also will not apologize for being someone who does not just blindly trust what I am told. I will ask for as second opinion if I feel the need. And a third opinion at that.

But in the end, I always have to come back to trusting my gut—which to me, is not some wild, irrational stab in the dark based on fear-- but rather a decision that is the end result of a process that includes: careful questioning of experts, close observation of my child, as much additional research as I have time for (so, not a ton, mind you), and in the end, choosing the path that feels the safest and most sound.

Sounds easy, right? Right.

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