Penny's Tips

I have learned a few things this week and thought I would share...none are really exciting, although I wish I had known before.

First, renting a Red Devil carpet cleaner for $19 seems like quite a deal, until you get a good professional cleaning for $100. Mike was adamant that we would not spend that kind of money on something he could do himself. However, Mike has very little time to spend an entire day shampooing carpets and because we have two busy office days a week, it takes some scheduling to have the carpet shampooed on a day that would then have several slow days following so it would dry sufficiently. After wallpapering, I splurged and had Stanley Steamer visit us. They did four rooms, immaculate in about an hour or two. Our carpets were dry by that evening. Mike had mentioned that because we had used the Red Devil carpet shampooer previously and repeatedly, we had over-saturated our carpets and ruined the backing so now our carpets are wrinkling. They were wrinkled when we moved in, but this does make perfect sense. We have invited the Stanley men to come and clean our carpets a few times a year so this is a chore Mike no longer needs to worry about.

Second, nose rings come in all types. I had significant difficulty getting in the spiral fashion I had purchased and was convinced my nose was just thicker than most. Others had said I was just a wimp and needed to grin and bear it. Then I stuck a long ear ring through my piercing and it barely came through the other side, proof there was no way that spiral was going to clear the piercing. I found a "bend-to-fit" ring that works perfectly. It is also micro-tiny and gives just a glimmer of sparkle on my nose which is what I had wanted. Fabulous. I also learned that it depends on what gauge you were pierced with which ring you should purchase. Keely and I were pierced with a 16 gauge needle (yes, that is large) and a few rings we have bought keep falling out. For those of you that plan to be pierced in the future, go smaller.

Third, I learned this week that you must clip the toe nails AND BEAKS of chickens. They can bleed. I have proof on my picture phone. I learned that buff ducks are gorgeous, male ducks have curly feathers on their hind end and females are loud quackers. I learned that chickens urinate and stool from the same place. I learned that we have mink and weasels in Indiana?!

I was reminded this week that I could potentially blow through a large lottery winning in a very short amount of time. I am content, but I can also find lots to do with a large sum of money.

Samuel's love language is words of affirmation and it makes a tremendous difference in his behavior, every little spoken word and tone in which they are spoken. He also hears everything, even when you are in another room.

I've also realized that I have lived the vast majority of my life without creating appropriate boundaries for how I expect to be treated. It has taken me a few years, but I think I have accomplished this life lesson and even though the scale says I weigh the same, my clothes fit better and I genuinely feel as if I am walking on air.

Bills of Interest to the Perinatal Community

SB 0071: Involuntary manslaughter and pregnancy. Provides that a person commits involuntary manslaughter if the person causes the death of a fetus while operating a vehicle while intoxicated. STATUS: Passed by the full Senate and the House Committee on Courts and Criminal Code, and will now go to third reading on a floor vote by the full House.

It could all start to change in Massachusetts. On March 2, the Massachusetts State Senate will consider the Male Genital Mutilation Bill, legislation that would outlaw genital mutilation of both young girls AND boys in Massachusetts. Time and again, Intact America has seen just how powerful stories like yours can be.

Congress banned female genital mutilation in the U.S. in 1996. But no one has ever considered extending the same protection to baby boys – until now! This is the first time a Male Genital Mutilation Bill has made it to debate in a state legislature.

What I've Learned about Lemons

Not a tricky title, this is really about lemons, the fruit. I love lemons. I love lemonade. I love their color. I love their smell. I love the way they have so many fabulous uses even beyond nutrition. Here are a few fascinating facts I've learned about lemons.

1. Lemons should feel heavy and should give a bit when squeezed. Green spots are okay and are related to temperature changes. Brown spots are bad.
2. One lemon contains a full day's supply of ascorbic acid, but that means you must eat the entire fruit. The juice only contains a third. Lemon juice is 5 percent citric acid, making it natural for slowing the browning or oxidation of fresh, raw foods.
3. The peel is versitle and can add flavor to meals, but wash it well as it may contain toxins.
4. Lemons preserved in salt are a fragrant, distinctive flavor in Moroccan and Middle Eastern dishes.
5. Limoncello is a southern Italian lemon liqueur and is very easy to make.
6. Makes a versatile household cleaner; for example, salt on a lemon becomes an excellent abrasive cleaner for brass, copper or stainless steel pots and sinks. Rub it on aluminum or drop one in your disposal as a deodorizer.
7. Lemongrass is not related to lemon.
8. There is such a thing as a "Meyer lemon" which is a cross between a mandarin orange and a lemon. Apparently it is lemon-fragrant with a sugary soul.
9. Roll the lemon prior to use to break down cells that hold juice. If it is really hard, microwave the fruit for 20 seconds.
10. Those cute little plastic lemons with lemon juice are not a good lemon substitute.

Dawn of a New Age

This past week I have began shredding some of my old papers from both my undergraduate studies and graduate program. I never thought I would toss what at the time was so coveted, but alas, many of them are simply too out-dated to be of any use today. The funny thing is that some of them were written by type-writer. Many were even hand-written. I don't think my kids even know what a type-writer is!

Keely's Bunnies

Funny...we have baby animals all over the place. For a really cute story about Keely's first experience being a midwife, read here. She swears it is all true!

Collecting & Storing Eggs

Noah and I are discussing how to care for the chicks. I didn't realize until reading within our fabulous book, "The Backyard Homestead: Produce all the food you need on just a quarter acre!" by Madigan, that an egg stored at room temperature ages more in one day than an egg stored in the refrigerator ages in one week. We also learned that eggs should be stored in the carton with the biggest part of the egg up so the yolk can rest in the middle of the egg.

I have often heard that eggs are the perfect food and many midwives require their pregnant moms to eat a certain number of eggs per day. One egg contains almost all the nutrients necessary for life. The only essential nutrient it lacks is Vitamin C. Most of an egg's fat, and all the cholesterol, is in the yolk. To lower the cholesterol in a recipe, if it calls for four eggs, use two whole eggs plus four egg whites (replacing two egg whites for each egg).

Determining Freshness

One way to tell if an egg is fresh is to put it in cold water. A fresh egg sinks, because it contains little air. As time goes by, moisture evaporates through the shell, creating an air space at the large end of the egg. The older the egg, the larger the air space will be. If the air space is big enough to make the egg float, the egg is too old to eat. When you break a fresh egg into a dish, the white is compact and firmly holds up the yolk. In an aging egg, the white is runny and the yolk flattens out.

Hard Cooked Eggs

I had thought I had lost the skill for cooking hard eggs because for quite some time when I would try to peel away the shell, several layers of the egg white would also peel away. Many friends gave me suggestions in how long to boil and/or other various tricks to perfecting the boiled egg, but according to my handy-dandy homestead book, fresh eggs simply can't be peeled easily and I just realized that my challenge presented when we began purchasing farm fresh eggs. The contents of an eggs that's at least a week old have shrunk away from the shell, making it easier to peel. Store-bought eggs peel easily because they are usually a week old by the time you get them home.

Occasionally, the yolk will be off center which makes them harder to peel as well. These eggs are even older than a week, so the trick is to use eggs that are 7 to 10 days old to hard cook or if you are using fresh eggs, leave them over-night at room temperature first.

Chickens!!

Noah and I are working together to raise chickens this year. He entered the poultry 4-H project this year and today we picked up our five chicks.

I have learned that chickens are chosen because one desires eggs or meat, or if both, a chicken that is an okay mix of both. However, if you genuinely want egg-layers, which we do, then those birds really aren't so good for meat. They put so much of their energy into making eggs they become rather scrawny. We have also learned that chickens only lay for about a year or two and then just drain money from your pocketbook unless they have become genuine pets (the cost of feeding them becomes greater than the value of their eggs).

We purchased our chicks from a national breeder in Wisconsin who is known for show birds or rather, exhibition breeds. These birds are bred for beauty rather than their ability to efficiently produce eggs or meat. Exhibition breeds in the Mediterranean class lay better than most other show breeds, even though they don't lay as well as production flocks of the same breed. I had requested Braham Bantam birds, which are miniature exhibition chickens, easy to care for, calm and absolutely beautiful. (The cocks are among the loudest though.)

When Mike and Noah picked them up today, they explained that the breeder didn't have any of those chicks and so were given another similar kind of bird; however, they don't remember the name (of course). The mystery should be solved in a few days because they also forgot the pedigree paperwork, which should arrive in the mail in a few days. I suspect they are another type of Bantam breed.

I am also interested in heritage breeds, but will have to look more into those birds another year. We're starting simple. Did you know that all hens lay eggs regardless of the presence of a rooster, as he is only necessary for fertilizing the eggs? Did you know the best egg-laying hens lay 24 dozen eggs a year and produce white-shelled eggs? These breeds originate from the Mediterranean Sea and are classified as such. Examples are the Miorca, Ancona and the popular Leghorn, which is the breed used commercially to produce eggs for the supermarket. These birds though are inherently nervous, flighty birds and I was hoping to start with a gentle, easy-to-care for bird our first year. Brown-egg layers are calmer and all American breeds lay brown eggs.

A pullet starts laying eggs when she is 20 to 24 weeks old. Her first eggs are quite small, and she will lay only one egg every three or four days. By the time she is 30 weeks old, her eggs will be normal in size and she will lay about two eggs every three days. I have to share that I find it fascinating (of course, I am a midwife) that a chicken is born with all its yolks, approximately 4,000. When it reaches laying age, one by one the ova grow into full-size yolks and drop into a 2-inch tube called the oviduct. The really interesting part is that while she already has all her yolks, the egg white becomes encased in the shell as it travels through the oviduct about 24 hours after it starts its journey. Cool huh? Just like a human female, a female chicken enters the world with all the eggs she could possibly lay in her lifetime.

As I mentioned before, a good egg-layer lays about 20 dozen eggs in her first year and at about 18 months of age she stops laying and goes into molt, during which her old feathers gradually fall out and are replaced with new ones. They molt once a year, usually in the fall, and the process takes two or three months. Chickens need most of their energy to replace their feathers so don't make many eggs during this time, or none at all. Once her new feathers are in, she looks sleek and shiny, and begins laying again. After her first molt, a hen lays larger but fewer eggs (16 to 18 dozen in the second year).

Hens lay best with the temperature is 45 to 80 degrees. Indiana will be tough on the ol' birds. All hens stop laying eggs in the winter. In the summer, the eggs are smaller and the shells are thinner. I've also learned that you can trick the hens into laying year-round by installing a 60-watt light bulb in their hen house to mimic 14 hours of daylight each day.

Another trick I have learned is how to identify the lazy egg-layers in the bunch, in the event one would want to use these hens in a tasty stew and replace them with more proficient egg layers. Lazy layers have smaller combs and wattles than good layers. A good layer also has a large, moist vent and a lazy layer has a tight, dry vent (I suppose I already knew that). The abdomen of the hen should be round, soft and pliable rather than small and hard.

To keep eggs rolling in, it seems we will have to buy or hatch a batch of chicks every year or two. As soon as the replacement pullets start laying, we are suppose to get rid of the hens. If we do this each year, we can sale the chickens because they will still produce a fairly good amount of eggs, but if we do this every two years, we can use them in a good stew (although if you remember from a previous post, skinning a hen was way more work than I am interested in committing.)

We have been unsuccessful in learning our counties code for chickens and roosters, even after searching on line through county ordinances, Indiana legislature and asking the police officers here in town. We are going to let our neighbors complaints guide us for now. A friend of ours down the street has a rooster and I never realized it. The goats on the next block are tolerated and they clearly are louder and a more obvious farm animal in the middle of town, so we're crossing our fingers.

Noah has them tucked under a heat lamp and Mike has plans for a chicken coop. Stay tuned.

Concierge Fee

A few years ago when I opened my practice I was told by a friend that a larger MD homebirth practice in her area charges a concierge fee in addition to the fees for their medical service. I am not sure I had much opinion about it at the time and clearly clients were willing to pay for it, so I just stored the thought away. This past week, one of my birth assistants cut out an article from the Indianapolis Star titled, "VIP treatment from your doc will cost you: concierge practices offer face time, for a yearly fee." Today, I applaud these practices.

Insurance companies contract providers, meaning they will put them in their network and refer their clients to them, but they have to settle with a drastically reduced fee. Mike sees a few physicians quite regularly and recently was charged $210.00 for a particular service that the insurance company paid in full at $21.00. Although we had no additional expense, it infuriated me! The only way a practice can survive at such low rates of reimbursement is to offer the bare minimum care and do it at a lightening rate speed so they can see as many clients as possible within any given clinic day. Counseling a client, educating them, and building a relationship is not reimbursable.

Medicaid is also guilty of minimal reimbursement. Indiana Medicaid does not recognize Nurse Midwives as independent providers so clients must find a physician willing to write a referral for all their maternity care to their chosen midwife. Then the midwife must call their specific managed health service and obtain a pre-authorization prior to every single visit or ultrasound. After each visit, they must file a claim for the care and while coordinating care for Medicaid clients is twice the work, our reimbursement is less than 25%... that is if it isn't denied all together.

You might think as I once did that fees are marked up extraordinarily to compensate for these low cuts. You would be wrong. The fees charged by your medical provider aren't simply to reimburse the time and expertise of your provider, but they also cover the building fees in which you visit your provider for that medical care. They cover the phone number, cell phone, internet access, fax number, utilities, professional fees, liability, supplies, capital expense, additional employees, gas, automobile maintenance, continuing education, student loan debt, billing, electrical documentation programs, storage fees for medical charts, marketing, and on and on and on. The fact is, Maternity Services DO NOT create a profit.

They don't bring money to any hospital in any community that I am aware of. The reason they exist in the facilities they do is almost always because it is believed that if you birth your child in a remote facility and you enjoyed your experience then you will bring your husband, children and parents back for their medical needs. The maternity centers wine and dine you so they can get your money later in genuine medical care offered elsewhere in the hospital. Larger facilities are much the same, but also use the service as a teaching opportunity for their residency programs. It is a well known fact that maternity care is very costly and the reimbursement falls hundreds of thousands of dollars short of covering its cost.

My strategy initially was to remain outside of insurance company contracts and be paid as an out-of-network provider assuring that I received the minimal dollar it requires for me to maintain a safe practice. This has its advantages and disadvantages, but ultimately will only be a viable option until another midwife opens her own practice and accepts a contract so that I have to follow suit to remain competitive.

Practices who request the concierge fee might be on the right track. I wasn't able to hire assistance until after my second year in practice, which means I independently managed every single aspect of my practice, both business and clinical. In effort for me to meet the needs of my clients more effectively, I had to hire additional staff. This increases my costs yet I have not increased the cost to my clients. I have however, decreased my one-on-one time with my clients and have drastically decreased my availability via phone and e-mail. I would be thrilled to hire additional staff to manage the many tasks that are outside of my own expertise, which would equal the entire business component of the practice, and spend more time with my clients. Clearly, the only way to do this is to increase costs beyond what insurance is willing to reimburse. A contracted provider would have to write off this fee, but bundling a fee for the additional time required to build a respectful relationship with a client and sharing expertise beyond writing a script into a concierge fee is potentially, genius!

American College of Nurse-Midwives: Legislative Update

Health Care Reform Update

The election in Massachusetts on Tuesday, January 19^th, to fill the seat Senator Edward Kennedy (D-MA) held for several decades, has taken the wind out of health care reform in Congress for the moment. The victory of Senator-Elect Scott Brown (R-MA), a Republican who ran on a platform sharply critical of the current federal health care reform legislation, is impacting movement of health reform legislation since no Republicans have been willing to support the legislation as it stands and Democrats in the Senate no longer have sufficient votes to pass a bill.

Legislators on Capitol Hill will need more than a few days to get over the shock of the election outcome, which has stalled efforts to reform the nation's health care system. At this point, ACNM is being told by members of Congress and their staffs that the House will not take up the Senate-passed version of health reform, which would have been the most direct route to a final bill for President Obama to sign into law. The path forward is not clear as of today, but will likely include a modified bill that is scaled down from what we have seen passed in the House and Senate.

ACNM continues to advocate for meaningful reform that addresses a woman's access to essential primary care and maternity services. In the coming days and weeks, ACNM will ask you to contact your members of Congress in relation to health care reform as the way forward becomes clearer. We want to make certain that the gains made for women and midwives in both the House and Senate bills are not lost in a modified health reform bill. ACNM will keep you up to date on major developments regarding this legislation.

FREE VBAC conference

The National Institutes of Health (NIH) will host a FREE conference on vaginal birth after cesarean March 8–10 at the NIH campus, in Bethesda, MD. For registration details and/or to learn how you can get involved, please visit here.

"Mom! You are blinding me!"

Simon had been playing in mom's office, with her teaching pelvis and breastfeeding dolls.

Aren't I adorable?!

This is my thinking face and I am going to get that camera!

I suppose a few pretzel sticks will do for now.

Samuel loves to take pictures and apparently he was too close for Simon's comfort, and maybe Sean's as well!!?

Hum...maybe that is Simon wanting his turn at taking pictures?


This is Sean, Candice's new husband. They were married just a few days after Simon was born. He is a great guy, a school teacher in Indianapolis at one of the alternative schools. As I understand, he is contracted with Teach for America and although his concentration was in history, they assigned him to teach English. We don't see much of them and haven't gotten to know him well, but the kids absolutely adore him, particularly Noah.

They came over a few days after Christmas to bring us all gifts and visit. They were well thought-out gifts which was quite endearing. Noah was given a gift to a hockey game, which they just attended this past weekend. He was thrilled. Keely was given a book, I believe about purity. Hoping she's read that! She also received some Starbucks money. Simon was given a Bible story book that Keely reads to Samuel each night before bed. Samuel received a soft sweatshirt that if I remember correctly was to remind him of the Lord's arms wrapped around him. They had cards with each gift that were very well thoughtout and again, very endearing. Mike and I were given a box of chocolates and coffee from Fair Trade. Fabulous.

Keely is always the party pooper on Christmas morning. She is not a morning person...none of us are...but she doesn't even enjoy being woken up to open presents on Christmas! Last year we sent her back to bed and opened gifts without her because she was so rotten. This year I tolerated her but I am guessing Santa just might not want to bother her next year.

These are our walls stripped of a century's worth of wall-paper too! Mike has taken the week off work to finish the plaster, prime and paint. It looks so beautiful. I can't wait to share.

This was the same phone toy I had as a child. He really loves it. I don't think my other kids have ever seen a phone like that! Ha! I am so old.

Noah always wanted skulls on his clothes and I wouldn't allow it. I was in the giving mood when I bought these, but they won't ever leave the house. This top he has on is a gift that mom snuck into our house through my sister. We hadn't a clue where the extra gifts came from on Christmas Eve and I asked everyone multiple times so we could thank them and I was so mystified. I didn't put it together until later. I am not sure why they were so secretive. It was a very kind thing to do.

Samuel likes to play with each toy as he opens them. He got the most this year because he was at that perfect age. The older kids were being surprised with a vacation, which Samuel wouldn't benefit a great deal from, so they got fewer gifts. Samuel took all day though, wanting to savor each one as it was opened. There was no rushing him and much as it was killing me!

Isn't he handsome. I love opening the stockings, mostly because everyone forgets about them and then is so relieved when they realize there is more to go! ...sort of like when your alarm clock went off in the morning as a kid and then you realized it was Saturday and you could go back to sleep. Ahh!

Just starting to become mobile.

Eyes the presents...

He's up!!!

Stretch!!!

Got 'em!

Christmas 2009

This year really snuck up on us. We got our tree up late and failed to get any lights up on the house. This always makes me feel so miserable. We did have a nice year though, although didn't even make any homemade gifts!

What was most memorable though, was a surprise visit by some of my family. As you know, we just don't have much relation with any of our extended family members. My grandmother though, has been dropping in from time to time these past few months and it has been quite enjoyable. She seems to really like our house and has passed the word among her family that they should come see our home. On Christmas day, she showed up with one of my aunts that I haven't seen since...well, unfortunately her own daughter's funeral this summer...but prior to that, maybe twenty-five years? Oh, no, this aunt and another one took me to court when I was eighteen years old over real-estate. Aren't we an interesting bunch?

It was so nice to see them though and I am glad they came. Corbin in this first picture is my newest aunt, adopted by my grandmother. She is Noah's age and absolutely sweet as pie. I'll have to say, she really seems to make my grandmother happy. They are so incredibly enjoyable. Noah stayed the night with them during one of their trips here and he was so delighted when he got home. It is odd that he is so unaccustomed to staying with family, although I never had any growing up either. I was very happy for him though.

Of course, the other beautiful brunette is my niece, Breanna. She is my sister's pride and joy. I think she looks a lot like one of my cousins, and her Dad. She is very sweet and tender-hearted. Simon was a bit over whelmed with all the people in his house, but he just sat and stared, loving it.

This is the group. Breanna is holding Simon. The young boy beside her is my cousin Rachel's young boy, Lane (not sure if there is an "y" in there or not). He is actually related to a friend I had in high school. Small world. Corbin. Noah. And the two wild ones in the bunch, Samuel and Averi. I think they look just alike and they are very much alike in demeanor. I have about five of these pictures and everyone looks pretty much the same in each one except those two are all over the place - on the ball, off the ball, on their head, hanging off the couch...whew!

Beautiful Keely and the old woman. Sorry, I'll have to crop her out of the picture on another edit!

My Journey to a VBAC from Lindsey Meehleis on Vimeo.


I had the pleasure of having a week, even a little bit more, of vacation from my practice. The Lord did not send us any moms for the month of January and I took it as a clear indication that He felt it time that I rest. I knew I was exhausted. I just didn't know how much. I knew I was growing bitter. I hadn't realized how much.

I don't know that I could have done it any other way, but the sacrifice that was required the first two years in practice to get to where we are today is accomplished and from here forward I vow to better care for myself and my family and my staff, so that I may be a better midwife.

Never did I grow weary in attending births. They continued to fascinate me and demonstrate how great our Lord is, but anything beyond birth seemed a bit daunting each morning. By Wednesday of this week however, especially by Thursday, I was missing my clients. I longed to feel another pregnant belly and sit and talk with another mommy. Being back in the clinic today was fabulous, in spite of my starting the day with my pants unzipped.

I hope you enjoy the above birth video. It made me cry. Her face speaks to why I do what it is I do, and why I thank the Lord that I was called to be His midwife.