Living Blog at CIMS "Reframing Birth and Breastfeeding"

The Coalition for Improving Maternity Service is co-hosting a conference with the Breastfeeding Feminism Symposia Series this weekend in Chapel Hill North Carolina. I'm there and I'm live blogging on my facebook page.

The topic is "Reframing Birth and Breastfeeding: Moving Forward" with great speakers like Eugene Declereq, Penny Simkin, Robbie-Davis Floyd and other experts in public health, breastfeeding, advocacy and birth.

Midwifery as A Calling

You have to check out this post at The Gift of Giving Life and read about how Mormons in the early days of their church considered midwifery a position in the church where women were called according to the inspiration of the spirit to serve the women in their congregations. Unfortunately, this practice did not persist beyond the days of birth moving to the hospital but for the time that it did exist, I can only imagine how empowering, spiritually uplifting and community strengthening such a tradition would be. 

As a Mormon by conversion, I am wistful for the days of this practice and wish that society hadn't changed so much that midwives called in each ward or take became a thing of the past. Right now in the church, there is no structure in the organization to connect Mormon (or as I prefer LDS) women with LDS midwives. I know they exist, along with a score of doulas, childbirth educators and birth junkies because I have become acquainted with many of them across the internet. 

I know that I as a birthing woman would love to work with an LDS midwife or have an LDS doula. I don't even know if there are LDS doulas or midwives in my area and I wish I did. I love the Christian midwife that I worked with during my last pregnancy but a Christian worldview was second best in comparison to a Mormon worldview. (I can clarify on this if my readers are interested). 

As an aspiring midwife and birth attendant, I feel prompted to offer my services as a doula during labor and postpartum to the women in my local congregations. In the past I have tried to get the word out that I am interested and willing to offer this as an act of service but like I said there are few ways to get this known to the local women. Meetings are structured so that there is time for very little else and the scope of the LDS church's women's organization is so broad that its hard to cover all of the many ways that relief can be provided through charity. 

I would really like to see a directory/registry/list of LDS doulas, midwives and childbirth educators that is shared on the internet for LDS women to refer to as they are looking for maternity care. In a way, it would bring back a little bit of the community that once existed in the church with Relief Society sisters literally providing relief during some of the most important and hard work of a Mormon woman's life.

Since the church is organized in geographical areas called stakes, I would love to see this list be organized by stakes. Usually a stake covers a city or town (or in some cases a few towns near each other) and has around 1,000 members of the church. Its usually within driving distance from one end of the stake to another and given the distances that I've heard some midwives travel to assist women at their births seems doable for one woman in the stake to reach any and all of the sisters when she is in labor. And there's nothing wrong with having more than one midwife listed in a stake. 

The main difference between a list like this and the former way of issuing callings is that no one is assigned to be a specific midwife or doula to a certain area. There could be a dozen midwives and doulas in a given stake (oh what a dream!) and there wouldn't need to be competition or obligation. A childbearing woman has so many options when it comes to birth attendants (hopefully) that often what she needs to make an informed choice is access to information about the options available to her. I truly think that if LDS women knew that there were LDS women near them who were trained and qualified in attending births that they would work together in many cases. What a blessing that would be to the community of sisters! 

Who's with me in creating his list? Do you know of any LDS doulas, midwives or childbirth educators in your stake or ward boundaries? Are you one? 

Or even better, does what I'm hoping for already exist?? 

Going global

I'm coming out all over the place, as a feminist, as a Mormon, as an activist, as an aspiring midwife. Awareness and passion for all of these ideas and activities has led me to expand my focus for what is wrong with the world and what I can do about it.

There is a great deal of conversation on birth blogs that birth advocacy is a inherently biased by privilege, class and race. And I could honestly be a poster child for that. White, middle-class, advanced education, had a negative birth experience and got all uppity about it. In my defense, I had to start somewhere and have my feminist awakening in some way.

I truly believe that my experience giving birth to Willem humbled me in a way where I felt compelled to be more compassionate and empathetic to the suffering of other women. I felt the need to do something about it and one step at a time, my perspective broadened and I took in more of the needless, unethical suffering women experience the world over.

For a few years now, I'm worked with Solace for Mothers and the Coalition for Improving Maternity Services on The Birth Survey. In the last year however, I felt strongly that there is more that I can do than tackle birth from a privileged view.

Some of the efforts of others have brought me to this awareness of thinking outside myself and people most like me. Through their efforts I have found the solidarity of sistership that comes from just being a woman among women. I know I will never be able to set aside my race or my privilege entirely but I cannot let that be an excuse to not be involved in where help is needed and where I am capable of doing something that can help.

Two documentaries shaped this broadening of thought and feminist activist: firstly, Tanya Lee Jones' documentary on preconception education and reducing prematurity in low-income, black America (I cannot find the link for the life of me, maybe someone can help) and "A Walk to Beautiful" which is the story of obstetric fistula patients in Africa who for years, in cases, are unable to access health care to repair their childbirth injuries.

Then I was introduced to two books, "The Life You Can Save" and "Half the Sky" both of which I reviewed (links go to my reviews) where I learned some of the simple ways to make an impact in relieving the suffering and poverty of women in developing countries.

In some ways, the activism work that can be done there seems much more simple than the activism that I do there. In developing countries, often it is infrastructure building and small micro-loans that can make a world of different to women and children who are without means to care for and educate themselves.  Yet, here in the United States, and especially with birth activism, its not about lack of resources its about misplaced resources. It is easier to build something than it is to move a monstrosity of an establishment that is entrenched in its ways.

Maybe its an act of trying to comfort myself, when I feel discouraged in getting obstetric violence laws enacted in the United States, or changing the way providers treat women during labor, I know I can get on Kiva.org and make a loan that will better someone's life.

But yet it goes beyond that, I want my children to have an awareness of the world that extends beyond vacations and resorts. I'd like to take them to Africa someday, not to stay where the tourists are, but to work with an organization like THARCE-Gulu where they can play with the local children, while my husband and I work to make a difference in people's lives. If one is going to travel to see the country and learn the culture, than what better way than among its people?

Please excuse the disjointedness of this entry. I am making sense of what is available to me and what I can realistically do. As a child being raised an a Unitarian Universalist, I developed a desire to make a difference and change the world. Now as a young mother, I'm still figuring it out. For a while I thought it was through my own family and being a mother to my children. But in being a mother, I found that I can be involved in changing the world for them. And it is through those efforts, that they too might have a desire to change the world for others. I do not need to put off these efforts until they are older, Someday I do hope to be a service missionary for my church and travel to countries in need of humanitarian aid, but as I learn about volunteer opportunities, I find that I can do some of it now and with children.

My next step is to figure out which organizations will encourage families to volunteer together. I know of WWOOF.org where families with young children can go and volunteer on organic farms around the world. I hope that someday my husband and I will do a trip like that, but I also would like to find opportunities that are more in line with my interests as a feminist, and birth activist.  Do you know of any?

Geeking out with Christ's birth

I found this tonight which I think is interesting:

December 8th: Immaculate Conception of Maryis celebrated in many Latin countries as, according to Catholic doctrine, the day of the conception of the Virgin Mary. The doctrine says that God had preserved Mary from original sin, giving her his grace, the divine life of Jesus Christ.

Read more at Suite101: Winter Holidays, Celebrate December!

This is actually referring to Mary's conception and birth but my mind immediately went to thinking about Christ's conception, and Mary's pregnancy with him. Fitting as its Christmas time and all.

We know that Christ wasn't actually born at Christmas time with most scholars thinking that he was actually born early to mid-Spring. Latter-day Saints believe he was born in April. Using the date, April 6, I thought it would be very cool to know the date of his conception AND birth.

If he had been born at 40 weeks gestation exactly, he would have been conceived in mid July. Using the birthing window that many women not ever faithful in their calculated due date, He may have been born between 37 weeks to be full term and 44 weeks at the outside, meaning he could have been conceived as early as mid June or as late as early August.

Wit that, I then ponder what those last few days of Mary's pregnancy was like based on those 2 scenarios.

First:

The Mary is compelled to go to Nazareth with Joseph to pay the taxes decreed by Cyrenius and she was full-term but not quite to 40 weeks. Maybe she was 37 or 38 weeks pregnant. She hopes that on the trip the baby will not be born and she can return to her home in Galilee to give birth after the tax collecting is done.

The long, arduous, dusty and dehydrating trip caused contractions to start before her due date. As she arrives in Nazareth and they are looking for an inn, she is having contractions and they are increasing in intensity and regularity. If she were me, she'd been freaking out a little. They settle into the stable and within a few hours, Christ is born into hers or Joseph's hands.

The other scenario:

She's past her due date like the majority of first time moms, the baby hasn't been born yet and they have to get to Nazareth to obey the decree of the governor. She hopes that either the baby will wait until after they get back or that the baby can be born before they leave. In most mother's minds, anything is better than laboring on the back of a donkey or giving birth far from home without the presence of wise women: mother, aunts, sisters and cousins. She doesn't get her wish and contractions start during the trip. She's contracting while trying to find a place to birth her baby. The stable does the job and the Christ child is born there.

Either way, my heart goes out to this young girl who gave birth far from her family and home amongst animals and hay. Maybe she was as Zen about it as she is portrayed in the scriptures, but maybe that was a very stressful and upsetting situation for her to be in. Either way, I've been in both of the situations described above. And honestly, I think the over-due scenario would be worse.

Though its not mentioned, I do guess that Mary and Joseph would have been able to locate a midwife to attend the birth if they so chose. Though perhaps it was in the day when the midwife only was called when assistance was needed after some concern or complication arose. Whether Christ's birth was attended by a midwife or unassisted is a toss-up. The unassisted birthers like to claim that Christ was an unassisted birth, so for the sake of not knowing, I won't rain on their parade.

Alright, end of birth geek mode at Christmas time, but that's what you get from a midwifery student...

Sacroiliac Joint Dysfunction

I've mentioned before that I've had intermittent hip pain since my last pregnancy. I had a spell for about a year where it didn't bother me (from August of 2009 to around May of 2010) so I thought it was something that I could just let work itself out. At some point, I realized that its become too much of a fixture in my life so I needed to do something about finding the root cause. On my birthday this year, it got really bad again so I became serious about addressing it.

I recently visited my naturopathic doctor/midwife who listened and poked around my hip and lower back to try to isolate where the pain was coming from. She mentioned the sacroiliac joint (a joint connecting the sacrum in the low back to the pelvic girdle. Its connected with ligaments and covered with cartilage). She then referred me to a physical therapist who specializes in lumbar-pelvic PT. While I'm waiting for an appointment with the PT, I've been doing some internet homework to try to figure out what is going on. With sacroiliac as a clue, I started my searches.

And this is what I found:

Another common cause of SI joint dysfunction is pregnancy. During pregnancy, hormones are released in the woman's body that allows ligaments to relax. This prepares the body for childbirth. Relaxation of the ligaments holding the SI joints together allows for increased motion in the joints and can lead to increased stresses and abnormal wear. The additional weight and walking pattern (altered gait) associated with pregnancy also places additional stress on the SI joints.

Any condition that alters the normal walking pattern places increased stress on the SI joints. This could include a leg length discrepancy (one leg longer than the other), or pain in the hip, knee, ankle, or foot. Patients with severe pain in the lower extremity often develop problems with either the lower back (lumbar spine) or SI joints. In most cases if the underlying problem is treated, the associated lumbar spine or SI joint dysfunction will also improve.

The most common symptom of SI joint dysfunction is pain. Patients often experience pain in the lower back or the back of the hips. Pain may also be present in the groin and thighs. In many cases, it can be difficult to determine the exact source of the pain. Inflammation and arthritis in the SI joint can also cause stiffness and a burning sensation in the pelvis. 1

Several things can aggravate the SI Joint too. Continual sitting or lying on the affected side will impinge nerves and skew the pelvis. Remember, the body will adopt a bad posture and accept it as normal after a period of time. The pain often worsens when riding in a car, sitting in a movie theater or putting weight on the hips while walking (for example, carrying a child). 2

As I read these findings, I was nodding along.

Pregnancy? Yes

Short leg? Yes (caused by scoliosis)

Pain in the low back, hip, thigh, and thigh, stiffness, burning, and difficulty determining the source of pain? yes, yes and yes.

Sitting or laying on the affected side aggravates? Yes

Worsened pain when carrying a child and walking? Yes (that's exactly what brought it on today, actually)

I'm still using chiropractic, yoga, massage and hip circles to address it. Hip circles, actually, make the most difference when my SI is tight and hurting. I'll have to remember to eat eggs for breakfast tomorrow and its probably time to make my grandma's famous baked custard because that's a mega dose of eggs and so good.

In addition to suggesting physical therapy, my naturopath suggested looking into craniosacral work. She also gave me a medical referral for massage. And she reminded me, which is embarrassing that I completely forgot, about homeopathic arnica for muscle soreness. I've also been seeing an Upper-Cervical chiropractor which is new and different for me than the typical pop and crack chiropractors I've been seeing.

At this point, my husband and I swearing off conceiving another baby. In my lower moments, I come close to despairing and giving up getting pregnant again ever. We even put the option of surgical sterilization on the table, which is a momentous and terrifying thought to me. In having those conversations, I realize in a new way how much I love and appreciate the children I have. I knew then that I can be happy being mother to my two and not regret having another. Still, if it is possible, I hope to recover enough that I can physically handle another one or two or three pregnancies and births. My hopes aren't so high so I can content myself with whatever that is coming my way.

Based on what Vanessa said on my blog page, I'm glad that I'm planning to put off more births. She told the story:

"That is what derailed my planned homebirth with Tess. It was excruciating and worse than any labor pain -at one point, I almost blacked out, threw up and peed myself from the pain. Thought I was in transition -except I was 1cm and 50% effac...ed. Saw an osteopath at 40+3 who tried her best to fix it, but couldn't really do anything. It took a long time to get better. I mainly saw the osteopath, but have also considered a chiropractor (and acupuncture) in case it comes up again in a future pregnancy."

I definitely hope I can avoid that. I have heard acupuncture being helpful for hip joint problems but I haven't pursued it yet either.

I'll update as I meet with and learn more from the physical therapist. I do hope that we can welcome additional biological children into our family and that it will not be at the expense of my physical well-being.

If you are interested in reading other posts that chronicle what I now know is SI joint dysfunction see the following posts (starting from earliest to most recent):

Belle's Birth Story: I describe the moment I felt my SI stretch abruptly.

Not a very interesting update: I describe the hip pain for the first time
Been Away: Started yoga at 3 months postpartum to be gentle on my hip (instead of returning to Irish dance)
Preparing to conceive again: I started wanting another baby but was feeling ambivalent because of my hip problems.
A remedy that might help my hip pain: I learned about lecithin to relieve joint pain
Check that Off the Bucket List: My husband and I took a massage class where he learned some strategies to help massage my hip when its hurting

Midwifery Inquisition: Enrolling in Ancient Art Midwifery Institute

Today I learned that AAMI is offering a new discounted price of $2850 for their 3 1/2 year advanced midwifery study coursework and I told some friends about it. I've gotten a couple of questions in response, so I figured I would share them with my readers because many others have the same questions or would also appreciate my answers.

Courtney wrote:

Hi Jenne,

I hadn't thought to start my education and training so soon, but this looks like a fabulous opportunity. There is a line on their website that actually mentions getting it done with young children so that it is possible to start practice when they are older. Just what I had in mind so it really spoke to me.

I know that you have started the coursework yourself, so I was interested in how easy you think it will be to truly work on it with babies around. Also, will I really be able to do it all at a distance, until apprenticing? And which of the extra coursework packages would you recommend? I like the idea of getting a bit more in depth education while I can and having longer to complete it, but was curious if you thought it was worth it.

Also, do you have an opinion on Doula certification programs? I've looked into several, and like the philosophies of Childbirth International, Birth Art International, and CAPPA and ALACE. DONA seems wise for referrals and recognition, but I don't like how rigid their restrictions and philosophy appears to be.

I was going to work on this first before midwifery, but maybe I will do them simultaneously.

Any feedback would be appreciated.

Thanks!
Courtney

Hi Courtney (and Chrissy who also asked)

I found myself in the same situation as you. I knew I wanted to do it and then was offered a discounted price and decided to take it up now instead of waiting until later. I've been enrolled since June and I have set aside Saturday mornings to work on it. I find that I can make really good progress if I have that 2-3 hours to just sit down, focus and get to work. Throughout the week I am able to get another few hours in after the children go to sleep at night. I've set up a work space right next to their play area so I can work on some of the definitions and worksheets (to help you take notes on important texts) while they play. Each definition takes a few minutes so if I'm interrupted frequently, there's no interference. Then there is nap time when I can get a bit done. That's how I've been able to work on all my organizations and schooling. I am looking forward to more interrupted time to work when my mom is closer to us and can watch the children, but so far I'm doing fine with my husband being my back-up and not hiring out for childcare.

At this point, I'm not planning on enrolling in any of the extras. I feel like I need to focus on the basic and minimum requirements and if I want to take on additional options later, I'll do that. I do expect to do a number of AEUs and will probably go for the Masters in Midwifery. Right now, I'm so involved in my phase of coursework that I haven't given much though to additional coursework. From what I've seen, AAMI offers so many extras that I have to streamline and learn to say no to some opportunities so I can be successful in my original commitments.

At one point, I looked into all of the doula certifying courses and I came to same conclusion as you about DONA. You might want to look into PALS which is local to the Northwest because its less impacted by political compromises like DONA has been. The in-person sessions would be in the Seattle area but only 3 days a time so you might be able to travel to the distance (and I don't know, stay with friends in the area...). I never got as far as choosing which doula certification program to do because I realized my interest was more in midwifery.

One thing to keep is mind is that AAMI does encourage its students to become childbirth educators in the course of the program so you may find that you'll end up do both, all three or dropping doula because support is covered in the midwifery training.

One thing that should be clear that AAMI is training midwives to be home birth attendants only. You would have the option of taking the test to become a CPM (certified professional midwife) which may allow you in some states to work in birth centers or hospitals. Basically by enrolling in AAMI, you are stating your allegiance to personal, in home, mother-centered care and supportive ultimately of a woman's right and ability to make choices for herself. These choices could include giving birth unassisted and the coursework provides training to you on the why's and hows of being supportive of women who choose that course. This is radical, feminist midwifery with a God-fearing bent. Its amazing and wonderful and I love it. In July I attended a Midwifery Skills Lab where I met other AAMI students, teachers and the founder and they are virtuous Christian feminist women, not what I was expecting from a profession that is stereotyped as atheist hippies.

Let me know if there are other questions I can answer. I would love to have a personal connection with someone also enrolled in the program.

Honoring our Veterans

Disclosure statement: this is not your typical Veterans Day message. I do appreciate the service of my ancestors, relatives, friends and fellow Americans in the armed forces and recognize the sacrifices that families throughout the world make when their nations and people engage in war. This post will be highlighting the fight that women find in the battlefields of their lives.

The authors of "Half the Sky: Turning Oppression into Opportunity for Women Worldwide" cite a statistic that in the years during World War I, more women died in childbirth than men died in battle. An even more interesting and galvanizing statistic would be comparing the number of women who have died in childbirth compared to the number of men who have died as a result of war in the course of history.

Another recognized fact is that a woman dies in childbirth somewhere in the world every minute which is over half a million a year. In addition to deaths, one in three women throughout the world experience the surgical removal of the fetus. The trauma rates of childbirth, expressing itself as PTSD up to 6% of the time, is also about one in three. This trauma can be caused from fear of losing the baby, intense physical pain and even violence perpetrated by health professionals. The number of abortions that take place through the world is upward of 40 million a year and spontaneous miscarriages and stillbirths are known to happen in approximately 30% of pregnancies. In countries where rape is used as a weapon of war, many babies are conceived in trauma and horror. In the Unites States were one in three girls experience sexual assault or molestation in their lives, childbirth can be a triggering event leading them to recall their assault. That's a lot of death, grief, trauma and loss caused by or experience in a normal event and that's not quantifying the childbirth injuries or complications like obstetric fistula, nerve damage, postpartum hemorrhage, etc.

Its not just a developing world issue, women in the developing world face the same possibilities though in some cases with reduced risks.

I think its safe to say that giving birth is the woman's war. Its the battle between life and death coalescing into a brief period of time ranging from a couple hours to a couple of days and it can happen a number of times in a woman's life. Though the total fertility rate is around 1.7 in many developed countries, some women give birth many more times than that in their lifetime.

And every woman has her birth story. That she often remembers in great detail throughout her life and into old age.

Childbirth has been an intensely fulfilling, peaceful, joyful and safe experience. While men can beat their swords into plowshares and refrain from war, women cannot stop bearing children (if we want our species to survive). Yet we can make childbirth safer, more fulfilling and joyful for women around the world. By ignoring, and allowing the governments of our planet to overlook childbirth issues, we are saying that a war on women ought to continue.

Each woman who has given birth is a veteran. Whether she bears the physical scars of a C-section, episiotomy and stretch marks or the psychological scars of a traumatic birth experience or she can returned home the victor after an orgasmic birth experience, she has survived and come out the other side of an intense battle for autonomy, confidence, life and attachment.

Today may be a day to recognize Veterans of wars and armed forces, but my remembrance is called up to my mothers and sisters who give birth.

Any remembrance post that is calling attention to an important topic needs a How-To address this issue. I'll refer you to the appendix in Half the Sky as the authors have created an impressive lists of ways to address global issues impacting women.

Removed My Amazon store

In catching up with blogs today, I've become alerted to a boycott being instituted against Amazon.com. Evidently they are selling, and defending their right to sell, a book written as a how-to guide for pedophiles.

This, understandably, has a few (read MANY) people upset and it leaves me wondering how it is even legal. First Amendment and Freedom of Speech, yes--all well and good, but basically an admission of guilt and incitement of others to commit a crime?

To find out more, read posts at We Are That Family and PhDinParenting.

My response is to suspend purchases from Amazon until they decide on the correct course of action. I also removed the link to my amazon store posted at the footer of my blog.

Dreaming of a Garden

This last planting season, I experimented with a vegetable garden for the first time in my life. Our apartment community provided P-Patches and in our we planted a variety of vegetables. I was anticipating disappointment so I was pleasantly surprised to be able to harvest beets, carrots, kale, swiss chard and cabbage from our garden. I enjoyed watching my children eat strawberries off the vine. On the other hand, the tomatoes rotted on the vine before they ripened (it was a hard season, very cool, not a lot of sun), the spinach and basil didn't come up, the cilantro dried up.

Now that I've met with some success and learned some things, I am really looking forward to the next planting season. I've gotten an idea of the types of vegetables that we use the most and want to grow on our own. Kale is one that we want to grow a great deal of because we know we would use it. Basil is another. I'll try tomatoes again but I'd probably start them from a nursery bought plant rather than seed. We'd do strawberries again, but probably in ground rather than in containers. The carrots were probably the biggest success though a few ended up looking more potato shaped.

One of the reasons why I'm getting so excited is that we are currently house hunting so I'm keep my eyes open for yards that would make for good planting. The current leader on our list of possibilities has the perfect 15 x 15 area for a garden. There's a small fence with a gate to keep children from playing it and jutting off one side is a side yard large enough to plant a small orchard.

If we are fortunate enough to move into that house, I would be so very happy to plant a great deal more next season than I did this last year. I would hope for an over abundance of kale and carrots. And really hope that we get some tomatoes.

My husband has a colleague who grows large quantities of tomatoes each year that she can make a freeze soups, sauces and eat many raw throughout the season. I aspire to something like that, because we love tomatoes in this house.

This year I was going for simple success, next year I'll be trying for abundance. This is going to be a long winter of anticipation...

EC: 17 months

Belle is indicating more and more frequently when she needs to go to the bathroom. A couple of months ago, she would adamantly nod her head if you asked "Do you need to go potty?" when she did need to go. Then she transitioned to nodding every time you asked, regardless of real need. That was fun...

Now she will start to pull at her clothes, her diaper, point to her bottom, run to the bathroom or nod at the person closest to her. Sometimes she'll grab my finger and pull me towards to bathroom and other times, she'll look intently at me like I'm supposed to know exactly what she needs.

She's starting to vocalize what she needs and will say "Puh" when pointing to her bottom. That's when I know she needs to poop. I'm glad and I think she's glad she knows that having poop wiped off her bottom is unpleasant and unnecessary for us both.

After months of frustration with the little potty, we finally found one that works for her. The Bjorn Little Potty would slide on the linoleum floor and was often very cold so she refused to use it. She preferred the adult toilet with the child insert. This was fine, but it was often a challenge to get her all the way up the stairs to the toilet before she released. When I saw this design for a potty chair, I figured it was worth a try. It has rubber stoppers on the feet to prevent it from sliding and was of a more substantial weight and a better height for her to sit comfortably.

Now she will take herself over the her potty chair and sit down. Sometimes she forgets she has clothes on so I have to watch pretty closely. She's not able to get herself onto the adult toilet yet on her own but she can with her potty chair.

She is starting to keep herself dry most of the time. When visiting friends, she'll indicate that she needs to go to the bathroom. Out and about in the car or on walks doesn't work so well. She is mainly nonverbal when it comes to her communication so when she's sitting in her rear-facing car seat, I can hear or see if she's indicating her need.

There are times when its obvious she needs to pee or that its a normal time for her to pee (after waking up from a nap) and she will refuse. At those times, I won't push her and keep up asking her more frequently until she does go.

She is starting to communicate with others regarding her elimination needs and not just me. The other day when our neighbor cared for her, Belle kept her diaper dry all day. She let the neighbor take her to the toilet and indicated when she needed to go. I was very impressed.

Today, she stayed dry all day and this is becoming a more regular occurrence. I found some underwear for her to start wearing and I dress her in soft knit pants that are easy for her to pull down. She's starting to try to pull her pants up herself and put her underwear on too.

Some nights she will stay dry. For a few months, it was more reliable but these days its not so much. Belle isn't particularly a fan of undressing to go to the bathroom at night, and I don't blame her...

I don't know when I'll start dressing her in underwear full-time; probably when she has a verbal cue for needing to head to the potty. Right now I use diapers as insurance. I expect she'll keep it dry but if in case, she doesn't we don't have a puddle to clean up. And she will let you know if she's about to pee in her diaper. She gets really upset and will scream about it. This can be hard to understand the meaning of her screaming in the moment because there are so many other things she could be screaming about. I'm really looking forward to the day when I hear her yell "Potty!"