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} | 4,218 | Thursday, 13 October 2016
The currency effects of Brexit
Sterling is falling. Predictably, the financial press describe its slide as a "pounding" and gleefully tell us that sterling is the worst-performing currency after the Argentinian peso.
But some people are cheering. Falling sterling is good for exports, isn't it? So if the pound keeps falling, the UK's large trade deficit will start to shrink, reducing the UK's dependence on external financing and hence its vulnerability to a "sudden stop".
Sadly, it's not that simple. Falling sterling is not an unalloyed good for exporters. The real effect is considerably more nuanced, and over the longer term, not necessarily positive.
As an exporter myself, I am certainly enjoying the pound's fall. These days, most of my income is in US dollars. This is how GBRUSD has performed this year:
Since my income is in dollars but my outgoings are in sterling, I've had a pretty substantial pay rise.
But my chickens will come home to roost shortly. The price of petrol is about to rise by 5p a litre because of sterling's fall. That is a real cost which I cannot avoid, since my singing teaching requires use of a car. My income is still rising, but my profits will be diminished by rising costs. When the fall in sterling affects other business costs too, such as air fares, train fares, hotels and subsistence, I might be looking at a rather substantial rise in my costs.
Business costs are already rising for exporters whose business inputs are raw materials and intermediate goods. And all of us face higher energy and transport costs, because the UK is dependent on imports of oil and natural gas, and those are priced in dollars and euros.
This chart from Reuters shows that producer price inflation is already rising fast:
The net gain for exporters is still positive, but energy price rises have yet to bite. Exactly how much of the income improvement due to currency effects will be wiped out by rising input costs remains to be seen. For some exporters - especially in the UK's fragile manufacturing sector - it could even be a wash.
And that is before we get to the effect of inflation on labour costs. I face rising prices for food, clothes and other consumer goods. As a sole trader, my profits are my income, so I will shortly face a reduction in my disposable income as inflation eats into my profits. But businesses with employees are likely to face demands for wage increases. The businesses most affected will be those that have skill shortages, powerful unions and/or need seasonal labour that could now be hard to come by, because the weak pound makes temporary migration from overseas less attractive.
The fact is that the UK is an import-dependent economy, and sterling's fall makes imports more expensive. For businesses, this means higher costs. For households, this means lower living standards, at least in the short term. As Paul Krugman says, sterling's depreciation makes Britain poorer.
Over the longer term, we might find that higher import prices encourage the growth of domestic industries producing goods and services that can substitute for expensive imports. But there are two obstacles to this.
The first is the UK's dependence on imports for energy. High energy prices due to sterling's weakness will put downward pressure on domestic demand, simply because people will prioritise heating, lighting and fuel over consumables. We've seen this before: high oil prices in 2010-13 were a major reason for the failure of the UK's recovery after the financial crisis. There is no reason to suppose that this time would be different.
The same energy price constraint bites on domestic businesses, which would face higher costs than their overseas competitors. Given this, would they really be able to undercut importers by enough to generate widespread substitution effects - especially if, after a hard Brexit, the Government decided to cut import tariffs unilaterally, as some have suggested?
We need substantial investment in replacement energy sources as North Sea Oil dries up. The UK has neglected this investment over many years now, and it is about to pay the price for this folly. Replacement energy sources take quite some time to come on stream, and during that time the UK will face higher energy prices and associated inflation, to the detriment of households, businesses and the economy as a whole.
The second obstacle is inward investment. The UK has historically been a favourite destination for foreign investors, attracting more capital investment than anywhere else in Europe. This is no doubt due to its dominant financial sector, deep and liquid capital markets, and enormous supply of investment assets. Being a favoured investment destination is of course, something of a double-edged sword: the UK's yawning current account deficit is to a considerable extent due to its attractiveness to foreign capital (the capital account is the mirror image of the current account, so a capital account surplus is matched by a current account deficit). But if the UK is to develop new domestic and export businesses, it will need inward investment.
Some people seem to think that the current starry performance of the FTSE 100 indicates that inward investment into the UK is holding up. Sadly, this is not true. The falling currency is a clear sign that investment is leaving the UK, as are rising yields on gilts. At present, all the signs are that investors are becoming exceedingly wary of investing in the UK.
All of this leads me to conclude that those who think a falling pound will somehow bring about radical rebalancing of the economy away from financial services and towards revitalisation of manufacturing are taking far too simplistic a view. The UK economy is highly financialised and largely consists of service industries. Manufacturing is still about 14% of the economy, but the heavy manufacturing of the past is gone: UK manufacturing now is specialised, highly skilled and makes extensive use of imports. Even were foreign investment to hold up, it would take a very long time for the UK to expand manufacturing to the level of say Germany. It's worth remembering that a 25% devaluation in 2008-9 made little significant difference to manufacturing production or goods exports. As I said above, why would this time be different?
Sterling's fall should be regarded as at most a short-term monetary stimulus to the economy. The UK now has the loosest monetary policy in the G7 (eat your heart out, Kuroda-san!). This is in large measure the reason for the apparent calm in the UK economy, along with buoyant consumer confidence (which is no surprise, since the great British public apparently believe that leaving the EU and restricting immigration will make them more prosperous). It creates a breathing space in which the Government can devise a sensible approach to leaving the EU. But if it is to foster lasting change, it must be partnered with a radical fiscal response involving substantial infrastructure investment, a properly funded business bank and a realistic industrial strategy. Without these, sterling's fall will simply herald the dawning of a poorer, meaner future for Britain.
Related reading:
Brexit is making Britons poorer and meaner - The Economist
UK's trade-weighted currency index slumps to historic new low on hard Brexit fears - The Independent
Brexit and Britain's Dutch disease - FT Alphaville
1. Great Article! You might have added a few things things, I'll be brief (and somewhat clumsy) since I am on mobile:
First, Russia suffered a shock since 2014 when oil crashed;this was on top of a decline in investment and the economy since Putin started nationalising things around 2012 or so.
In the UK's case the currency crash is already happening since investors can anticipate the decline in the pound. But the actual reduction in export revenues nor any potential decline in productivity or increase in the state sector hasn't happened yet. So there is much more pain to come.
Second, you will likely see an increase in political instability going forward as the depreciation starts to make itself felt. This will drive away even more investors. The "people's power" could be the thin end of the wedge, like the start of the French Revolution.
Third, the UK's food dependence guarantees trouble. The UK will not be able to impose tariffs on food or otherwise dissuade foreign countries from selling into the British market IMHO unless it wants to end up like Russia. Since Moscow has imposed "counter-sanctions" on foreign produce, combined with the depreciation in the ruble, Russians now spend half their income on food.
So the UK will not be able to prevent the EU from just dumping its surplus production on Britain without British farmers getting reciprocal rights. It would suit the EU to wreck the UK's agriculture in any case to prevent competition and for geopolitical reasons. The alternative is for the UK to risk food riots it seems when combined with a weak pound. So this will weaken the UK's hand during the Article 50 negotiations.
Fourth, a weaker currency means that the UK's geopolitical weight is smaller, which makes trade deals harder to get. A smaller economy can't afford to open as many diplomatic missions abroad either.
In particular, the military will be hurt by an inability to buy expensive equipment and components from abroad, so their means less F-35s or noise reducing components for submarines and the such. This will be embarrassing when the cuts are announced. The UK is a merchantile sea power, not a frugal land power like Russia; I'm not sure it will cope with these changes circumstances well
The cumulative effect will be to make the UK less useful to the US, so Washington will be less inclined to do favours for London, or turn a blind eye to things like shady tax schemes in the City. This will diminish the pound further,
Fifth, I'm not sure how the UK could break out of a wage-price spiral with stagflation in this political climate. Thatcherite tactics would just make more trouble. This will cause inflation to increase even more.
I am seeing hints of Latin-American style populism that will be very hard to get away from if it gets into the UK's political system. It could be considered a bad political equilibrium.
Sixth, as the pound gets weaker and more volatile, an independent Scottish currency will be more viable. A country at risk of breaking up will find it harder to attract investment and will be more unstable.
Seventh, All of these factors are mutually reinforcing to some degree. Most people seem to expect
pound-euro parity to be sufficient to balance out the current account deficit. But taking all of the above into account, the true equilibrium will be lower, I'm not sure by how much though.
Finally, Ireland and the punt might give an idea for the future of the UK going forward, the Irish Central Bank was always paranoid about inflation.
1. I might rephrase part of that post actually since it was potentially unclear.
Instead of thinking of modelling the rate of the pound, or even modelling the British economy, think in terms of modelling the UK as a holistic entity.
The UK as an entity roughly consists of several "systems" : the political , the economic, the military, the diplomatic and so on. In this case the monetary system could be viewed as a subset of the economic system.Obviously all of these various parts interact with each other.
A sufficiently severe shock in one system can propagate to the other ones and influence them. The first order effect can then spread out again in turn and so on and so on until a new stable point is reached.
A currency crash will weaken the UK politically and militarily. But the weakness there can feed back into the economy. This in turn means a weaker currency which will weaken the UK further.
In the meantime the political system is becoming less effective: Scotland is considering seceding. Politicians call for price controls and complain that the Bank of England should be serving the people instead of fatcat bankers.
London finds it harder to get the ear of Washington, which diminishes its influence in Europe further. As a result, EU policy tends to be more anti-British which harms the UK's economy and causes more political instability.
I could continue adding in more factors, but I think people get the point.
The breakup of the Soviet Union, which was precipitated by an oil price crash, shows how far this could go. The UK in 5-10 years time will likely be weaker in every dimension and not just in macroeconomic terms, as a result any long term forecasts of the state of the British economy based on economic models alone are likely to be too optimistic.
2. Seems like British economists forgot the external conditions of the UK in the post-war period. And even then, the UK had a larger manufacturing sector than nowadays. Import restrictions and exchange controls were the norm, am I wrong? Devaluations weren't much of a help even at that time. This is my main disagreement with MMT people who believe that floating your currency solves the balance-of-payments constraint. You had a good post on this before.
3. Perhaps you were saying this, Frances, but it doesn't feel apt to describe the UK's unusually high historical inward FDI as good "performance". I appreciate the capital and current account are both endogenously determined, but it seems much more likely that the FDI was driven by strong imports than that the foreign demand for FDI pushed the UK to a large current account deficit.
As I see it, the main component of inward FDI which is surged is retained earnings at the UK affiliates of international corporations.
1. I really don't agree. Imports do not drive the demand for London property, nor for sterling-denominated financial assets sold worldwide. The UK's economy is financialised and it hosts the world's premier financial centre. That, not imports, is what drives the UK's current account deficit - just as the US's current account deficit is driven by global demand for US dollars and US treasuries.
4. The last three UK Article IV annual reports from the IMF indicated overvaluation of Sterling estimated at 12%-18% in the latest report. With a current account deficit reaching 7% of GDP the “kindness of strangers” has, perhaps, reached its limits.
1. Please don't read too much into the current account deficit. The trade deficit is much smaller and very stable. The big increase in the last couple of years is because of divergence of returns on sterling and Euro assets, which is mainly due to ECB monetary policy.
2. I think the contrast to Brexit inspired depreciation and current account inspired depreciation is well founded. Maybe, Brexit was the final straw but the trade weighted index has been trending down for a while. The BoE underground blog has a good piece.
3. Very sorry, Mike, but Dork of Cork is banned from commenting here, so I've deleted his post.
5. I am in the opposite situation to you: earnings in pounds but costs in dollars; so e.g. a 2kg bag of sugar is now 1.66 and before 1.42, approximately. But still a leaver. If UK businesses as these fine folks suggest are partly just using the depreciation as a cover to increase their sterling prices then that will gradually come into the spotlight: no increase in output etc. Marmite should be going through an export boom as a wholly UK made product without any currency depreciation import inflation costs yet they are raising their UK prices. If they have raised their export sterling price then it is clear that they are just profiteering at the expense of UK output.
1. You seem to be suggesting that Unilever was taking advantage of the sterling fall to force through an unwarranted price rise on a product on which its costs had not risen.
I'm afraid I disagree. Unilever produces its accounts in Euros, so it faces translation losses on all sales in sterling, regardless of where the product is produced. So although Marmite is produced entirely in the UK, Unilever would still want to raise the sterling price if sterling fell versus the Euro. In fact, although it caught the attention of the UK media because it is an archetypal British product, Marmite was far from being the only product affected. Unilever wanted to raise prices across the board.
2. Why is Unilever trying the same thing with some Irish supermarkets?
6. Frances, yours is more or less the line taken by Eichengreen as well.
Although I don't quite understand what the fuss is about. That Brexit is a shock is clear, capital flows are reversing. Would it have happened anyway at some point in the future given the high CA deficit? Maybe but who cares. Now the point is: the UK with a floating currency can implement countercyclical policies (fiscal and monetary) to respond to the shock. The ball is in the government side now.
It should be stressed though that if UK had a peg (or had joined the Euro) the impact of the capital flight would have had pro-cyclical effects with much much worse consequences on output and employment.
In the end, crises happen, whether triggered by political decisions or by changes in investors' mood. The UK has the tools to respond, unlike some of its EU partners. Let's hope they use the tools well now.
1. Mirco, I completely agree. If the UK were in a fixed exchange rate system the policy options open to it would be far more restricted and it would be at serious risk of a "sudden stop". Because it has an independent and well-respected central bank, and control of monetary policy due to the floating exchange rate, it can buffer the productive economy to a considerable extent. With supportive fiscal policy, we should be able to ride out this short-term storm reasonably well.
That said, however, the Bank of England can't do everything. Falling sterling does mean inflation in essential goods, particularly oil, gas, foodstuffs and raw materials. This means firstly that businesses will face higher costs, which will squeeze their profits if they are not exporters. Only 11% of UK businesses are exporters, so that means MOST UK businesses will face higher costs. This is bound to have negative consequences for wages and employment. On top of this, households face higher domestic bills. So real incomes will be squeezed from two directions. The Bank of England could raise interest rates to prevent inflation rising too much, but at the moment the Governor is signalling that monetary policy will remain loose. This is probably wise: raising interest rates into a short-term supply shock is not good policy unless inflation is really spiralling badly, which at the moment it is not. It is widely thought that the ECB raising interest rates in the 2011 oil price shock triggered the Eurozone crisis. The Bank of England won't have forgotten that.
Longer-term, recovering from what will be quite a nasty supply-side shock will require fiscal, not monetary, policy.
7. Back to coal then as the indigenous energy source?
1. Not coal but new very efficient combined cycle gas power stations. Natural gas import prices are at a "[...]current level of 4.21 (MMBtu), down from 4.47 last month and down from 6.71 one year ago. This is a change of -5.82% from last month and -37.26% from one year ago". It is a pity that these price reductions are not fully passed on to consumers in our dysfunctional energy markets.
2. Interesting. Why can't these new systems be stuck on top of fracking ng wells, not literally, but very local to the well.
3. Horizontal fracking too new to understand lifespan of a single well. Many small gas plants, e.g. one per site, would be uneconomic. Also, the opposition to fracking might be overcome by the small footprint of well site. But a 200MW plant with electricity pylons to the grid would be hard to disguise with a few trees. And, it is doubtful that a single field could keep such a plant running so build near additional supply points.
BTW - cheaper energy equals cheaper Marmite.
Admirable reply. You can make a valuable contribution to the specific requests asked for by the new infrastructure commission. It does cover energy production.
5. UK fracking due to start early 2017 and Ineos already importing cheap US shale gas via Grangemouth. I suspect Ineos is considering building/buying CC gas plants once it has secured sufficient [cheap] gas supply.
6. Can they not be persuaded to do some crude refining too: jet a1 and diesel with chemicals in completely modern plants.
8. The long term success of the UK economy has been chronically neglected by successive governments for decades. It is now in permanent decline heading towards third world status.
The "point scoring" adversarial political system is unable to establish and support longterm multidecade policies to bring the economy out of the mess.
Built upon an empire, essentially theft from other nations, the uk has since done almost nothing to remain globally competitive. All the hubris has to be knocked out of the island and the stark reality that the uk is now an insignificant and unattractive place to do business must be faced.
India is the largest industrial employer, China is to build a nuclear power station, France is to supply steel for submarines. Britain has entirely lost the plot, seemingly an economy based on rising house prices and a parastic financial industry.
Inward investment? Oh dear, another symptom of third world status. If the uk had an economy then the uk would be making investments abroad, not expecting developing countries to invest in the uk. Which they will no longer be doing, as the gateway to Europe is now closing.
There is no hope. The uk has become a nation of property speculators and benefit collectors run by a bunch of self-serving incompetent politicians.
1. You seem to hit the nail on the head, good and hard.
9. Maybe somebody has already made this point - in which case, apologies - but we keep hearing about serious skill shortages in the UK (which of course is one very good reason why we need well-qualified immigrants). But improving the skills levels of the existing population is much easier said than done, and successive governments have been trying, and failing to correct this problem for decades now. My point is that while it may be a "good thing" in the long run to move away from an unbalanced, finance-based economy, we won't be able to do this without a radical improvement in skills. And it could take a generation, IF it ever succeeds. Our comparative advantage in finance has developed over two or three centuries. You can't just wave a magic wand and turn the UK into....Germany.
10. "But improving the skills levels of the existing population is much easier said than done, "
We did do this rather well during WW2.
How many UK citizens could pilot a four-engine plane, service a radar installation, or even drive an HGV, in 1939?
Mind you, I suspect this was accomplished without input from even one Professor of Education.
11. The GB Pound exchange rate seems to be following a linear downward trend that was going on before Brexit.
In graph #1, if you drew a strait line from the 1st data point to the last you roughly get a linear interpolation (line) fit. The divergence seems to be three months before Brexit when the pound exchange value was rising above the linear line. Then you get reversion to the line with an temporary overshoot after the vote.
Thus, it might not be the fault of Brexit, as the fall started earlier.
1. No way. The sudden fall in sterling in June is very clear, and even more evident on the GBPEUR chart in my latest post. Also, a chart going back further would show sterling falling from the beginning of the year. News reports throughout this time clearly show the fall was due to Brexit uncertainty.
An interesting attempt to rewrite history,but I'm not convinced.
2. "News reports throughout this time clearly show the fall was due to Brexit uncertainty."
So, that explains more than year drop.
Thank you. I stand corrected for analyzing from a foreign country such little information as a graph of two variables. (GBPUSD exchange rate and time.)
After doing some research, it looks as if the referendum was known before it's announcement in February of 2016. As, and in out referendum was a campane promise by Mr. Cameron who was elected prime minister in May 2015. And, there must have been discussions and news before as you mentioned.
My speculative interpretation was not intended to rewrite history. I should have framed it as a question.
So, are the folks in the financial markets acting that far ahead, before referendum announcements?
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} | 2,146 | Patrick Minford's holidays
Skewering Patrick Minford has become something of an economists' bloodsport. I admit, I have done my fair share of Minford-bashing, though I do try to stay away from trade economics. Others are much better at lampooning Minford's antediluvian approach to trade economics than me.
But when Minford starts pontificating on the effect of currency movements on the balance of trade, I can't resist getting out the shotgun. Minford is appallingly bad on anything that involves foreign exchange. He just doesn't seem to understand how floating exchange rates interact with trade dynamics and capital flows. So it is unsurprising that his latest venture into this complex subject is as disastrous as the last.
Here is Minford, in the Express, talking about Brits and their holidays:
The mood of British consumers is good, reflecting the fact that the economy continues to grow and create record employment.
A staycation is best because of the Brexit devaluation, which makes British holidays unbeatable value and is driving a strong improvement in the UK’s balance of payments.
As a reminder, here is the Brexit depreciation,* charted:
No, you are not seeing things. Most of the real depreciation happened before the Brexit vote. Maybe the FX community priced in Brexit even though they didn't really expect it? Mind you, the pound has never recovered - perhaps Brexit might have something to do with that. Though personally I think it is more likely that what is keeping the pound down is the total shambles that the Government is making of Brexit. Would you invest in sterling assets right now, if you didn't have to?
But even if there were a "Brexit devaluation", the notion that it makes holidays in the U.K. "unbeatable value" for Brits is completely loony. What sterling depreciation has done is make holidays everywhere else more expensive for Brits. Holidays in the U.K. are no cheaper than they were before. They may even be more expensive, if the tourist industry is cashing in on a windfall from Brits forced to forego their customary 10 days on the Algarve. You know, demand rising faster than supply results in higher prices? For some reason, when foreign exchange is involved, Minford's grasp of basic economics seems to desert him. However you look at it, British holidays for Brits are not "unbeatable value". They are a poor substitute for the sun and sand to which Brits have become accustomed. I would also have to say, from my own experience of holidaying in the U.K., that even with sterling depreciation they may not work out much cheaper than a holiday abroad. Entertaining the kids in the British rain can be extremely expensive.
But are holidays in Britain "unbeatable value" for everyone else? This is sterling versus the U.S. dollar:
Hmm. If I were an American, I would be kicking myself if I didn't visit the UK in late 2016 or early 2017. That was "unbeatable value". Now, not so much.
It's also worth noting that the "Brexit devaluation" in the second half of 2016 was short-lived: by the end of 2017 the pound was almost back to where it had been before the vote, though not back to where it was in 2015. Sterling depreciation in 2018 is mainly because of a very strong dollar, driven up by Fed interest rate rises, quantitative tightening and the Trump administration's tax cuts. The pound is far from the only currency that is depreciating versus the dollar.
How about Europeans? Here's sterling versus the Euro:
Holidaying in the U.K. looks pretty good for Europeans right now - as indeed it has for the whole of the last year, largely because of the strength of the Euro due to the Eurozone economic recovery. Yes, you read that right. The persistent weakness of sterling versus the Euro is because the Eurozone is growing more strongly than the U.K. The U.K. may have record low unemployment, but real wages are barely keeping pace with the inflation caused by sterling depreciation and, more recently, oil price rises. Furthermore, U.K. GDP growth has collapsed since the Brexit vote and is now weaker than in either the Eurozone or the U.S., according to the OECD:
.But what about the "mood of consumers"? Is it as buoyant as Minford says? Here is what Deloitte has to say about U.K. consumer confidence right now:
Consumer confidence improved in the second quarter of 2018, according to the latest Deloitte Consumer Tracker. Overall consumer confidence grew by two percentage points to -4% benefitting from the effects of a strong labour market, gradual wage growth and the feel-good factor associated with the start of the summer...
Eh, wait....minus four percent?
...This represents the highest level of consumer confidence since the Tracker started in 2011 and comes after a year of consistent growth from a low point of -10% in Q2 2017. However, there is a note of caution alongside these results as confidence remains in overall negative territory.
Consumer mood, gloomy but improving. Hardly "good", is it, Patrick?
But I have been saving the best till last. Minford says that the "Brexit devaluation" - which remember is now over two years old - is "driving a strong improvement in the balance of payments". Now of course he is quoted in the Express, which is not noted for its strength in the economics department. I'm not sure that the average Express reader would have much idea what the "balance of payments" is. But readers of this blog do, so I've fact-checked Minford's statement. It's complete baloney.
Here is the U.K.'s balance of payments since 2015, from the latest ONS balance of payments release (which unfortunately does not take us beyond March 2018):
Perhaps my eyes aren't what they used to be, but this doesn't look like a "strong improvement" to me. It looks like a stubborn deficit in trade in goods, an equally stubborn surplus in trade in services, and some variation in primary income. The narrowing of the current account deficit since Q4 2015 appears to be almost entirely driven by changes in primary income, and all it has done is restore the balance to where it was in Q1 2015. That's not "improvement", it's stagnation.
But perhaps Minford means the trade balance, not the current account. The trade balance is the balance of exports and imports in both goods and services. Here it is from 2016 to Q2 2018:
Umm, this doesn't look like a "strong improvement" either. What does the ONS itself have to say about the trade balance?
• The total UK trade deficit widened £4.7 billion to £8.6 billion in the three months to June 2018, due mainly to falling goods exports and rising goods imports.
• Removing the effect of inflation, the total trade deficit widened £4.1 billion in the three months to June 2018; falling goods export volumes were the main factor as prices generally increased.
• The trade in goods deficit widened £2.9 billion with countries outside the EU and £2.6 billion with the EU in the three months to June 2018.
Oops. So much for sterling depreciation causing a "strong improvement in the balance of payments". Currently, the trade deficit is worsening.
The fact is that everything Minford said is wrong. There is no "strong improvement" in the balance of payments, holidays in Britain aren't "unbeatable value" for Brits, consumer mood is not "good", and although the U.K. economy is "continuing to grow", it is much weaker than before the Brexit vote. Brexit uncertainty is undoubtedly weighing on the pound, but the "Brexit devaluation" simply is not generating the benefits that Minford claims.
Of course, if Brits all chose to holiday in Britain instead of flying to the sun, there would be an improvement in the balance of payments. Perhaps that's what Minford wants. After all, his exuberant post-Brexit forecasts (as much as 6.8% boost to GDP) depend upon sterling depreciation strongly boosting the UK's external position. He's got to bring it about somehow. So, Brits, stay at home. Your country needs it.
If I were of a suspicious frame of mind, I would at this point start wondering whether Minford set out to deceive Express readers, who - let's face it - are somewhat gullible when it comes to fictitious data and voodoo economics which support their Brexit faith. But it may be that he was misquoted by Express journalists, who aren't exactly known for factual accuracy. Or perhaps he is just losing it.
Whatever the reason, those two sentences from Minford are no more true than "£350m for the NHS" on the side of a bus. And no more honest.
Related reading:
Tariffs, trade and money illusion
An Alternative Brexit Polemic
The snake oil sellers
* Minford incorrectly uses the term "devaluation" to mean "depreciation". Devaluation is a deliberate act of policy, usually in a fixed or managed exchange rate system - for example, Wilson's devaluation of the pound in 1967. Depreciation is a fall in the market exchange rate.
1. Some indication of what Minford had in mind on the balance of payments might be given by his letter to The Times from July ( His figures are correct and only a little selective. However, I think his assertion that this reflects changes in trade rather than in investment income is incorrect.
1. Thanks Nick. That's interesting. I think you may well be right about investment income. I will have a look at the NIIP for that period.
2. Nick, it's definitely caused by changes in primary income, not trade. Specifically, income from direct investment turned negative in Q4 2015, but has now recovered and is roughly back to where it was in Q1 2015. The peak to trough movement is getting on for £10bn, which is more than enough to account for the improvement in the current account balance. See chart 3 here:
2. This comment has been removed by the author.
1. I used figures going back over two years. That is what the charts show, including the trade balance chart from the latest ONS release.
I have warned you before about personal attacks and rudeness. I will not post comments from you that attack me or anyone else commenting on this site.
2. This comment has been removed by the author.
3. This is not a political post, it is simply a debunking of extremely dodgy economic assertions and wrong statistics. Please confine yourself to discussing the subject of the post and refrain from political grandstanding.
4. I remind you AGAIN of the comment policy of his blog, as stated on the About This Blog page:
- be polite and refrain from personal attacks on me or anyone else
- stick to the topic.
I will delete any posts you make that violate either of these rules.
5. This comment has been removed by a blog administrator.
6. This comment has been removed by a blog administrator.
3. Depends entirely on the period over which the analysis takes place, e.g.
1. Consumer confidence - is (i) much higher than in 08/09, (ii) lower than in 15, and (iii) had been increasing from late 17.
2. Current account balance - is significantly better than in Q5 15, worse than in Q1 17, had been trending up since Q2 17.
On the 'value' point, similarly depends on if the term is being used on an absolute or comparative basis.
Minford may not have made all of that clear. I'm not taking a position either way. But there are valid arguments supported by selective data points for his position, just as there are for yours.
4. Do other economies - the Eurozone for example - take 0.7% of all domestic sales/purchases, i.e. their GDP and send it abroad by law as foreign aid?
Our 2018 Economic growth figure is an expansion in sales/purchases (GDP) in the economy, of just 0.3%.
If 0.7% of that economies GDP is then to be taken, and sent abroad, doesn't that mean actual domestic economic activity has shrunk overall by -0.5%???
If GDP = C + I + G + (I -E) i.e. the Balance of Payments bit (Imports-Exports) on the end, means we subtract the money that is sent/spent abroad, this would indicate we are in a recession caused by excessive foreign aid payments.
How have I got this wrong???
1. It's not that simple.
Firstly, you have the national accounting wrong. Foreign aid is not part of the external sector (I-E). It is part of G. If you reduce G by that amount, total GDP is reduced, obviously. But as the benefit of foreign aid shows itself in the balance of payments (countries receiving aid can be better able to afford our exports), removing it from G only overstates GDP ex-foreign aid.
Secondly, you have GDP growth figures wrong. 0.3% is a quarterly figure, not a full-year figure. Independent forecast figures published by HM Treasury show estimated full-year GDP growth rate for 2018 as 1.4%.
Nice try, but foreign aid is a fleabite, no more.
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} | 703 | Can the U.K. Grow Through Devaluation?
Why didn’t the U.K.’s 25% devaluation work?
The answer most Keynesians immediately offer up is the U.K. government’s insistence on pursuing an austerity program during a period when there’s a shortfall of aggregate demand and a tightening of credit conditions–never mind the private sector’s urge to deleverage.
On the other hand, not everyone trusts the GDP data. U.K. employment has grown strongly during recent months, belying the GDP reports’ suggestion the country is back in recession.
But even if you doubt the GDP data, it’s hard to escape the view that the U.K. economy is struggling relative to previous recoveries.
One major problem with the devaluation was that businesses tend to take time to respond to changes in exchange rates. Supply contracts are usually for many months ahead and it takes a while for increased demand to filter through to increased investment and employment. What’s more, input costs go up pretty quickly as commodity prices rise. So the benefit of higher prices for exported goods is delayed while cost pressures are felt pretty quickly.
At the same time, households are hit by higher prices of imported goods, especially food and fuel. The Bank of England underestimated the degree of price pass-through by a big margin in calculating the effects of the depreciation on inflation.
In the U.K., price rises from the devaluation were exacerbated by rises in the value-added consumption tax. With earnings remaining static and inflation rising, British households were squeezed hard.
What’s more, the U.K.’s manufacturing sector had shrunk so much over the decades that even to the degree that it was helped by a weaker pound, the effect was swamped by the hit to household incomes.
Meanwhile, sterling’s devaluation has in part been reversed. Sterling has appreciated roughly 8% on a trade-weighted basis over the past year.
It’s not clear that devaluations are necessarily expansionary even on a theoretical basis. A paper by Paul Krugman during the 1970s argued that in so far as devaluation shifts resources towards economic actors with higher propensities to save, a falling currency can be contractionary. Which, it seems, happened in the U.K. over the past few years.
As Tyler Cowen, a George Mason University professor, recently pointed out on his Marginal Revolution blog, country-specific factors are extremely important when discussing the effects of depreciation.
What’s more, to the degree that foreign exchange movements are a barometer of sentiment about an economy’s future outlook, a falling currency can be a disincentive for companies to invest. This is most easily seen by the relative performance of the German, Japanese and Swiss export sectors during their strong currency periods. Firms invested in labor-saving technology, went up the feeding chain in terms of technology and quality, and therefore to higher-margin activities.
And yet the Bank of England is committed to its view that the way forward is growth through a weaker pound through continued expansion of its quantitative easing program and lower for ever interest rates. Maybe it’ll work. Eventually.
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} | 1,521 | Does a devaluation help the economy?
A devaluation (depreciation) occurs when the exchange rate falls in value. This causes exports to be cheaper and imports to be more expensive. In theory, it can help increase economic growth, though it may cause inflation.
In theory, a devaluation will cause the following to happen:
• The price of UK exports will be lower in foreign currencies. This will increase the competitiveness of UK exports and should cause an increase in demand for UK exports.
• The price of imported goods into the UK will increase. This will reduce our spending on imports and instead we will be more likely to buy domestic goods.
• The increase in (X-M) should cause an increase in Aggregate Demand (AD), economic growth and cause a reduction in unemployment.
• The increased competitiveness should cause an improvement in the current account on the balance of payments.
The impact of a devaluation depends on economic circumstances.
• If a country is suffering from being uncompetitive with high unemployment and low inflation – a devaluation may help considerably.
• However, in a severely depressed global economy (e.g. 2008-13), a devaluation may be insufficient to restore economic growth.
• The fall in the value of the Pound (2016) is partly due to concerns over Brexit (British exit from EU). This is causing uncertainty and will likely to reduce investment from export firms. In this situation, the devaluation will probably do little to boost economic growth. However, with inflation near zero, the usual inflationary pressure of devaluation will not be a problem.
UK Devaluation between 2008 and 2013
Between 2008 and 2013, the Pound experienced a 25-30% devaluation in Sterling, but the UK had only a weak recovery, some cost push inflation and a surprisingly large current account deficit. It seems the depreciation in the pound did little to help the UK economy. This was due to several factors
• Demand for exports and imports relatively inelastic. UK continued to import more expensive German cars, but export demand also inelastic.
• Weak Eurozone growth. 2008-13 was a period of low EU growth, therefore more competitive UK exports were insufficient to boost export demand.
• Fiscal austerity and fall in bank lending were major factors depressing the economy. Therefore, the devaluation was insufficient to compensate for the fall in other components of AD.
Pound Sterling Index
Pound Sterling index. The Index measures the value of the Pound Sterling against a basket of major trading countries.
Impact of devaluation on economic growth
1. Economic growth. In terms of economic growth, the five years after 2007/08 devaluation were relatively low. The devaluation was insufficient to stop the deepest recession for a long time, and the recovery was weak – compared to other recoveries. (see: Comparison of different recessions)
2. Current account deficit. The current account deficit actually got bigger from 2010.
In 2008, the current account deficit was less than 2% of GDP. At the end of 2013, this current account deficit fell to more than 5% of GDP – a very high deficit (more at current account balance of payments) This seems to contradict economic theory – as you would expect a devaluation to improve the current account – not worsen it.
How do we explain the relative failure of devaluation to rebalance the economy in UK 2007-13?
1. Inelastic demand for exports and imports Evidence suggests that demand for UK exports is relatively inelastic. UK exports have become less price competitive as we’ve moved away from low-cost manufacturers to a variety of services and high-tech manufacturing; these goods tend to have relatively few close substitutes. Therefore, even if the price falls, the increase in demand is relatively low. Similarly, demand for imports is relatively inelastic meaning we continue to pay the higher price. (The Marshall-Lerner condition states a devaluation will worsen the current account if PEDx + PEDm >1)
2. Firms didn’t always pass on the effects of devaluation. In theory, devaluation leads to a lower price of exports. However, firms could choose instead to keep the foreign currency prices the same, but increase their profit margins instead. Rather than passing the devaluation onto foreign customers, UK exporters just make more profit. In a recession, exporters are keen to improve their cash balances and so are keen to increase profit margins.
In 2008, the Bank of England showed that the rapid devaluation hadn’t caused a fall in the UK terms of trade. UK export prices didn’t fall, but actually increased. It explains how a devaluation may not cause lower export prices – at least in the short term.
Source: Bank of England. See terms of trade effect
3. Weak external demand
A devaluation is not much help if your main export partners are in a recession. The double dip EU recession means there has been a fall in demand for UK exports. This has outweighed the more competitive prices. The weak external demand is a key factor in disappointing current account figures.
4. Higher import prices
UK Inflation showing cost push inflation in 2008 and 2012
The problem of devaluation is that it leads to higher import prices. Raw materials used in production increase in price and contribute to cost-push inflation. To some extent, higher raw material costs offsets the lower export prices. Recently, the Bank of England deputy governor, Paul Tucker stated he would be open to a weaker pound, but the benefits of a weaker pound would be lost if inflation expectations rose. (Reuters)
The impact on inflation has been muted because of the negative output gap; but, in the past few years, the inflationary impact of devaluation has often been greater than the Bank of England forecast and was a major factor in explaining the cost push inflation we have seen in recent years.
As a rough rule of thumb, a 10% devaluation may increase prices by 2-3%.
The components of the CPI most effected by a devaluation are (regression coefficient)
1. Air travel (-1.29)
2. Vegetables (-1.22)
3. Gas (-0.71)
4. Fuel (-0.54)
5. Books (-0.35)
5. Poor Productivity growth
Devaluation only really affects demand. The other side of the equation is supply and productive capacity. The past five years have been very disappointing from the perspective of UK productivity. Devaluation doesn’t necessarily do anything to promote investment and higher productivity. Some even argue that devaluation can reduce the incentive to be efficient because you become competitive without the effort of increasing productivity. Poor productivity could be another factor explaining the current account deficit.
Overall Impact of devaluation
Devaluation 2008-12 had less impact on the economy than we might expect. Devaluation is certainly no magic bullet, which solves the ills of the economy. Part of the reason is that the whole global economy, and Europe in particular, was depressed. In a depressed global environment, the benefits of a devaluation are muted. However, despite the limited impact of devaluation, I believe the economy would be significantly worse, if we were in the Euro and 30% overvalued. If that was the case, we would be struggling to regain competitiveness through internal devaluation – an even deeper recession.
Devaluation of 2016
What about the devaluation of 2016, will this help the UK economy?
In many regards, it may be a repeat of 2008 – a fall in the value of the Pound doing little to help the economy.
• Global growth is weak
• Demand is relatively inelastic
• The pound is falling over uncertainty – e.g. Brexit. This will not encourage manufacturers to invest.
Examples of devaluation
(1) See technical difference between depreciation and devaluation here. I sometimes use devaluation when correct term is depreciation only because in everyday language people tend to talk about devaluations when strictly speaking it is a depreciation.
By on June 2nd, 2016
5 thoughts on “Does a devaluation help the economy?
1. If firms do not pass on the price reduction made possible via currency depreciation, say by maintaining $ or Euro prices, they will receive more Sterling for their exports. If the demand for such goods is price inelastic, that might be beneficial to UK Balance of Trade.
1. So any adjustment in output would have to be in import replacing sectors. It takes time and it seems likely that the uncertainty slows down adjustment.
Nobody will add capacity while the outlook is uncertain and exporters may be happy to take higher Sterling margins rather than extra volume.
2. It depends on how quickly information is received by the parties concerned – the importers and exporters – when more time is taken, even with the devaluation Balance of trade would worsen. The situation will gradually improve as seen from the j curve effect. However, if the rate of inflation rises, than those of its competitors, a country will not be able to manage its competitiveness in the international front, and export revenue is likely to fall and imports show a rising trend. This would deteriorate the current account balance. Therefore devaluation should be exercised with great care.
3. Isn’t a further problem that the UK has lost a lot of exporting companies – particularly during the Thatcher years – so whilst the devaluation of sterling should give us an advantage we no longer of the goods to sell?
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} | 1,176 | Advantages and disadvantages of devaluation
Readers question: what are the advantages and disadvantages of devaluation?
Devaluation is the decision to reduce the value of a currency in a fixed exchange rate. A devaluation means that the value of the currency falls. Domestic residents will find imports and foreign travel more expensive. However domestic exports will benefit from their exports becoming cheaper.
Advantages of devaluation
1. Exports become cheaper and more competitive to foreign buyers. Therefore, this provides a boost for domestic demand and could lead to job creation in the export sector.
2. A higher level of exports should lead to an improvement in the current account deficit. This is important if the country has a large current account deficit due to a lack of competitiveness.
3. Higher exports and aggregate demand (AD) can lead to higher rates of economic growth.
4. Devaluation is a less damaging way to restore competitiveness than ‘internal devaluation‘. Internal devaluation relies on deflationary policies to reduce prices by reducing aggregate demand. Devaluation can restore competitiveness without reducing aggregate demand.
5. With a decision to devalue the currency, the Central Bank can cut interest rates as it no longer needs to ‘prop up’ the currency with high interest rates.
Disadvantages of devaluation
1. Inflation. Devaluation is likely to cause inflation because:
• Imports will be more expensive (any imported good or raw material will increase in price)
• Aggregate Demand (AD) increases – causing demand-pull inflation.
• Firms/exporters have less incentive to cut costs because they can rely on the devaluation to improve competitiveness. The concern is in the long-term devaluation may lead to lower productivity because of the decline in incentives.
2. Reduces the purchasing power of citizens abroad. e.g. it is more expensive to go on holiday abroad.
3. Reduced real wages. In a period of low wage growth, a devaluation which causes rising import prices will make many consumers feel worse off. This was an issue in the UK during the period 2007-2018.
4. A large and rapid devaluation may scare off international investors. It makes investors less willing to hold government debt because the devaluation is effectively reducing the real value of their holdings. In some cases, rapid devaluation can trigger capital flight.
5. If consumers have debts, e.g. mortgages in foreign currency – after a devaluation, they will see a sharp rise in the cost of their debt repayments. This occurred in Hungary when many had taken out a mortgage in foreign currency and after the devaluation it became very expensive to pay off Euro denominated mortgages.
Evaluation of impact of devaluation
• It depends on the state of the business cycle – In a recession a devaluation can help boost growth without causing inflation. In a boom, a devaluation is more likely to cause inflation.
• The elasticity of demand. A devaluation may take a while to improve current account because demand is inelastic in the short term. However, if demand is price elastic, then it will cause a relatively bigger increase in demand for exports. (See: J-Curve effect)
• If the country has lost competitiveness in a fixed exchange rate, a devaluation could be beneficial in solving that decline in competitiveness.
• Exports and imports increasingly invoiced in dominant currencies such as Euro and Dollar. This means that a fall in the value of Sterling has less impact on UK competitiveness because UK exports may be involved in Euros anyway. See paper on “Dominant Currency Paradigm” August 7, 2017 (Casas, Gopinath)
• Type of economy. A developing economy which relies on import of raw materials may experience serious costs from a devaluation which makes basic goods and food more expensive.
Case studies of devaluation
UK leaving ERM in 1992
In 1992, the UK was in recession. Trying to keep the Pound in the ERM, the government increased interest rates to 15%. When the government left the ERM, the Pound devalued 20%, but more importantly, it allowed interest rates to be cut, and the economy recovered. This is widely considered to be a beneficial devaluation. An important note is that the Pound was overvalued in early 1992.
See: also: UK in the ERM 1992
2. UK – 25% fall in value of Sterling in 2008/09
The pound fell considerably after the financial crisis of 2008/09, the depreciation in the Pound made UK goods more competitive. It also caused some cost-push inflation. The benefits of this depreciation were muted because of weak export demand in the global recession. The depreciation in the Pound also caused imported inflation, which during a time of low wage growth, reduced household living standards.
Between 2007 and 2018, UK prices rose 30%, compared to 17% in the Eurozone.
With low wage growth, imported inflation has led to periods of falling real wages.
3. Russian economic crisis – 2014
The Rouble plunged during the economic crisis. This was due to fall in price of oil and balance of payments problems. The scale of this devaluation was not helpful – causing a rise in inflation and decline in living standards. The problem was not so much the devaluation as the fact the economy was reliant on oil exports – so when oil prices fell there was a significant fall in demand for the Rouble.
See: Fall in value of the Rouble – an example of the impact of the devaluation in the value of the Rouble on the Russian economy.
Long-term effects vs short-term effects
A long-term devaluation tends to reflect an underperforming economy.
In the post-war period, the UK has experienced a decline in the value of the Pounds against its main competitors
• 1948, £1 = $4 and 13.4DM
• 2018, £1= $1.3 and 2.2DM
This shows the Pound has fallen, but in this period, UK living standards have increased at a slower rate than the main G7 economies (apart from Canada) Generally, in the long-term the weak pound is caused by a weak economy (relatively high inflation)
Note: See explanation on the technical difference between devaluation and depreciation.
See also:
By on September 19th, 2018
15 thoughts on “Advantages and disadvantages of devaluation
1. one of the disadvantage of devaluation is:A large and rapid devaluation may scare off international investors. It makes investors less willing to hold government debt because it is effectively reducing the value of their holdings. Can it work to developing countries?
2. Am sory to say that devaluation has no significant positive impact on the Nigerian economy.its disadvantage is more felt and therefore not good in our context.we havnt significant export to enjoy devaluation.
3. To some developing countries like Zimbabwe if imports are basic eg raw materials,oil wich has inelastic demand,the importers wil b left wit no altanative bt to pass the next cost to consumers by way of high prices.If so we wil be at the mercy of cost push inflation
4. What are the operation that the world trade organisation undertake to operates in global system of trade rules
5. My name is Tandaika Michael am studying at saut in Tanzania. I like to visit this site, but can we specify exactly the roles of devaluation in country’s economy??
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An appreciation means an increase in the value of a currency against other foreign currency.
An appreciation makes exports more expensive and imports cheaper.
An example of an appreciation in the value of the Pound 2009 – 2012
• Jan 2009 If £1 = €1.1
• June 2012 £1 = €1.27
• In this case, we can say there was a 15% appreciation in the value of the Pound against the Euro – between Jan 2009 and June 2012.
Effects of an appreciation on the UK economy
1. Exports more expensive. The foreign price of UK exports will increase – so Europeans will find British exports more expensive. Therefore with a higher price, we would expect to see a fall in the quantity of UK exports.
1. Imports are cheaper. UK consumers will find that £1 now buys a greater quantity of European goods. Therefore, with cheaper imports, we would expect to see an increase in the number of imports.
1. Lower (X-M) With lower export demand and greater spending on imports, we would expect fall in domestic aggregate demand (AD), causing lower economic growth.
1. Lower inflation. An appreciation tends to cause lower inflation because:
• import prices are cheaper. The cost of imported goods and raw materials will fall after an appreciation, e.g. imported oil will decrease, leading to cheaper petrol prices.
• Lower AD leads to lower demand-pull inflation.
• With export prices more expensive, manufacturers have greater incentives to cut costs to try and remain competitive.
2. Monetary policy. It is possible that an appreciation in the exchange rate may make the Central Bank more willing to cut interest rates.
• An appreciation reduces inflationary pressure so interest rates can be lower.
• Also higher interest rates would cause the currency to rise even more. If the Central Bank thought appreciation was too rapid, they may cut rates to reduce the value of the currency.
Impact of appreciation on AD/AS
Assuming demand is relatively elastic, an appreciation contributes to lower AD (or a slower growth of AD), leading to lower inflation and lower economic growth.
Impact of an appreciation on the current account
Assuming demand is relatively elastic, we would expect an appreciation to worsen the current account position. Exports are more expensive, so we get a fall in eXports. Imports are cheaper and so we see an increase in iMports. This will cause a bigger deficit on the current account.
However, the impact on the current account is not certain:
1. An appreciation will tend to reduce inflation. This can make UK goods more competitive, leading to stronger exports in the long term, therefore, this could help improve the current account.
2. The impact on the current account depends on the elasticity of demand. If demand for imports and exports is inelastic, then the current account could even improve. Exports are more expensive, but if demand is inelastic, there will only be a small fall in demand. The value of exports will increase. If demand for exports is price elastic, there will be a proportionately greater fall in export demand, and there will be a fall in the value of exports.
3. Often in the short term, demand is inelastic, but over time people become more price sensitive and demand more elastic. It also depends on what goods you export. Some goods with little competition will be inelastic. China’s manufacturing exports are more likely to be price sensitive because there is more competition.
Evaluating the effects of an appreciation
• Elasticity. The impact of an appreciation depends upon the price elasticity of demand for exports and imports. The Marshall Lerner condition stations that an appreciation will worsen the current account if (PEDx + PEDm >1)
• Elasticity varies over time. In the short run, we often find demand for exports and imports is inelastic, so an appreciation improves current account. But, over time, demand becomes more elastic as people switch to alternatives.
• The impact of an appreciation depends on the situation of the economy. If the economy is in a recession, then an appreciation will cause a significant fall in aggregate demand, and will probably contribute to higher unemployment. However, if the economy is in a boom, then an appreciation will help reduce inflationary pressures and limit the growth rate without too much adverse impact.
• It also depends on economic growth in other countries. If Europe was experiencing strong growth, they would be more likely to keep buying UK exports, even though they are more expensive. However, in 2012, the EU economy was in a recession and therefore was sensitive to the increased price of UK exports.
• It also depends on why the exchange rate is increasing in value. If there is an appreciation because the economy is becoming more competitive, then the appreciation will not be causing a loss of competitiveness. But, if there is an appreciation because of speculation or weakness in other countries, then the appreciation could cause a bigger loss of competitiveness.
Is an appreciation good or bad?
• An appreciation can help improve living standards – it enables consumers to buy cheaper imports.
• If the appreciation is a result of improved competitiveness, then the appreciation is sustainable, and it shouldn’t cause lower growth.
• An appreciation could be a problem if the currency appreciates rapidly during difficult economic circumstances.
Rapid appreciation in 1979 and 1980 contributed to recession of 1980 – 81
For example, in 1979 and 1980, the UK had a sharp appreciation in the exchange rate, partly due to the discovery of North Sea oil. The value of the Pound increased from £1=$1.5 to £1 = $2.5. However, this appreciation was a factor in causing the recession of 1981 – which particularly affected UK exports and manufacturing.
14 thoughts on “The effects of an appreciation”
1. the only problem with the appreciation is it makes the exports expensive which in turn will affect the economy after some years. so according to me the ratio of imports and exports must be maintained properly.
• appreciation will to some extent induce deflation since imports will be cheaper and domestic producers will be now loosing the market as their prices will be high so they will reduce their prices so as to fight competition against import prices and attract consumers to shift and buy domestic products.
• Foreign investment will fall in case of appreciation and pull out of the domestic country since it will be more expensive for the foreign country’s currency to convert into the domestic country’s currency after the rise in the exchange rate.
Local investment will also fall since exports will become expensive and foreign country’s may switch to cheaper exports from other countries. It will be more expensive for the local investors to undertake production for exports since entrepreneurs are often profit maximizing. However, this happens when the PED for the exports is elastic. In case of inelastic goods, exports revenue may actually rise and local investors will gain from the appreciation of the currency.
2. appreciation is good in a closed economy and in command economies but in open economies in the long run it is not beneficial
3. if a country still has fixed exchange rate system (e.g domestic currency is pegged to the dollar) and displays a large imbalance in balance of payment in form of a current account deficit then what can b e potential monetary medium to long term problems the country may face?
4. The UK is in a unique position where it doesn’t really have much to export – especially products that will be effected by fx (north sea oil etc…).
It’s therefore more suited to following an economic policy that keeps the GBP at a stronger level, since it has little to gain from exports.
The stronger GBP would also mean that the UK is able to benefit from being a strong currency haven that is able home in as a banking center.
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} | 1,990 | The Exchange Rate and the Balance of Payments
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The Exchange Rate and the Balance of Payments
For those of you who have not read the previous Learn-It, here is a quick recap. Theoretically, a current account deficit should cause the value of the pound to fall. In this case, the value of imports into the UK is higher than the value of exports sold to foreigners. Hence, the demand for foreign currencies to buy these imports is higher than the demand for the pound to by our exports. Simple supply and demand analysis, therefore, suggests that the value of the pound should fall. For a current account surplus, simply reverse the above explanation.
In the case of a deficit, the subsequent lower value of the pound will make exports relatively cheaper and imports relatively more expensive. The value of exports sold should rise and the value of imports bought should fall. The deficit should be eliminated automatically (again, reverse the explanation for a surplus).
This story worked well until the controls on the world capital markets were lifted. Once capital could go wherever it wanted, currency transactions for investment and speculative purposes took over. A country's trade position is no longer relevant. If an economy is doing well, which usually means that consumer spending is high (spending on imports in particular), a current account deficit is expected. Perversely, instead of the currency falling for the reasons outlined above, the currency is as likely to rise, because investors and speculators like to place their money on 'winners' (for example, economies that are doing well). In fact, a currency may even rise following a cut in interest rates (which would normally cause the currency to fall following the outflow of money trying to find better rates elsewhere) because the markets may take it as a sign that the economy will improve in the future! See the previous Learn-It for more discussion on the determination of the exchange rate.
In the rest of this Learn-It, we shall be looking at the theoretical relationship between a change in the exchange rate and current account disequilibria.
Assume that the UK has a current account deficit (which is not hard to do!). If the pound were to devalue (a large drop in its value) then one would expect the deficit to reduce. Why? Because exports will become relatively cheaper, and so their demand should rise in foreign markets, and imports will become relatively more expensive, so their demand should fall in the UK.
But will this always be the case? The success of a devaluation of the pound in terms of reducing a current account deficit will depend on foreigners' elasticity of demand for British exports and UK consumer's elasticity of demand for foreign imports.
The Marshall Lerner condition states that for a devaluation to be successful in terms of a reduced current account deficit, the sum of the two elasticities, must be greater than one.
To illustrate that this should be true, let's look at exports and imports separately.
Export elasticity
If you think about it, UK exporters can't go wrong if the pound falls in value. How ever small the depreciation in the pound is, and however low the elasticity for their exports is, the revenue they will receive will have to rise.
For example, let's take a car company that is exporting cars to the USA whose price is £10,000 in the UK. Let us also assume that the exchange rate between these two countries is £1 = $2. These cars will have a price of $20,000 in the USA. Now assume that the pound devalues by 10% so that the new exchange rate is £1 = $1.80. The price in the USA is now $18,000. Unless the elasticity of demand for these cars in the USA is zero (highly unlikely) then the demand for these cars in the USA will increase. Although American consumers now only have to pay $18,000, the British car company still receives £10,000 for each sale. However large or small the fall in the value of the pound is, the sterling price of the car stays the same. Even if this company only sells one extra car, they will still receive an extra £10,000.
In summary, for export revenue to rise following a devaluation of the pound, the elasticity of demand for these exports simply has to be greater than zero (which is perfectly inelastic demand). Obviously, the higher the elasticity the bigger the increase in export revenue, but anything over zero will help reduce the current account deficit.
Import elasticity
In the case of imports the situation is a little less favourable. A devaluation of the pound will cause the price of imports into the UK to rise. The demand for these imports will fall, but the revenue that the foreign producers receive will not necessarily fall.
For example, assume that an American car company exports their cars into the UK. The price for these cars in the USA is $30,000. Again, assume that the initial exchange rate is £1 = $2. This means that the price of these cars in the UK will be £15,000. Now assume that the pound devalues by 25% giving an exchange rate of £1 = $1.50. Swapping this exchange rate around to give the price of dollars in terms of pounds, we have $1 = £0.67. So now the American cars are priced at £20,000 in the UK. The change in the revenue received by the American car company will depend on the elasticity of demand for their cars in the UK.
Assume that the elasticity is 1.5, which is relatively elastic. As you will know from the topic called 'Elasticities', if demand is relatively elastic and the price rises, the decrease in demand will be relatively larger. This means that the loss in revenue from the decrease in demand is higher than the gain in revenue on each unit due to the higher price. The diagram below helps to explain:
Import elasticity
Note that the elastic demand curve is relatively flat, so that when the price rises, the fall in demand is relatively larger, and the 'gain' box is much smaller than the 'loss' box. The more elastic the demand for UK imports is, the more successful a devaluation will be in terms of reducing import revenues (which go out of the country) and the bigger the reduction in the current account deficit.
Now assume that the elasticity is 0.5, which is relatively inelastic. Again, you should know that, in this case, when the price rises, the decrease in demand in relatively smaller. This means that the loss in revenue from the decrease in demand is lower than the gain in revenue on each unit due to the higher price:
Import elasticity
This demand curve is relatively inelastic, and so is fairly steep. You can see that the price rise is proportionately much larger than the fall in demand, so the 'gain' box is much larger than the 'loss' box. If the demand for UK imports is relatively inelastic then devaluation will result in increasing import revenues (which go out of the country), which contribute to a larger current account deficit.
Putting exports and imports together
So, the condition for exports and imports separately can be summarised as follows:
Eex > 0 for a devaluation to increase export revenues
Eim > 1 for a devaluation to reduce foreigners import revenue
By adding the zero and the one, we get the following overall condition:
Eex + Eim > 1 For a devaluation to be successful in terms of reducing a current account deficit.
Note that, overall, as long as the two elasticities add up to more than one the devaluation will reduce the deficit, even if the two individual conditions above are not satisfied. For example, if Eex = 0.6 and Eim = 0.6, import revenue will rise following a devaluation, but this will be more than compensated for by a larger rise in export revenue. The elasticities add up to 1.2, which is more than one, so overall the situation improves. Obviously, the higher both elasticities are, the more successful devaluation will be in terms of reducing the current account deficit.
As the title suggests, this is a curve that is shaped like a 'J'. Look at the diagram below:
The J-curve
Let us assume that the economy is at point A, experiencing a current account deficit. The government decides to devalue the pound to help eliminate this deficit. The J-curve shows that, in the short term, the deficit may get bigger before, eventually, it starts to reduce. In other words, the Marshall Lerner condition is not satisfied in the short run, even though it will be in the medium to long term.
Why might this be the case? The main reason is time lags. It takes time for producers and consumers to adjust their purchases to the changed prices brought about by the devalued exchange rate. Certainly, firms will have orders planned in advance, and will not react to the price changes for a number of months.
Exports revenues may not rise immediately, but they will not fall either, but foreign import revenues may well rise, as increased import prices are combined with static, or at least very inelastic, demand. The current account deficit will probably get worse. After a period of time, foreigners will react to the lower export prices and UK firms and consumers will react to the higher import prices. The Marshall Lerner condition should be satisfied as demand for both exports and imports become more elastic and the deficit should start to fall.
Remember that higher import prices will feed through to higher inflation eventually. This will reduce the competitiveness of British industry causing long-term problems for the current account. This is why many politicians see devaluation as failure. Once the economy is past the trough of the J-curve and the deficit is falling, the devaluation may seem like a good idea. But the subsequent rise in inflation (the government's number one macroeconomic objective nowadays) and its implications for competitiveness mean that devaluation is never a good long-term solution. British exporters complain of the high pound, but devaluation will not necessarily do them any favours.
It should be noted that in today's world of free flowing capital, it is very hard (some would say impossible) for a government to actually implement a policy of devaluation. The markets decide the country's exchange rate. When the UK was part of the Bretton Woods fixed exchange rate system, occasional 'realignments' would occur (i.e. devaluations). Now that the pound floats on the foreign exchange markets, the currency might appreciate (rise gently in value) or depreciate (fall gently in value) but big, one off drops in the value of the currency do not really happen. The last big devaluation was when the pound fell out of the ERM and the pound fell by around 15% in one day.
The 'upside down' J-curve
The analysis above can work for countries with persistent current account surpluses that they want to eliminate. Look at the diagram below:
The 'upside down' J-curve
Assume that the economy is at point B, experiencing a current account surplus. Rather than devaluation, the government will want to revalue their currency to make exports relatively more expensive (reducing their demand) and imports relatively cheaper (increasing their demand). Again, there will be time lags. Consumers and producers will not react to these changes immediately. The demand for both exports and imports will be relatively inelastic in the short run. Export revenues will not change (a fixed UK price, remember) but the revenue paid for foreign imports will fall. This will make the current account surplus get even bigger in the short run.
In the medium term, firms and consumers will adjust their purchases in line with the changed prices. The demand for both exports and imports will become more elastic and the surplus will eventually start to fall. The result is an upside down J-curve!
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} | 2,648 | Tariffs, trade and money illusion
In the past few days, I have read three pieces from Economists for Brexit - now renamed "Economists for Free Trade" - extolling the virtues of "hard" (or "clean") Brexit and calling for the UK to drop all external tariffs to zero unilaterally after Brexit. Two are written by professors of finance (Kent Matthews and Kevin Dowd). The third is from the veteran economist Patrick Minford.
All three of these pieces wax lyrical about the benefits to GDP and welfare from unilaterally reducing external tariffs to zero. But bizarrely, not one gives adequate consideration to the currency effects of trade adjustment and the likely monetary policy response. Minford's brief discussion contains a schoolboy error (of which more shortly). The other two never mention it at all.
In today's free-floating currency regime, trade shifts and currency movements are intimately linked. Indeed, for some countries, trade shifts are driven more by capital flows and associated currency valuation changes than they are by trade policy. So I am at a loss to understand how anyone can seriously discuss trade policy without considering currency effects and monetary policy. Especially professors of finance, who really should know better.
First, let's consider how trade policy changes affect currency exchange rates. Recently, there was much discussion of a "border adjustment tax" by policymakers in the USA. The idea was that imposing a tax of, say, 20% on all imports to the USA would discourage businesses and consumers from buying imports, thus encouraging domestic US businesses at the expense of foreign exporters to the US. Additionally, US exporters would be exempt from import taxes, thus encouraging exports. The combination of the tax on imports with exemption from the tax for exporters is the reason why this is called a "border adjustment tax". It is similar to a VAT, except that VAT is typically also imposed on domestic production.
American economists Caroline Freund and Joseph E. Gagnon studied the effects of border adjustment taxes in a number of countries. They concluded that changes in the inflation-adjusted trade weighted exchange rate ("real effective exchange rate", or RER) wipe out any advantage from a border adjustment tax:
Overall, our results support the basic theoretical conclusion that RER movements fully offset borderadjusted consumption taxes, including the VAT. Our results also suggest that a large share of the movement in the RER comes via consumer prices. In particular, increases in VAT rates temporarily increase inflation, which permanently changes the RER. There is little evidence of any significant effect of border-adjusted consumption taxes on the current account balance, although there may be different effects on the components of the current account. Most of the adjustment occurs within three years.
For foreign exporters who are paid in their own currency, the effect of the import tax is a wash: the tax raises the sales price of their products in the importing country, but the strengthening dollar entirely offsets this. In theory, importers could force FX losses on to foreign exporters by insisting on paying in their own currency: but exporters faced with FX losses are likely to respond either by raising export prices in their own currency or by diverting sales elsewhere. After all, there are always other markets.
For US exporters, the effect is also a wash, since any benefit they get from being excused the import tax is lost in the exchange rate appreciation. No-one benefits from a border adjustment tax.
But wait. Aren't Economists for Free Trade talking about tariffs, not taxes?
As Gavyn Davies explains, the US's border adjustment tax plan is equivalent to a tariff on imports and a subsidy on exports. Unilaterally reducing all tariffs to zero is therefore equivalent to reducing taxes on imports without adding an export subsidy.
For example, if the average import tax is currently 25%, made up of 20% VAT and 5% external tariff, reducing the external tariff to zero is a 20% cut in import taxes. Note that domestic businesses do not benefit from this cut, and neither do exporters. Trading conditions therefore become more difficult for domestic businesses relative to foreign exporters, while export trading conditions remain unchanged if other countries do not respond to the tariff cut.
Economists for Free Trade argue that falling nominal import prices would improve people's real disposable incomes, giving a demand boost to the economy which should kickstart a supply-side response. Additionally, nominal business input costs would fall, enabling a production increase to meet higher consumer demand and improve export performance, while increased competition from imports would force domestic businesses to raise productivity, improving both GDP and nominal wage growth. It sounds like a paradise. What's not to like?
Sadly, this omits the effect of exchange rate changes. If raising taxes on imports causes the currency exchange rate to rise sufficiently to wipe out the benefit to domestic businesses, similarly we would expect cutting import taxes to cause real exchange rate depreciation sufficient to wipe out the benefit to foreign exporters.
There would, however, potentially be a benefit to exporters from the exchange rate depreciation. Therefore, we might expect that unilaterally reducing import tariffs to zero would give a boost not to domestic demand but to exports. This would apply even if trade partners did not reciprocate with tariff cuts of their own.
Neither Kent Matthews nor Kevin Dowd mention this. Worse, Minford bizarrely assumes that sterling depreciation only applies to exporters, not importers:
Now, think about what happens if we reduce our trade barriers on imports. We reduce the prices of imports to consumers, and this creates both a gain to them and more competition with our home producers, forcing them to raise productivity. This is a most definite and permanent gain to our economy - a rise in consumer welfare and in GDP. A natural by-product of this is, as we produce more, we export more to pay for our higher imports. In the short run, this comes about by a fall in sterling to stimulate these sales; in the long run, once our new markets are established, sterling recovers to its old level, its job done. We are quite familiar in the UK with this sterling movement; the pound regularly falls when we need to stimulate output in export industries, as it has done after Black Wednesday when we left the ERM, also after the financial crisis, and latterly after Brexit.
The exchange rate depreciation arising from unilaterally cutting import tariffs would benefit exporters while making no difference at all to importers? Really?
This is the schoolboy error I mentioned at the start of the post. It is by no means the only glaring error in Minford's paper, but it is the one that concerns me here. Combined with persistent confusion of nominal and real effects throughout the paper, it fatally undermines his entire economic analysis.
Falling import prices would indeed encourage consumers to spend more initially. But as the effects of the sterling depreciation began to bite, import prices would rise again. The consumer stimulus would fizzle out and sales would return to where they were before. Freund and Gagnon's research is definitive. The deflationary stimulus would be temporary, not permanent, and would be followed by rising inflation that wiped out its short-term benefits.
On the export side, as I've already noted, sterling depreciation should boost exports - although as the UK is very integrated in international supply chains, the effect is highly uncertain and could be very short term. But there is no evidence to support Minford's assertion that in the long run sterling's exchange rate would recover. To the contrary, Freund and Gagnon show that the RER adjustment is permanent - and it is the real, not the nominal, exchange rate that matters for export competitiveness.
Nor would the nominal exchange rate necessarily recover, either - at least not permanently. In each of the examples that Minford gives, the pound did indeed bounce back to some extent as the economy recovered: but over the much longer term, the story is one of continual decline. For example, sterling's exchange rate versus the dollar has declined from $4.70 in 1915 to $1.28 today.
This is not to say that cutting import tariffs is a bad thing. Reducing tariffs to zero as part of a free trade agreement usually benefits everyone. But unilaterally cutting tariffs simply cannot give the real benefits that Economists for Brexit claim. The nominal changes might look good, but they would be entirely illusory.
However, Dowd cites Hong Kong and Singapore as examples of countries that successfully operate zero-tariff regimes. If those countries can do it, why can't the UK?
There is an obvious size difference, of course. There are also significant differences of culture and regime: Singapore, for example, has high levels of state ownership and practises severe financial repression. But this post is about currency effects. Why doesn't the benefit of their zero-tariff regimes disappear in currency adjustments?
The simple answer is that neither country has a freely floating exchange rate. Hong Kong has a currency board which pegs its currency to the US dollar. Singapore's monetary authority explicitly maintains the value of the Singapore dollar within an (undisclosed) band. Neither country would allow its currency to depreciate sharply as a freely floating British pound would be likely to under a zero-tariff regime.
A unilateral zero-tariff regime could deliver the domestic benefits that Economists for Free Trade envisage if the Bank of England actively intervened to prop up sterling. This appears counterintuitive, but remember that the benefits are supposed to accrue from falling real import prices. Nominal falls accompanied by sterling depreciation would not deliver those benefits. Therefore, sterling would have to be prevented from depreciating. This would mean sharp rises in interest rates even while consumer prices were undergoing a short-term fall. In the UK's highly indebted, fragile economy, the consequences for financial stability could be severe. Anyway, why would you want to hobble exports to encourage a consumer boom, in a country that has large trade and fiscal deficits and relies on debt-financed consumer spending to maintain economic growth?
Not one of the Economists for Free Trade mentions any of this, let alone discusses it. The total absence of any consideration of currency effects in both Dowd's piece and Matthew's suggests to me that they don't understand the connection between trade and currency, which as they are not trade economists is perhaps not all that surprising. But if their grasp of trade economics is really so weak, why are they writing about it at all?
And as for Minford - words fail me. This man is a professor of economics, but his paper is riddled with elementary errors. Are these people really the best and brightest economic brains in the Brexit camp? I sincerely hope they are not. For if they are, God help us.
Related reading:
Brexit, trade and echoes of the past
Some unpleasant trade realities
The dominance of Brexit
Three reasons why the UK could be going into recession - Forbes
The "Britain Alone" scenario: how Economists for Brexit defy the laws of gravity - LSE
Brexit free trade illusions from the 19th century - FT
The economic benefits of Brexit, revisited and rectified - Professor Alan Winters
Image from Real-World Economics Review Blog
1. It's hard to know whether Minford's proposals would raise GDP and make we plucky Britons richer unless the UK's export performance under Unilateral Free Trade (UFT), as Minford's proposal has become known, is considered. On the face of it, UK export performance would be damaged by UFT because of tarrifs, or other barriers, imposed by the EU and the Rest of the World on UK exports.
As for the effect of dropping all import tarrifs the addition to GDP claimed by Minford, so far as I can determine, would depend on the elasticity of UK imports.
If the elasticity of imports is zero then the volume of imports will not change if import tarrifs are dropped. If so, then the entire benefit of the tarrif reductions will be captured in GDP such that the increase in GDP will be equal to the reduction in the nation's import bill. The reduced demand for foreign currency required to meet this new shiny import bill should by itself raise sterling's value. If so, this would logically be deleterious to UK exports, which would presumably face EU and ROW tarrifs in any case. Not good.
If the elasticity of imports is unity then there will be a small reduction in the nation's import bill leading to an equivalent small gain to GDP. Presumably a small upward pressure exerted on sterling's value will result. Consumers will presumab;y binge on the cheaper imports.
I suspect in reality import elasticity lies somewhere between zero and unity. I also suspect that any consumption binge arising from UFT will be short lived, although much depends on how the UK's post Brexit performance develops. Minford et al do not seem to have squarely addressed the issue of Britain's export performance post Brexit.
Pig in a poke, anyone?
1. Actually, on reflection, I am as probably as mistaken as Minford et al.
Changing the value of imports does not change the value of GDP (double entry bookkeeping) . So the impact of eliminating import tarrifs will simply reduce government revenue and, by itself, have no impact on GDP.
I hope I'm correct to say this
2. And there is a second error in my first piece:
Given import elasticity, then the value of imports denominated in foreign currency would rise if import tarrifs were removed. So as Frances says, this by itself would cause sterling to depreciate, not appreciate as I incorrectly first said, once import tarrifs are removed.
I believe my mistakes are similar to Minford's, ie I failed to separate fiscal effects from GDP effects.
I shall hang my head in shame
2. Its very strange that a country that is being forced to sell its own assets to pay for a massive trade deficit is seeking to devalue its assets in order to reclaim control over its assets. I suppose believing that markets buy dear and sell cheap would give every optimist a Brexit wet dream.
3. Dismal propaganda dressed up as academic argument. This is all we seem to get these days from the right especially over their pet obsessions like Brexit. The media lap it up.
4. As an aside, the UK government currently raises approximately £3bn per annum from customs duties, which would be lost under Minford's UFT proposal. His proposal, by itself, would thus increase the annual fiscal deficit by this amount.
5. Thanks Frances for this piece. I wish this type of rebuttal could be more widely published. The devastating thing is, we have triggered A50, cut the hawsers and are sailing into the Atlantic with our S/S Global Britain - I don't get the feeling it is reversible. I am extremely concerned about the UK's economic future.
6. There is at least one fallacy in this article. As far as consumers and producers are concerned, tariffs have the same effect as transport costs. They push up prices of imported products, imported raw materials and imported components. This gives rise to inefficiencies as access to the best-value source is artificially restricted in favour of the locally produced item. "Anti-dumping" tariffs are particularly damaging as producers are deprived of access to low cost inputs, which makes them less competitive. They are then fighting for market share against producers in other countries which allow the dumped items to be imported.
It seems to be not appreciated that the main losers from dumping are the dumpers who have wasted resources in producing something and selling at below the cost of production.
Exchange rates are influenced by other factors than exports and imports. Sterling is supported by the attraction of low-tax real estate.
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Tuesday, 6 December 2016
The OBR and the impact of Brexit
In doing my homework for an appearance at the Treasury Select Committee this morning, I noticed one point which is of some relevance to the debate about whether the OBR is being too pessimistic about the impact of Brexit. Two major ways in which Brexit will have an influence on the public finances is through lower immigration from the EU and lower productivity. The two are linked, because the OBR correctly assumes that lower immigration of skilled labour will in itself reduce productivity. (Productivity also falls in the OBR’s analysis because of reduced investment.)
The OBR also assumes that Brexit will reduce the trade intensity of the UK: less exports and imports. This is pretty obvious to anyone who has looked at international trade: transport costs may not be as high as they once were, but gravity equations tell us that geographical distance is still a key factor in influencing whether trade takes place, which means that reduced trade with the EU will not be matched by new trade outside the EU.
The Treasury analysis of Brexit assumed that this lower trade intensity would also reduce productivity. The OBR do not include this effect, calling it too uncertain. This is a slightly surprising judgement. To see this, look at this piece by Maurice Obstfeld, chief economist at the IMF. Here is a quote:
“Empirical research supports Ricardo’s fundamental insight that trade fosters productivity [by increasing efficiency through comparative advantage]. But the productivity and growth benefits of trade go far beyond Ricardo’s insight. With trade, competition from abroad forces domestic producers to raise their game. Trade also offers a wider variety of intermediate production inputs firms can use to produce at lower cost. Finally, exporters can learn better techniques through their engagement in foreign markets, and are forced to compete for customers by raising efficiency and upgrading product quality (for example, Dabla-Norris and Duval, 2016).”
Now few things are ever certain in economics, but none of these transmission mechanisms from greater trade to higher productivity are particularly fanciful: they all make common sense (at least as seen by an economist). They are all one directional, which means assuming an effect of zero is an extreme point in every case. In this sense, the OBR is being rather optimistic about the impact of Brexit on the UK economy.
1. 'The former Conservative minister repeated advice he gave 30 years ago saying people in the UK should follow the examples of Poland, Hungary and Lithuania...When asked if people should get on their bikes to look for work Lord Tebbit, 79, said: “Yes. People do it in Poland, in Hungary, in Lithuania. Why are they more willing to do it than we are?”' (Daily Mail, NATHAN RAO, Wed, Feb 23, 2011).
Funny how the 'semi-house-trained polecat' and his Leave allies weren't making that point during the 2106 referendum.
But they'll be back to it once the poorer Tory voters have outlived their Leavey usefulness.
2. I watched your testimony at the select committee. It must be frustrating being asked misconceived questions when the person sitting next to you shares some of the misconceptions! Well done though, just wish more MPs had bothered to show up to hear it.
1. To be fair to the MPs, the previous session (with Portes + Weale) had overrun, so our session went well over time, and maybe some MPs had prior appointments. But knowing some people watch these things helps me in deciding whether they are worth doing.
3. I have no idea of the degree to which popular optimism about "making Britain great again" reflects residual imperial thinking. But, looking from afar, I can assure Britons that there is no UK-shaped hole in the world economy waiting your return.
New Zealand had its own Brexit in 1973 when the UK unceremoniously dumped us to enter the EEC. At that time the residuals of imperial mercantilism were still alive and well. We shipped the frozen carcasses of grossly overweight sheep to London in return for Austin Allegros. Hint: it was a terrible deal all round.
New Zealand adapted because it had to. But changing after a major trade shock takes time. It feels like 20,30 or 40 years here. And all that time all the other ups and downs in the world are still going on.
Now we no longer have those special ties and I can't see us ever wanting to recreate them.
4. Alexander Harvey7 December 2016 at 04:52
Well put, and thanks.
What part of uni-directional don't people understand?
Robert Chotes (OBR) is reported to have said:
"... negative effects are partially offset by a near-term boost to GDP from stronger net trade volumes, as the weaker pound encourages exports and discourages imports and as weaker consumer and investment spending mean less demand for imports."
I noted the "nerm-term" qualifier.
FWIW I find him to be a little optimistic, but he is excellently qualified to do his job, so I defer.
Further afied:
The ONS article:
Explanation beyond exchange rates: trends in UK trade since 2007 (2013)
"Economic theory suggests that a country’s trade balance should increase following a depreciation of its currency. Goods produced abroad become more expensive compared with domestic alternatives,
while the price of domestic goods falls relative to the price of goods produced abroad. Consequently, imports are expected to fall and exports are expected to rise, leading to an increase in the home country’s balance of trade. This broad pattern is evident with a lag following sterling’s exit from the European Exchange Rate Mechanism (ERM) in 1992, after which the UK’s trade balance returned to surplus for much of the period between 1993 and 1998. However, the absence of a clear response of the UK’s balance of trade to the depreciation of sterling during 2007 and 2008 suggests that something more complex has occurred."
It goes on to comment on a modern tendency for import and export prices to move in tandem, both increasing after a sterling devaluation more or less in step.
The "textbook" divergence of UK import and export prices and the differential advantage for exporters over importers in volume terms did not hold. This may suggest that much of the "good news" over accelerating export sales is neither going to be across the board nor sustained.
5. I think your analysis is perfectly reasonable as far as it goes but it is a partial picture. I realize that it is meant to be a partial picture but Brexit is only one issue that will materially affect the economy in the next twenty or thirty years and one has to place it in some sort of context.
As far as Brexit is concerned I actually believe that the situation will be worse than even you paint it because I think there are now increasing signs that the Euro may fail and, if this is the case, then there have to be doubts about the future of the EU itself. The turmoil that may be engendered by all this is not good for the UK although of course the UK is not the proximate cause of this. If this does happen it will likely reinforce some of the factors you rightly highlight.
The more fundamental point is that Brexit is only one of several major structural issues that will determine the future of the UK economy. Both demographics and robotics/AI will be major issues over the next twenty/thirty years and, in my view, will dwarf the effects of Brexit.
My point is that you may be right about Brexit on what might be termed the ceteris paribus basis but there are other influences that are at least as important that will make a huge difference and will likely interact with the factors that you are highlighting.
6. people at the OBR know it, people at the bank of england know it, everyone knows it, but, it has become politically impossible in the UK to "question the merits of brexit".
7. No such thing as comparative advantage.
It's just another failed model using Tiger Woods cutting his neighbours grass.
8. The idea is to create MegaCityOne in the UK. In fact if you run the 'clustering' free trade models to their conclusion that is what you end up with - everybody living in a very small space.
And to think we spent the early part of the 20th century demolishing tenements as slums.
9. It might be the case that less trade lowers productivity, but I guess it is pretty hard for the OBR to quantify this. Ie, whether the effect will be significant. Whether it will be significant in the short term or just the long term.
Also given the fact that normally the direction is from less trade to more trade, it is not necessarily clear that the same would happen in the other direction. Ie. if companies have previously been in a free trade environment, it does not follow that their productivity will drop from removal from that free trade environment (it might just stay the same). Whereas it does follow that their productivity would increase upon exposure to that environment.
Also more generally lots of other things that might potentially raise productivity that I'm sure OBR do not take account of, given the complete myriad of things that will potentially be affected.
10. If Brexit lowers the 'trade intensity' of the UK, then it will presumably lower the trade intensity of the EU.
Surely, the best way to avoid this would be to have a free trade agreement between the UK and the EU. Yet oddly, the noises from the EU hierarchy are that there will be no such agreement - or that it's conditional on free movement. But I would have thought the EU would be delighted to keep more of their talented citizens rather than have them come to the UK.
Given your analysis, it looks like what seems to be the UK government's desire (free trade but no free movement) is a win-win for the EU given the UK is currently a 'net importer' of EU citizens.
Why on earth would the people running the EU not want to have something that would benefit their citizens?
Or is there something else going on? It almost seems the Juncker's of this world are more interested in 'punishing' the UK than the welfare of their own people. That way they discourage others from leaving the club and get to keep their personal power and privileges.
Sounds like a protection racket to me.
11. Obstfeld's statement ' With trade, competition from abroad forces domestic producers to raise their game' seems intuitively valid, but the problem is that the anatomy of this process is not benign. What happens is that inefficient producers go out of business with attendant job losses, while more efficient ones may or may not expand. Improvements in productivity often occur when business segments shrink to a more efficient core but this may not be accompanied by net benefit to the general population.
12. Why are you still using the Tory framing of the OBR? There is more fiscal space than that. Quit playing away from home at Tory united.
- Random
13. Thanks for this article, however can I ask whether the UK economy was in "rude good health" prior to Brexit, or whether the current and eventual impacts of Brexit will make a bad situation worse.
Since the Referendum there has been a rush to blame most things on the outcome, and I'm just trying on a personal level to put it in context.
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} | 920 | How the UK can benefit from a free trade future after Brexit – even outside the single market
The benefits of free trade have been familiar to economists since Adam Smith. Trade encourages specialisation and leads to lower costs, higher productivity and higher living standards.
Yet for some economists, things are different when it comes to the UK leaving the EU’s customs union and single market. The customs union was built on the German Zollverein model of protecting domestic industries from foreign competition around the time of German unification 150 years ago. Today, free trade is promoted within the EU, which is good. But the customs union imposes barriers to trade with the rest of the world, which is not.
The single market also imposes a hugely burdensome regulatory edifice on economic activity within the EU. Brexit will give the UK the opportunity to pursue its own free trade policy with the rest of the world and to escape the needless regulatory burdens of the single market.
Too many economists have refused to take seriously the idea that Brexit has the potential to provide economic benefits to the UK. Before the referendum, Treasury economists assured the public that a vote to leave would cause “an immediate and profound shock to our economy” leading to recession and a large increase in unemployment.
These are predictions that have since proved to be very wide of the mark. Modelling by the LSE’s Centre for Economic Performance (CEP) predicted that leaving the EU could only have negative consequences for the UK economy.
The consensus is misleading
One of the problems with much of this analysis is the apparent reluctance by many economists to model scenarios in which Brexit provides any benefit at all to the UK economy. For example, a key plank of the CEP modelling is their assumption that Brexit would cause a reduction in foreign direct investment (FDI) of over 20%.
In fact, inward investment in the UK has been at record levels since the referendum, while confidence about future FDI into the UK is higher now than before the referendum. Clearly, had the CEP been prepared to model a scenario in which Brexit increased FDI, they would have come up with a much more balanced range of estimates of the net effect of leaving the EU.
Even worse, the impression is sometimes given that the economics profession is united in predicting that Brexit can only lead to significant losses for the UK economy. In fact, as a new book by economists Phil Whyman and Alina Petrescu demonstrates, this idea of a consensus is misleading.
For example, work by Patrick Minford, chair of Economists for Free Trade (EFT), concludes that embracing free trade, regaining control over the net EU budget contributions and reducing the regulatory burden could give a boost to the UK economy of up to 7% of GDP – some £135 billion a year.
A different approach
It has been suggested that the model used in the EFT analysis is so flawed as to be worthless in comparison to the “gravity model” used for calculations favoured by the Treasury and CEP. With the gravity model, bilateral trade and FDI flows between two countries are modelled as a function of economic variables such as a country’s economic output (GDP), demographic variables such as population size, geographic variables such as distance, and cultural variables such as a common language. A standard conclusion of this model is that it is better to be as close as possible to a big trading block.
But how well does the gravity model predict trade and FDI flows? Not that well. Britain’s main trading partners in the 19th century were the US, Canada, the West Indies, Argentina, Brazil and China. Not a near neighbour from the European continent in sight. The UK’s share of exports to the EU has fallen from 54% in 2006 to 43% today, whereas given the move to “ever closer union” over this period, the gravity model would suggest that the share should have moved in the opposite direction.
In the 19th century, the US was one of the UK’s biggest trade partners.
Minford’s work takes a different approach, emphasising rational expectations and the supply side of the economy. Now, of course it is normal for economists to debate the pros and cons of different modelling approaches and it is quite reasonable to question them.
What is not reasonable is to dismiss out of hand any attempt to take seriously potential gains to the supply side of the economy and the efficiency gains from greater free trade. Indeed, Minford has made a detailed and robust defence of his model arguing that it fits the reality of trade flows much better than the gravity approach.
The Brexit issue has brought out the worst of many economists. In some cases, they have allowed their political prejudices to colour their scientific judgement. Whether or not Brexit leads to improvements or reductions in economic well-being remains to be seen.
What should not be in doubt is that there are sound economic reasons for believing that Brexit has the potential to bring about significant economic gains for the UK. The referendum is over and Britain knows that it will be leaving the EU. Rather than prolonging the discredited Project Fear, now is the time for economists to work hard to ensure that those potential benefits from Brexit come to fruition.
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Thought leadership
How the UK can benefit from a free trade future after Brexit – even outside the single market
(20 September 2017)
Professor of Finance and Economics, Kevin Dowd (Durham University), Professor David Paton (Nottingham University) and Professor David Blake (University of London) discuss how the UK can benefit from a free trade future after Brexit.
The benefits of free trade have been familiar to economists since Adam Smith. Trade encourages specialisation and leads to lower costs, higher productivity and higher living standards.
Yet for some economists, things are different when it comes to the UK leaving the EU’s customs union and single market. The customs union was built on the German Zollverein model of protecting domestic industries from foreign competition around the time of German unification 150 years ago. Today, free trade is promoted within the EU, which is good. But the customs union imposes barriers to trade with the rest of the world, which is not.
The single market also imposes a hugely burdensome regulatory edifice on economic activity within the EU. Brexit will give the UK the opportunity to pursue its own free trade policy with the rest of the world and to escape the needless regulatory burdens of the single market.
Too many economists have refused to take seriously the idea that Brexit has the potential to provide economic benefits to the UK. Before the referendum, Treasury economists assured the public that a vote to leave would cause “an immediate and profound shock to our economy” leading to recession and a large increase in unemployment.
These are predictions that have since proved to be very wide of the mark. Modelling by the LSE’s Centre for Economic Performance (CEP) predicted that leaving the EU could only have negative consequences for the UK economy.
The consensus is misleading
One of the problems with much of this analysis is the apparent reluctance by many economists to model scenarios in which Brexit provides any benefit at all to the UK economy. For example, a key plank of the CEP modelling is their assumption that Brexit would cause a reduction in foreign direct investment (FDI) of over 20%.
In fact, inward investment in the UK has been at record levels since the referendum, while confidence about future FDI into the UK is higher now than before the referendum. Clearly, had the CEP been prepared to model a scenario in which Brexit increased FDI, they would have come up with a much more balanced range of estimates of the net effect of leaving the EU.
Even worse, the impression is sometimes given that the economics profession is united in predicting that Brexit can only lead to significant losses for the UK economy. In fact, as a new book by economists Phil Whyman and Alina Petrescu demonstrates, this idea of a consensus is misleading.
For example, work by Patrick Minford, chair of Economists for Free Trade (EFT), concludes that embracing free trade, regaining control over the net EU budget contributions and reducing the regulatory burden could give a boost to the UK economy of up to 7% of GDP – some £135 billion a year.
A different approach
It has been suggested that the model used in the EFT analysis is so flawed as to be worthless in comparison to the “gravity model” used for calculations favoured by the Treasury and CEP. With the gravity model, bilateral trade and FDI flows between two countries are modelled as a function of economic variables such as a country’s economic output (GDP), demographic variables such as population size, geographic variables such as distance, and cultural variables such as a common language. A standard conclusion of this model is that it is better to be as close as possible to a big trading block.
But how well does the gravity model predict trade and FDI flows? Not that well. Britain’s main trading partners in the 19th century were the US, Canada, the West Indies, Argentina, Brazil and China. Not a near neighbour from the European continent in sight. The UK’s share of exports to the EU has fallen from 54% in 2006 to 43% today, whereas given the move to “ever closer union” over this period, the gravity model would suggest that the share should have moved in the opposite direction.
Minford’s work takes a different approach, emphasising rational expectations and the supply side of the economy. Now, of course it is normal for economists to debate the pros and cons of different modelling approaches and it is quite reasonable to question them.
What is not reasonable is to dismiss out of hand any attempt to take seriously potential gains to the supply side of the economy and the efficiency gains from greater free trade. Indeed, Minford has made a detailed and robust defence of his model arguing that it fits the reality of trade flows much better than the gravity approach.
The Brexit issue has brought out the worst of many economists. In some cases, they have allowed their political prejudices to colour their scientific judgement. Whether or not Brexit leads to improvements or reductions in economic well-being remains to be seen.
The ConversationWhat should not be in doubt is that there are sound economic reasons for believing that Brexit has the potential to bring about significant economic gains for the UK. The referendum is over and Britain knows that it will be leaving the EU. Rather than prolonging the discredited Project Fear, now is the time for economists to work hard to ensure that those potential benefits from Brexit come to fruition.
David Paton, Chair of Industrial Economics, Nottingham University Business School, University of Nottingham; David Blake, Professor of Finance & Director of Pensions Institute, City, University of London, and Kevin Dowd, Professor of Finance and Economics, Durham University
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Why fears about a Brexit ‘no deal’ are vastly overstated
Philip B. Whyman
It has become increasingly accepted, not least by the prime minister and opposition leadership, that the negotiation of a comprehensive trade relationship with the EU is necessary to prevent the UK economy falling off a ‘cliff edge’.
It is assumed by leaders of all the main political parties and the Confederation of British Industry (CBI) to be economically necessary to prioritise continued EU market access over other policy goals that could be achieved through Brexit.
This concern is shaping the UK's strategy towards negotiations with the EU and has provided at least part of the motivation for the UK to consider requesting a transition period to facilitate the Brexit process.
This approach is not, however, without profound consequences. The most obvious quid pro quo of a transitional agreement is the UK having to accept similar rules and regulations to those currently required by full membership.
The most contentious aspect of this is the likely insistence from the EU that continued access to the single market requires the perpetuation of the free movement of capital and labour for the duration of this transition term. This would be a particular problem for the prime minister, given her previous statements in favour of a tighter immigration system.
A lengthy transition period also has the potential to further undermine the status of politics and politicians for those who voted to withdraw from the EU given that, more than half a decade after what had been portrayed as a decisive vote, there would have been little substantive change on the ground.
Given the pivotal nature of the ‘cliff edge’ hypothesis, it is perhaps surprising that so little attention has been given to evaluating whether ‘no deal’ would represent a ‘chaotic Brexit’, or whether it would simply represent only a slight disruption of normal economic activity.
Essentially, would it represent a ‘cliff edge’ or more of ‘a slight bump in the road’?
The downsides to post-Brexit economic models
It is often claimed that there is a broad consensus amongst economists that Brexit would prove damaging to the UK economy. Yet, out of the forty or so economic studies which have sought to predict likely economic impacts relating to Brexit, fully one third suggest either a net gain to the UK economy or that the cost–benefit is dependent upon the form of relationship ultimately agreed between the UK and the EU.
The currently best available economic predictions were developed before the European referendum, and the most prominent of these suffer from a flawed approach, particularly in relation to missing variable bias. Yet their conclusions are still influencing much that happens in the Brexit debate.
Moreover, the danger is that forecasts can themselves become self‐fulfilling prophesies, as individual businesspeople or consumers react to predicted events and by their changed actions precipitate these same predicted outcomes.
Future options
A wide variety of potential future trading relationships could be forged between the UK and the EU (each has its own advantages and drawbacks):
1. Full membership of the EU—the current status quo, which could only be pursued by either ignoring the European referendum result or holding a second referendum;
2. Apply for membership of the European Free Trade Agreement (EFTA) and through this, membership of the European Economic Area (EEA);
3. Negotiate a customs union with the EU;
4. Negotiate a free trade agreement (FTA) with the EU;
5. Failure to negotiate a mutually satisfactory agreement with the EU, which would lead to the UK trading according to WTO rules.
There is a clear policy trade‐off between market access and policy flexibility when considering the various trading arrangements that could be negotiated between the UK and the EU. So it is a pity that none of the economic studies undertaken to date have sought to test rigorously the relative merits of this trade‐off in order to determine which of these choices would be preferable.
The WTO option
How disastrous would it be for the UK to revert to trading with the EU on the same basis as most other countries in the world, namely according to World Trade Organisation rules? Perhaps not as much as is generally assumed.
Trading according to WTO rules does incur costs, which are detailed further in my journal article for the Political Quarterly. But the WTO option has a number of advantages.
For example, compared to EEA membership, where the UK would have to abide by current EU rules on the free movement of labour and regulations across all trade‐related matters, the UK would have none of these restrictions under the WTO option. Similarly, whereas the UK would be constrained to accept the common external tariff within a customs union arrangement, under FTA or WTO arrangements the UK would be free to negotiate its own trade agreements with any other country across the globe as it would wish.
Thus, the WTO option maximises the policy flexibility that could be utilised by UK policy makers following the completion of Brexit, but at the expense of incurring additional trade‐related costs.
Whilst a comprehensive FTA would be the preferred option for this author, reverting to trading by WTO rules does not appear likely to result in the damaging economic scenario that many commentators seem to suggest. Rather than ‘no deal’ resulting in the UK economy ‘falling off a cliff edge’, a more accurate metaphor might be that it might experience a small bump in the road.
Indeed, it may offer greater potential for reshaping the UK economy over time, rather than tying it more closely to the EU for short term advantage.
Philip B. Whyman is Professor of Economics and Director of the Lancashire Institute for Economic and Business Research (LIEBR), at the University of Central Lancashire.
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I am shocked that the Remain interest has been so successful in wrongly frightening people about the problems of the UK functioning under WTO if there is no EU deal. The EU accounts for a diminishing part of the world economy and of our trade. Its markets are slow-growing, and its population is ageing. Its share of world output has halved since 1980 and will continue to reduce. The growth markets of the future are outside the EU. The GDP of the Commonwealth is now some 30 per cent more than that of the EU (including the UK).
We are also clear that we do not want to be tied to accepting instructions from the EU and ECJ, unable to establish our own trade agreements; and that it is also undesirable to remain tied to the EU economically with its antiquated and protectionist Customs Union, protectionist Single Market, and its overweight regulation model. Membership of the EU has been a drag on the UK economy for a long time. What we need is a post-Brexit competitiveness boost, which to be effective requires a clean break. Post-Brexit, we also need to be able to decide our own regulatory regimes.
My preference for some time has been a Canada-style managed “Free Trade Plus” Agreement, but the Prime Minister’s negotiations have opted for keeping the UK tied to the EU, in several ways and for a long time. I would, therefore, now prefer the option of a managed, No Deal Brexit, trading under WTO rules. The WTO option is not about falling off a cliff or crashing out. Rather it would provide us with the economic freedoms we need in order to make the best of Brexit. It was this which the citizens of this country voted for in the referendum. Around a half of our international trade (55 per cent) is already conducted under WTO rules, and with non-EU, WTO members.
The WTO has made huge advances in facilitating trade across customs borders: under the Landmark Trade Facilitation Agreement (TFA) developed countries with adequate resources are expected to install state of the art, border systems to avoid impeding trade. Streamlined, computerised borders are now the norm. The WTO’s rule-based trading regime is comprehensive, tried and tested and respected by the world’s trading nations.
Over the last decade Britain’s exports have grown by over 60 per cent. Exports to the EU grew by only 40 per cent, but to non-EU economies by 80 per cent. It is clear where the growing markets are. Trade and the UK can thrive under WTO rules. Trade is driven by commercial realities, irrespective of the Single Market – to which we would still have access under WTO rules, as a third country. From an EU perspective, the possibility of free trade with the UK should be extremely attractive. The EU has a trade surplus with the UK of approximately £100 billion a year. For Germany, the UK is the second biggest market for its cars.
The WTO fear campaign has hugely exaggerated the potential risks of temporary and short-term crisis in moving our EU trade to WTO rules. Given the preparation that has gone on, I believe there would be very few glitches in practice. For the longer term, just as we conduct our trade successfully with the US under WTO rules, so too we can conduct our trade successfully with the EU under WTO rules.
How are the last-minute negotiations are likely to break? Theresa May is on clear record as saying that “no deal would be better than a bad deal”. But she does not want No Deal, as it would run the political risk of breaking up the Conservative Party. She has now delayed the “meaningful vote” in the Commons until March 12th at the latest, when the Prime Minister’s deal will be the only option. It is also clear that there is no parliamentary majority for even a managed No Deal.
The EU would also like to achieve a deal, in part to secure the £39 billion UK contribution to the EU; and, longer term, to support EU trade and the EU £100 billion, UK trade surplus. The EU does not, however, wish to make departure from the EU ‘too easy’, and wants to discourage others from seeking to depart. This could end up causing the UK to withdraw to WTO, unilaterally, but this now looks unlikely. The key territory is the Northern Ireland backstop terms. An acceptable deal for the UK could be achieved with modern technology. But in the backstop agreement that the Prime Minister has negotiated so far, the UK is left being required to accept ECJ law and rulings, without any appeal. The main reason for the referendum result was a strong objection to being told what to do by EU organisations.
I suspect both the UK and the EU will, ‘at the last minute’, manage to agree an unsatisfactory compromise, which sounds just about acceptable to both; although I fear it would be a bad deal for the UK, and could be a sell-out on the crucial issue of having to accept ECJ law.
Whichever way the Prime Minister eventually goes, she will also continue to run the risk of splitting the Conservative Party. For what it is worth, my advice to her would be to stick to principle (which is always defendable) rather than opt for fudge. I anticipate, however, that we will end up with a standard EU, last minute, ‘fudge’ Deal.
57 comments for: Howard Flight: The Brexit deal. I suspect we will end up being presented with a last-minute fudge.
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} | 1,467 | Bargaining post-Brexit trade deals: worse even than "project fear"
Negotiating a post-Brexit trade deal with the EU will be harder than the outers say: every EU country, even those Britain doesn't trade much with, will be able to wield a veto
David Harbord Tim Lord
13 June 2016
Brexiteers hope to convince us that Britain will, after exit, be able to retain its status as a global trading nation with special deals with its largest trading partners in the EU and elsewhere. Remain has painted a bleak picture of what will happen to the economy if Britain exits. Applying some elementary game theory to post-Brexit negotiations suggests that things might be worse for an EU trade deal than even Remain's so-called "project fear" is arguing.
The OECD's recently published analysis of the economic consequences of Brexit concluded that by 2020, UK GDP will be 3.1% smaller than it would be with continued EU membership, and more than 5% smaller by 2030. [The Economic Consequences of Brexit: a Taxing Decision, April 2016]. Other analyses have arrived at similar conclusions. Such estimates have, unsurprisingly, been cited by Remain campaigners as a powerful argument against the UK leaving the EU.
The OECD estimates that UK growth will be 0.5% lower in 2017 and 2018 following Brexit, and that a "trade shock" in 2019, the end of the two-year negotiation period, will reduce growth by a further 1.5% in that year.
The OECD assumes that the UK will not reach a new trade deal with the EU until 2023, implying that trade after 2018 will be conducted under WTO rules, which will raise costs for UK exporters. It also assumes that the UK will not sign any new free trade deals with non-EU countries before 2030.
Brexiteers contend that these estimates are based on a flawed account of the UK's bargaining position in negotiating (or renegotiating) trade deals post-Brexit. They argue that the UK will be in a strong position to negotiate with the EU, as EU countries have as much to lose from a cessation or worsening of trade relations as the UK does. As the world's fifth largest economy, they argue that countries would be queuing up to do deals with Britain if it left the bloc.
Brexiteers further contend that Britain could use its clout, as Europe's second-biggest economy, to get an even better deal than it currently has. They point to Britain's trade deficit with the rest of Europe to argue that EU countries need access to the British market more than Britain needs access to Europe. They also imply that if no deal with Europe is forthcoming, relying on WTO rules or having a free-trade deal like Canada's might be good enough.
The Economist points out that the Brexiteers' trade deficit argument may not make much sense, however. [Brexit brief: Unfavourable trade winds, The Economist, March 26 2016]. What probably matters more is the share of exports, and roughly 45% of British exports go to other EU countries, while only around 7% of their exports come to Britain. While it is no doubt true that German carmakers will wish to continue selling into the British market, several EU countries barely trade with the UK at all. A new trade deal will likely be of little interest them.
Moreover, the WTO rules do not remove tariffs on all products, so exports of cars to the EU would attract a tariff of about 10%, and both the WTO and Canadian arrangements exclude financial services which make up Britain's biggest exports to the EU.
These details aside, the key area of contention remains the likelihood of reaching advantageous trade agreements quickly after Brexit. Evaluating the competing claims and counterclaims is not straightforward, as all are based on uncertain and untestable assumptions about the ease of concluding new trade deals. There is a well-established body of economic theory, however, which can be used to shed some light on this issue, as well as on the likely outcomes of any negotiations, at least in relatively simple cases. Nash bargaining theory (named after the mathematician and Nobel prize winning economist who's remarkable life was portrayed in the movie A Beautiful Mind), is the only fully developed economic theory for analysing bargaining situations and identifying the key factors which determine their outcomes.
How can Nash bargaining theory be used to shed light on the post-Brexit UK/EU trade negotiations? A key factor in the negotiations is the fact that any trade deal with the EU requires the approval of all 27 other member countries (plus the European Parliament). This means that any member state, even if it has only negligible trading ties with the UK, can use its veto power to extort concessions before approving an agreement.
To see this in its simplest and starkest form, let us suppose that the post-Brexit EU consists of just two states, Germany and "Small". Also suppose, as the Brexiteers claim, that Germany places a great deal of importance on its trade with the UK, leaving the UK and Germany in symmetrical negotiating positions, or in positions of equal “bargaining power”. If trade between the two countries creates a total surplus (or what economists call "gains from trade") of 2X million Euros over the status quo of restricted or no trade, the Nash Bargaining Solution would allocate X to each side. That is, the gains from trade will be split equally between the two countries.
"Small" on the other hand, has almost no trade with the UK, which to keep things stark we may assume to have a value of 1Euro. One might presume that in this case "Small" would have no important role to play in the negotiations. But since "Small" has veto power over the deal which allows Britain to obtain X from trade with Germany, the Nash Bargaining Solution gives "Small" a payoff of (1+X)/2. That is, "Small" is able to “extort” half of X from the UK simply by wielding its veto power.
This is an extreme example based on the simplest imaginable scenario. Clearly countries don't directly bargain over the division of the gains from trade when negotiating trade agreements. But the point is that EU countries with little or nothing to gain from a trade deal with the UK, but with veto power, will have every incentive to use their veto power to scupper any deal that does not offer them sufficient benefits. This fact alone could make Brexiteers' hopes of reaching an advantageous trade deal quickly with the EU post Brexit a wild pipe dream.
The agreements bargainers will reach under the Nash Bargaining Solution typically depend upon a number of other factors, including the bargainers' payoffs in the event that an agreement is not reached (the “disagreement payoffs”) and their degree of Impatience, or how important it is to each side that a deal is reached sooner rather than later.
Both of these factors seem to weigh against the Brexiteers' arguments. Since it will be common knowledge that the UK's trading position will worsen after the initial two-year negotiation period is up, even large EU trading partners like Germany will likely be in no hurry to negotiate an new trade agreement. After two years, Germany will continue trading within the EU as before, but the UK will trade under WTO rules. This increases Germany's disagreement payoff relative to the UK's and results in Germany receiving a higher share of the gains from trade in any agreement. The two-year deadline also makes reaching an agreement more urgent for the UK than for other the EU countries, which once again reduces the UK's expected share of the gains from trade. This is because the less impatient bargainers can credibly threaten to delay any agreement until the more impatient bargainer makes further concessions.
Finally, the UK will need to establish new trade agreements with countries that it currently has access to via EU treaties, such as Korea, Mexico and South Africa. These countries too will likely be aware that strategically delaying agreement might be to their advantage, as the UK's bargaining position deteriorates over time. Brexiteers may be wildly overly optimistic about the prospects of reaching new and better trade deals around the world soon after Brexit.
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} | 1,569 | Options for a ‘Global Britain’ after Brexit
Steven Brakman, Harry Garretsen, Tristan Kohl 11 May 2017
On 29 March 2017, the British Prime Minister, Theresa May, wrote officially to the EU that the UK has the intention to terminate its EU membership.1 This announcement is the starting point for upcoming negotiations between the UK and the EU. New trade deals for the UK will be an important part of the negotiations, not only with the EU but also with the rest of the world. The letter from the Prime Minister indicates that for the UK government, the principles of Brexit are as outlined in the White Paper of 2 February 2017, which states that the UK aims to “forge a new strategic partnership with the EU, including a wide reaching, bold and ambitious free trade agreement...” and that “we will forge ambitious free trade relationships across the world” (HM Government 2017: 8).
From an international trade perspective, the choice of the UK to leave the EU is remarkable. Leaving a large free trade area like the EU will most likely be trade- and welfare-reducing for the UK. Without a new trade agreement, relative trade barriers will change such that trade with the EU will become relatively more expensive, resulting in trade diversion away from the EU and trade creation with the non-EU world. The balance between these developments will most likely be trade- and welfare-reducing, as trade barriers between the UK and the EU – the largest trading block in the world – increase. This gloomy evaluation is corroborated by almost all trade analyses of Brexit. The estimates range between roughly a 1.5% reduction in GDP to more than 7%, depending on the assumptions made on how Brexit will take shape (see Baldwin 2016 for an overview). Only ‘Economists for Brexit’ have produced a positive estimate, but this is a clear outlier in the available estimates (see Miles 2016 for a survey).
The need to strike new trade deals for the UK seems obvious. This begs the question: what kind of trade deal? Does the UK really has a viable alternative to its current membership of the EU, like the ‘Global Britain’ strategy advocated by the May government? A few options come to mind when considering this issue, such as a US-UK trade partnership or a trade deal with all non-EU countries. On a more pessimistic note, one could not look at Brexit in isolation but also consider the consequences of the present anti-trade or anti-EU sentiments, such as a collapse of the EU following a possible ‘Frexit’, or even the most extreme anti-globalisation scenario, a total collapse of all trade agreements, and analyse how a Brexit scenario would play out if the overall international trade climate (further) worsens.
Predicting the consequences of these scenarios is of course difficult – because we do not know what future trade arrangements might look like – but based on past experience with trade agreements, one can approximate the size of the trade effects. In a new paper, we analyse a few of these options for the UK with the help of a gravity model (Brakman et al. 2017). A gravity model explains bilateral trade flows by looking at the economic size of countries (GDP) and the trade barriers (distance, membership of a trade agreement) between countries. The logic of the model says that the larger the trading partners and the smaller the trade barriers, the larger the volume of trade. The calculations of alternative trade scenarios are relatively simple. First, one estimates the model for the world as it is, including all existing trade agreements. Alternative scenarios can then easily be implemented by turning a specific trade agreement on or off and recalculating the (hypothetical) trade flows. This gives a reasonable indication of the static trade effects.2
Brexit scenarios
The benchmark for the alternative scenarios is Brexit itself. The trade effects on the global economy in the case of a hard Brexit – that is, the UK leaves the EU and all trade agreements that the EU has with the rest of the world – are depicted in Figure 1. On the horizontal axis, countries are ranked according to their GDP per capita, and on the vertical axis the percentage change in value-added exports (VAX).[3]
Figure 1 Hard Brexit: The UK terminates its EU membership and membership of all other EU-based trade agreements
Note: Bubbles are proportional to countries’ value-added exports in 2014.
As Figure 1 shows, a hard Brexit scenario has a strong negative impact on the value-added exports of the UK, decreasing these exports by almost 18%, mainly because trade with the (remainder of the) EU becomes more expensive. So what about the alternatives, such as a US-UK trade deal or a trade deal between the UK and the rest of the world? Figures 2 and 3 give the answer.
The main effect of the trade agreement between the UK and the US is that it increases the value-added exports for both countries by approximately 2%. For the UK, this implies that the negative impact of Brexit is only marginally offset by a bilateral trade agreement with the US (compare the -18% in Figure 1 with the -16% in Figure 2). Easier access to the US market compensates the trade loss of Brexit to some extent, but within the logic of the gravity model the US is further away and thereby less attractive and relevant as a trade partner.
Figure 2 Hard Brexit followed by a trade agreement between the UK and US
Note: Bubbles proportional to countries’ value-added exports in 2014.
What happens if the UK goes for a hard Brexit but at the same time manages to strike a trade agreement with all other countries outside the EU in our sample? As Figure 3 shows, this scenario would indeed provide a boost for the value-added exports of the UK and many other countries. For the UK, it is still the case that the impact of a combination of hard Brexit with a true Global Britain scenario is negative to the extent that its value-added exports fall by more than 6%. The main reason is distance – although the ‘rest of the world’ is large, it is also distant to the UK, not just in the sense of actual distance (compared to the EU) but also with respect to cultural, institutional, legal, and other differences that act as impediments to trade. The net effect of more access to the rest of the world and a hard Brexit is such that it is hard to see how Global Britain can be a viable alternative to or substitute for the UK’s current EU membership.
Figure 3 Hard Brexit followed by the UK joining trade agreements with all countries in the world except EU members
Figures 2 and 3 still describe relatively optimistic scenarios, where it is possible to negotiate new trade deals. However, it is not impossible that the Brexit will be part of larger anti-EU wave that possibly results in the dissolution of the EU itself. Many current national elections offer voters the option to cast an anti-EU vote. In some EU countries, these parties are popular, increasing the likelihood of another exit. The trade effects of such an extreme situation are much more dramatic than those depicted in Figure 1; it is not only the UK that would experience a significant reduction of international trade, but all other countries as well (see Brakman et al. 2017 for these additional scenarios).
The UK government states that it is aiming to replace the UK’s membership of the EU by other, broad trade agreements. However, at this stage it is not clear what these new trade agreements will look like and which countries could be involved. What are the alternatives for the UK government? A US-UK trade deal? A more extreme worldwide trade deal? If the UK government aims to compensate for the large negative trade shock of Brexit, the options seem limited. Based on existing empirical evidence on trade agreements, our conclusion is simple. If the UK wants to limit the negative trade effects of Brexit, the UK has no trade-enhancing alternative to an agreement with the EU that essentially mimics the situation in which the UK is a member of the EU.
Baldwin, R E (ed.) (2016) Brexit Beckons: Thinking ahead by Leading Economists, CEPR Press.
Brakman, S, H Garretsen, and T Kohl (2017), “Consequences of Brexit and Options for a ‘Global Britain”, CESifo Working Paper No. 6448.
Dhingra, S, H Huang, G Ottaviano, J-P Pessoa, T Sampson, and J Van Reenen (2017), “The Costs and Benefits of Leaving the EU: Trade Effects”, CEP Discussion Paper No. 1478.
HM Government (2017), The United Kingdom’s exit from and new partnership with the European Union
Miles, D (2016), “Brexit Realism: What Economists know about costs and voter motives,” in R E Baldwin (ed.), Brexit Beckons: Thinking ahead by Leading Economists, CEPR Press.
[1] http://news.bbc.co.uk/1/shared/bsp/hi/pdfs/29_03_17_ article50.pdf
[2] This underestimates the possible effects of a Brexit as we do not include long-term effects on innovation, productivity, or migration (Dhingra et al. 2017).
[3] We use ‘value-added exports’ (VAX) because changes in value-added trade are more directly linked to the income and welfare of the countries involved than gross exports; these data also include domestic (non-tradable) services that are used in the production of tradable goods.
Topics: Europe's nations and regions International trade
Tags: Brexit, EU, free trade agreements, Global Britain
Professor of International Economics, University of Groningen
Professor of International Economics and Business, University of Groningen
Assistant Professor of Global Economics & Management, University of Groningen
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In this two part series for the CSBR Zero-Sum blog, senior writers Lloyd Lyall and Jason Xiao go head-to-head over the Brexit debate. This week they tackle the constructive arguments for their position; next week, they will have an opportunity to respond to each other’s claims.
On June 23rd, British voters will take to the polls with a chance to shape their country’s economic future. The ballot will feature just one question: Should the United Kingdom remain a member of the European Union, or leave it? While EU membership entails a plethora of social and political issues, the economic consequences of the EU referendum will certainly be among its most far-reaching and impactful legacies. Here, I will argue what has largely been the consensus among Britain’s economic policy experts and leading academics: “Brexit” will be an economic disaster.
The first reason for Britain to stay in the EU is the enormous swath of inter-EU trade benefits it will lose by leaving. Trade with the EU is enormously important for Britain; 45% of British exports go to European Union countries. Much of this trade is only possible because of the shared regulatory standards, trade agreements and ease of movement provisions between EU member states. If the UK left, if would immediately face higher tariffs as a result of losing the preferential trade status conferred upon EU members. Non-tariff barriers to trade would also rise: most EU regulation collapses 28 national standards into one European one, but by leaving the union, UK businesses would have to navigate significantly more red-tape to sell their products. This significantly dampens Britain’s ability to do business with its most important group of trading partners.
A second reason not to go is that Britain’s departure would leave it without the ability to benefit from EU-negotiated international trade deals. The EU currently holds many major trade agreements with other economic world powers (upwards of 50 are either currently in force or provisionally applied), and as an EU member the UK benefits from the terms of these agreements. For example, the EU is currently in the midst of negotiating new major agreements with the United States (the Transatlantic Trade and Investment Partnership) and Japan. The London School of Economics estimates that these new trade deals would lower UK prices by a further 0.6% and save UK consumers £6.3 billion per year. If Britain leaves the EU, its ability to benefit from agreements like these will disappear.
Proponents of Brexit argue that the UK can simply renegotiate trade agreements with all of its current partners, but there are several reasons to believe that the renegotiation process will be both painfully long and largely unsuccessful. First, it is important to recognize the sheer logistical challenge of renegotiating hundreds of trade agreements with dozens of countries at the same time. A limited amount of UK negotiators will need to tackle a massive number of issues, and as a consequence there is likely to be a long and painful transition as new deals are ironed out.
Even in the long run, however, there is good reason to believe that UK-negotiated deals will simply be worse than the current EU deals the UK benefits from. With a combined GDP larger than any single world country, the EU bloc has tremendous power in international trade negotiations. It can negotiate from a position of strength, because its member states constitute a significant portion of other countries’ buyers. The UK alone, however, is a much less important trade partner for other countries and hence has far less ability to secure favorable deals for itself.
To illustrate, consider the role played by the United States. The US is one of the UK’s most crucial trade partners: as the UK’s largest single-country export destination it consumes $50.2 billion worth of British goods and services annually. When UK trade interests are represented by the EU block at the negotiating table, the US has an incentive to listen: the EU as a bloc does more trade with the US than any single country in the world. As only one component of that bloc, however, the UK accounts for just 3% of US total trade. If the US were instead negotiating trade deals with just the UK, it would be far easier for the US to ignore British interests and offer unfair deals: the UK needs the US far more than the US needs the UK. The result is tariffs and regulations that are more one-sided and biased against the UK than the status quo.
Even if all I have argued thus far turns out to be wrong and Britain does miraculously renegotiate outstanding deals with all of its current trade partners, the uncertainty that exists at present will impact another crucial area: investment. Foreign direct investment in particular is a crucial issue for the UK: it is the biggest net recipient of FDI in the European Union, and needs capital inflows to finance its large current-account deficit. Uncertainty over the UK’s future after a Brexit will turn away foreign investment, damning the UK to a long and painful road to recovery.
A UK exit from the EU would pose massive and long-lasting damage to the British economy. The London School of Economics has estimated such an exit could sink UK income immediately by £50 billion per year, with the long-run impacts of Brexit this figure could turn out to be far more. The magnitude of this choice is scary indeed: British voters have an opportunity this June to cripple the world’s foremost political union and launch their country to instability and recession. If they vote responsibly, they will reject Brexit and avoid this fate.
By Lloyd Lyall
Works Cited
"Foreign Trade." United States Census Bureau. U.S. Department of Commerce, Dec. 2015. Web. 27 Feb. 2016.
“A Background Guide to “Brexit” from the European Union.” The Economist. Feb. 2016.Web. 27. Feb. 2016.
Dhingra, Swati; Gianmarco Ottaviano and Thomas Sampson. “Should We Stay or Should We Go? The Economic Consequences of Leaving the EU.” The London School of Economics and Political Science. Feb. 2016. Web. 27. Feb. 2016.
Picture taken by Pavlina Jane on July 13, 2013, titled "Time Bank, London", obtained through Creative Commons. | http://www.csbusinessreview.com/the-blog/2016/3/2/stay-why-brexit-will-be-an-economic-disaster-for-britain | robots: classic
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} | 700 | Brexit Implications: The Future of Britain
Following the successful re-election of David Cameron in 2015, the reality of a British exit (Brexit) from the European Union became clear. Now, the date has been set for the referendum to determine the future of Britain. David Cameron opposes an exit. The powerful London mayor, Boris Johnson supports the idea. Boris has been ranked as the most senior official to take the lead from Cameron. While many polls predict that Britain will stay in the Eurozone, what would be the implications of a Brexit? The significance of EU to the United Kingdom’s economy cannot be underestimated. In fact, a large percentage of the United Kingdom (UK) trade is conducted by the EU. The role of the UK (and all the member states) is in promotion. Currently, more than 60% of all trade agreements the UK is is as a result of its membership to the EU. This will probably increase to 85% if the negotiations spearheaded by Cameron bear fruits. In addition, as part of the European Union (EU), the UK enjoys no tariffs on goods moving within all the member states. This ensures that there is a free movement of goods and services within different countries. In addition, the EU is a key negotiator for all the 28 member states in the World Trade Organization (WTO). It also negotiates the Free Trade Agreements (FTA) on behalf of the member states. The UK is also a full member of the European Commission (which proposes legislation). It is also a member to the EU Council of Ministers and European Parliament.
Graphic Crispus
Brexit Implications: Understanding the Losses
Therefore, with all these issues, it is clear that UK will have major losses if it exits the union. According to a research by Open Europe, an exit will lead to a 0.8% decrease in Gross Domestic Product (GDP) by 2030. Other studies by NISR states that the GDP will drop by 2.5% after the Brexit. In addition, UK will have a reduced role in Europe because of the new tarrifs that will be introduced. Some might argue that UK will also levy other countries. However, as an individual country doing business around Europe, this will be to Britain’s disadvantage. A research by CEPR states that the withdrawal will cost 1.77% of GDP annually. With a GDP of £25.7 billion, this means that £3.8 billion will go to tariff barriers while the rest will go to non-tariff barriers (NTB). Another challenge for a Brexit will be on the agreements and FTAs the UK is party to as a member of the EU. The UK has many treaties and agreements (trade and political) with many countries such as South Korea, South Africa, and Mexico among others. After the exit, it is expected that the UK will not automatically retain these agreements. This will bring its fair share of challenges. As a trader, having a good understanding of the various sectors of the UK’s economy will help you allocate capital to the right areas. Remember that the UK has for long had an important role in trade in the European Union.
The chart below shows the trade balance between UK and the EU member states. Many UK’s companies have a footprint in other EU member states. For instance, the aerospace sector in the UK is responsible for about 2.3% of exports. Imposing trade barriers among the countries will have significant impacts. The food, beverages, and tobacco sector is a highly protected sector within the European Union where the key beneficiaries are the producers. If UK exits, then this sector will be greatly affected. With these implications, it is certain that the UK will lose if it exits the European Union. This will lead to a decline in value to the pound. In fact, a few weeks ago, when Boris endorsed the idea of a Brexit, the pound lost more than 2%. In addition, the other sectors of the economy will be negatively affected. In days (or months) before the poll, I expect the major indices in the UK to decline. The same will be true to the pound. However, since I believe that the UK will not exit, these asset classes will go up after the poll.
Brexit Implications – Useful Links | https://www.daytradetheworld.com/trading-blog/brexit-implications/ | isPartOf: CC-MAIN-2018-47
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} | 1,334 | One year until Brexit: How is it shaping up?
With the official date for Brexit just one year away, we look at what the future might hold for the UK and EU.
It’s hardly been out of the news since the vote to leave the EU was announced over 18 months ago. Now, the UK is just one year away from exiting the common market trading bloc that it has been a part of since 1973 (when the EU was the European Economic Community). How are the exit negotiations shaping up, and what are the likely consequences of Brexit, as we currently understand it?
Is the official leaving date actually March 29 2019?
Yes, but with caveats. On March 19 this year Britain and the EU agreed the terms for an official ‘transition period’ which has been created to allow what has been termed an ‘orderly withdrawal’. Effectively this means that the UK will still have to play by the EU’s rules until December 31 2020, but during this time can proceed with global trade negotiations that will come into force in 2021.
The transition period terms are relatively straightforward, however the continuing issue of the Irish border is a sticking point within them. In brief, they are:
• EU citizens arriving in the UK between March 19 2019 and December 31 2020 will have the same rights as those who arrive prior. The same will apply to UK expats on the continent
• The UK can create its own trade deals during the transition period
• The UK will still have to abide by existing EU trade deals with other countries
• The UK will effectively remain part of the Common Fisheries Policy, yet without a direct say in its rules, until the end of 2020
• Northern Ireland will effectively stay in parts of the single market and the customs union until the border issue with the Republic of Ireland can be solved.
What has to be negotiated on a global level?
Essentially a huge number of treaties with countries spanning the globe, the trading rules for which have been agreed with the EU as a trading bloc rather than individual countries such as the UK. The country hasn’t been in this position since joining the (then) EEC back in 1973, so from the big trade deals with partners such as the USA, through to agreeing tariffs on the import of cereals from minor partners, the UK has to make new agreements.
According to a report in the Financial Times in May 2017, the UK has to renegotiate at least 759 treaties with approximately 168 countries thanks to Brexit. The FT article states that at worst many of the deals will simple replace “EU” with “UK” in the treaty, and at best the UK might get a better deal, but there are no guarantees. In some cases there are treaties that the UK will simply not bother trying to replace where a workaround is available. There is a lot of is administration but there isn’t a lot of is time.
Kent Business School’s Dr Carmen Stoian;
“Leaving the EU inevitably means forgoing some of these gains (of being part of the EU) as a result of the increased barriers to trade and investment that are likely to occur in all possible scenarios. Whilst free trade with non-EU partners is likely to generate some economic growth, the UK’s geographical location, historical, economic, political and business links with the continent makes the EU the UK’s most logical and natural business partner. So no wonder that impact studies are finding that long-term economic growth will be affected negatively by Brexit, in all scenarios.”
As well as trade and tariffs, the UK will repeal all EU laws currently governing the country and, over a period of time, have to replace these with home-grown laws. According to the government’s own white paper there is “no single figure” for the number of EU laws that are enacted in the UK, however the BBC cites 12,000 EU regulations, 7,900 statutory instruments passed by Parliament to implement EU legislation and 186 acts of Parliament that incorporate EU influence. This is just the tip of the iceberg, and until the UK formally leaves the EU new laws still apply and will subsequently have to be unpicked and replaced.
The economy
In the run-up to the referendum, and ever since, there has been an ongoing and often savage row over the economic impact of Brexit on the UK economy. Who can forget the Leave camp’s big red bus that seemed to promise £350m per week, saved from the EU, to be pumped into the NHS?
Of course the actual outcome is near-impossible to predict with any degree of accuracy as quite simply, we don’t know what will happen. EU countries are unlikely to want to make it easy for the UK to create deals within the common market than already exist, so realistically Great Britain has to look further afield and hope that it can retain and even increase tariff-free trade agreements. Moreover, EU countries are scrambling to attract tech, manufacturing and financial companies away from their traditional hubs in the UK through a host of financial incentives.
In recent weeks Anglo-Dutch giant, Unilever announced that it was going to move its headquarters from London to Rotterdam. Dr Carmen Stoian wrote;
“…the move is driven by both push and pull factors, amongst which political factors cannot be neglected. Since the British vote in the EU referendum in June 2016, governments, local authorities and business networks in various European countries have worked hard to improve the investment climate in their markets in order to attract multinationals headquartered in London that may be wary of Brexit.”
Aside from the £40bn (if not more) ‘divorce bill’, the UK will no longer receive EU grants and rebates, however as one of the ten countries that pays in more than it receives, we will be better off. For example, the UK received £4.6bn in 2014/15 from the EU, but contributed £8.8bn in the same period. But for UK businesses, the majority of which were pro-EU, the uncertainty of the future has caused many to be pessimistic about their own and wider economic growth. When the UK leaves it will become a member of the World Trade Organisation of its own right which should protect the country from unfair or discriminatory tariffs, but the ultimate shape of the trade agreements may take years to come out in the wash.
International Trade Secretary, Liam Fox, is optimistic;
“We have a £17bn surplus in services with the European Union, the European Union has a £102bn surplus with the UK, so it would be very damaging to businesses in Europe not to come to a deal. Therefore I think that the economic well-being of the people of Europe, of the businesses of Europe will ultimately take precedence in these negotiations over the politics of every closer union.”
Moving forward
The relationship between the UK and EU will undoubtedly continue to be very strong; after all, the EU is Britain’s biggest trading partner. With negotiations very much ongoing there will be a lot more clarity as to the situation in the coming 12 months.
Both sides are fighting hard to protect their own interests whilst balancing the rights of the people who will be most affected and the businesses that rely on a ‘good’ deal being struck. It’s of no interest to either side to be too hard on the other, but equally in any break-up there is going to be a level of animosity and neither wants to lose out.
The big issues surrounding the customs union, Irish border, fishing policy and migration will continue to be debated – hard and difficult decisions need to be made and agreed over the next year. What is likely, however, is that come March 19 2019 there will still be a very long way to go until the picture for the UK-EU relationship is clear.
For more information on the internationally-focused undergraduate and postgraduate programmes Kent Business School can offer, have a look at our website.
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} | 2,480 | What Is The Economic Impact Of Hard Brexit vs. Soft Brexit? - Friedberg Direct
When British voters voted on the "Brexit" option in a June 2016 referendum, it was understood that it meant the nation was leaving its membership in the European Union. But ever since the measure was approved by a 53% to 47% margin during that vote, debate has arisen over exactly what the idea of "exiting" the European Union actually will entail.
Voices from all sides are engaged in negotiating the terms of an eventual exit. Will it be a "soft Brexit," which would imply a continuation of some trade, immigration and close cultural linkages with continental Europe? Or will it be a "hard Brexit," which would mean complete separation from the EU and a return to an arrangement that existed before Britain's entrance into the organisation?
Brexit may represent the will of a majority of British voters, but the road to actually achieving it from the EU is rife with complications.
Britain joined the European Economic Community (EEC) in 1975 after earlier decisions to stay out of the organisation, which had formed in the 1950s during the reconstruction of Europe after World War II.[1]
In 1993, with the Maastricht Treaty, the EEC became known as the EU. Despite calls to opt out of the organisation, the U.K. initially decided not to do so. However, the country did resist some features of the membership, including adoption of the euro currency and participating in the Schengen area, which allows free flow of individuals without strict passport controls.[1]
In 2009, the EU formalised Article 50 that would allow members to opt out of EU membership if they chose to do so. Although the British government didn't initially make use of the rule, former Prime Minister David Cameron following his re-election in 2012 made good on a campaign promise saying he would put the matter up for vote in a referendum. That set the stage for the referendum vote of June 2016.[1]
Triggering Article 50
One complicating factor for both Britain and the EU is that the provision that would allow country to exit the union has never before been used. Further, the language of the provision is not entirely specific about how such a breakup should be carried out. That means both parties will largely be determining what can and won't be permitted in the Brexit as they carry out the process.
The procedure is that the British government would invoke Article 50 of the EU treaty. Upon this action, the 27 member countries would meet to discuss the terms of Britain's withdrawal. The EU member nations would need to approve the terms with a majority vote during a two-year period. British Prime Minister Theresa May has said she plans to invoke Article 50 by March 2017, meaning the negotiation of Brexit would be completed by 2019.[2]
Under Article 50, the EU must "negotiate and conclude an agreement with that State, setting out the arrangements for its withdrawal." The terms of the withdrawal must be approved by 20 of the 27 remaining EU countries, provided they also represent 65% of the EU population. Currently, EU laws and regulations are automatically internalised in Britain. Upon Britain's official withdrawal, British institutions would resume full authority over regulations that were previously delegated to EU authority.[3]
Court Decision
After a challenge to the government's ability to trigger Article 50, a British High Court ruled that the government must submit the decision to the British Parliament. The court decision must still be reviewed by the U.K.'s Supreme Court and a decision on that is expected by January 2017.
Although considered unlikely, the British parliament could ignore the result of the Brexit vote and block Brexit. That's because technically the Brexit vote was considered an "advisory" referendum rather than a "binary" referendum with a predetermined outcome.[4]
What Brexit Negotiations May Cover
Just as there are a number of procedural hurdles to negotiating the terms of Brexit, there are also a number of practical implications. They include:
• The U.K. will no longer participate in political decisions at the EU and only the U.K. House of Commons will decide how Britain will be governed.
• The U.K. will lose direct access to the EU's consumer market.
• All British goods would have to undergo customs procedures for entry into the EU.
• The U.K. will resume full management of immigration and travel of non-citizens within its borders.
• Diplomatically, the U.K. will no longer negotiate in a unified manner with the EU on subjects of global importance. Additionally, it will have to make its own security arrangements.
• U.K. citizens living and working in the EU will also lose their rights to residency there.[5]
Theoretically, negotiations with the EU will cover a transition in all these topics, whether an immediate "hard Brexit" solution, or a "soft Brexit" solution is chosen.[5]
Hard Brexit
When asked about Brexit following the referendum, British Prime Minister Theresa May said "Brexit means Brexit." But given some confusion over the details, May later clarified her position in a talk with a group of Conservative Party members, defining what has come to be interpreted as the "hard Brexit."
"Let me be clear," she said. "We are not leaving the European Union only to give up control of immigration again. And we are not leaving only to return to the jurisdiction of the European Court of Justice."[6]
In view of that position, the harder Brexit option is understood to be a withdrawal in which Britain would give up participation in the EU single market and its legal rules. It would also resume full control over its own immigration system, introducing stricter controls on immigration from the EU and elsewhere. The harder option would require Britain to carry out trade with Europe and other nations under World Trade Organisation (WTO) rules.[6]
Soft Brexit
By contrast, the "soft Brexit" is interpreted as any number of possible arrangements that might be negotiated with the EU representing anything less than a full withdrawal. Soft Brexit options are seen to be promoted mostly by British officials who were against the Brexit and would like to try to partially honor the outcome of the referendum without fully severing ties with Europe.
There are varying possible scenarios for a soft Brexit. However, many proponents of a softer solution imagine a "strategic partnership agreement." In this case, the U.K. would resume control of its national immigration rules, and both the EU and the U.K. would maintain mutual market access and avoid application of nontariff barriers to trade in goods and services. This would imply that the UK would need to maintain full compliance with EU legislation for all goods and services imported and exported with the EU single market.
The softer option would require authorisation from the 27 EU governments to allow the U.K. to remain inside the EU for a period while the nation transitions to something of an observer status in the organisation. A part of the negotiation could also allow for agreements on reciprocal rights covering immigration for the purpose of tourism, employment, education and retirement.
During this time, the U.K. would likely be required to continue its financial contributions to the EU. Depending on how the agreement was negotiated, the country would either remain under its privileged current trading status with the EU, or re-establish a trading relationship with the EU single market under the framework of the WTO. The advantage of this option, according to its supporters, is that it would allow for greater certainty and a smooth transition of trade and investment rules.
The British Government Position
Despite what initially sounded like tough rhetoric from Prime Minister Theresa May on a Brexit plan, the British government has been guarded about how it actually intends to approach the negotiations with the EU. However, there have been hints that it hopes to preserve some of its key economic ties with the continent.
This could include, for example, keeping Britain within the Europe-wide patent system, which is under the jurisdiction of the European Court of Justice in Luxembourg. As part of an effort to protect intellectual property, Britain was an early proponent of the patent system from the 1970s.[8]
May's government has also shown sympathy toward selective EU integration for UK certain industries as well as participation in EU-wide security arrangements, such as sharing crime databases. This type of selective cooperation with the EU would suggest that where possible, Britain hopes to opt in to certain mechanisms where they prove economically beneficial, in a manner used by countries such as Norway and Switzerland.[8]
May has also said that she doesn't want the U.K. to face a "cliff's edge." By that she means some form of substitute arrangement should be in place before the two-year negotiating process comes to an end. To obtain any kind of softer deal from the EU, the British government is seen having to offer some special, favourable concessions for its EU trading partners in negotiations.[8]
EU Position: No "Cherry Picking"
The decision on whether Britain will be able to adopt a soft Brexit or be forced to undergo a hard Brexit, will ultimately be up to the EU and its evaluation of allowing the country to maintain certain. So far, the positioning of the EU leadership has been unreceptive to suggestions that Britain should be able to close its doors to Europe while "cherry picking" what advantages it can obtain.[9]
EU leaders—such as high-profile figures Commission President Jean-Claude Juncker, German Chancellor Angela Merkel and French President François Hollande—have been vocal in insisting that maintenance of the so-called "four freedoms" is a prerequisite for obtaining the advantages of full access to the single market. The four freedoms, which serve as the underpinning principles for the union, include the free movement of goods, services, capital and labor.[9]
European officials have expressed concerns that if one nation is allowed pick and choose which rules it wants to follow "á la carte," then all other EU members will make a similar demand and make the organisation unviable.[9]
Possible Economic Impacts Of A Hard Brexit
According to initial estimates by the British government, leaving the advantages of EU membership behind and switching to use of WTO trade rules would cost the U.K.'s businesses about £65.5 billion per year (or around US$82 billion). Over a 15-year period, this would lower the country's GDP by between 5.4% and 9.5%. In addition to lost trade, the U.K. may also be on the hook for paying about £20 billion in unpaid bills to the EU.[10]
Analysts believe that the U.K. would find it difficult to replace the lost trade revenues from the EU, which has a consumer market of around 500 million people and a GDP around €12 trillion (US$13 trillion or £10 trillion). About 44% (or £220 billion of £510 billion) of the U.K.'s exports currently go to EU countries. Export trade with the EU is linked to about 12.5% of U.K.'s GDP, while the EU's trade with the nation is linked to only about 3% of its GDP.[10]
While the country might be able to expand trade unfettered around the world once out of the EU, it might also find it difficult to match the negotiating power of the EU. With more than 50 partners around the globe, the union has more free trade agreements than any other single nation or trading bloc. And in addition to its existing trade agreements, the EU is negotiating agreements with the U.S., Canada, Japan, India, Australia, New Zealand and others.[10]
Weakening Britain's Financial Might?
In addition to hurting trade prospects, the harder option is seen as a possible threat to the UK's financial services industry. According to some estimates, the limitation of access to Europe's financial markets could cost Britain as much as the following:
• £38 billion in business,
• £10 billion in tax revenues,
• and more than 70,000 jobs.
Further, international companies may hesitate to invest and locate in the nation going forward, seeking instead countries that do have access to the EU single market.[11]
Possible Economic Impacts Of A Soft Brexit
While the potential impact of a hard Brexit has been calculated, the impacts of a soft Brexit seem less clear. Much of the potential impact of the softer option has already been felt. In the wake of the Brexit vote, the GBP fell to a six-year low against the euro and a 31-year low against the dollar.[12]
The U.K. also suffered downward credit ratings revisions from ratings agencies Standard & Poor's, Moody's and Fitch, losing its top-rated credit status.[13]
Pro-exit campaigners have argued that the country participation in the EU is not as advantageous as it seems, and so the cost of continued participation through a soft Brexit would need to be measured in terms of a loss of competitiveness in the rest of the world. They argue that the U.K. is the second-largest economy in the EU, contributing €14.1 billion to the region's GDP, while receiving back only €7.1 billion in EU subsidies. At the same time, the U.K. sends more of its exports (56%) to regions outside the EU and might stand to gain more if it was unhindered by tariff and nontariff barriers mandated by EU membership.[14]
Pro-exit campaigners have estimated that with a clean break from the EU, the U.K. could negotiate free trade agreements with other countries in a sufficient number to make up for lost EU trade within 12 to 24 months. It is also possible that with a weakened currency U.K. companies could begin to see an uptick in export sales and business abroad, reinforcing the country's current account balance and economic growth. [14]
So far, the Brexit approval has led to a weakening of the British pound against other major currencies along with the introduction of uncertainties about the potential future strength of the U.K. economy. Those trends may continue ahead, but the weaker currency may also bring some advantages in the form of greater global competitiveness for the country's economy.
Economically, Britain stands to lose more in the short term by pushing for a hard Brexit. In the long-term, though, its citizens may find that the autonomy and right to self-determination afforded by that decision to be worth it. Ultimately, the decision about whether Britain will face a soft or a hard option will depend on the EU member states and how much advantage they see in allowing Britain to maintain direct ties with the single market.
In either case, the long-term outlook for Britain will now depend on the skill of its negotiators and the will of its government and businesses to forge new arrangements that can substitute its existing trade arrangements with the EU.
Additional Reading
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} | 1,180 | Consequences of #Brexit
In the wake of the referendum David Cameron called out for the 23rd June 2016, discussions are heated and charged with emotion. The Prime Minister of the UK evoked the possibility of a referendum in order to win national elections, and thus got the discussions of a possible Brexit going. Little did he know that this discussion would develop its own dynamic, and could possibly even cost his mandate, as recent polls suggest. While Cameron forcefully rejected this, his party and Britain are largely divided, and some former allies sense political opportunities. However, since most polls suggest there is no clear indication on whether Britain will vote to leave or to stay in the EU, it is worth looking at how a possible Brexit would affect the UK and the EU – economically and legally.
The Legality of a Brexit
It is not since the Treaty of Lisbon (signed in 2007, entered into force in 2009) that leaving the European Union is an actual legal possibility. Article 50 of the Treaty of the European Union (TEU) lays down the framework for a withdrawal from the EU, and its mechanics have been debated on academic blogs. Assuming that Britain would vote to withdraw from the EU on the June referendum, this will initiate a process, which can last up two two years, as a Withdrawal Treaty (WT) will have to be negotiated. Since the withdrawal from the EU is of unilateral matter, the WT does not need to be ratified by the other 27 Member States, nor does it need a common accord in the Council, even though the WT would “be ‘accompanied’ by” amendments to existing Treaties. These negotiations will thus be held between the EU, with the Commission as broker, and the government of the UK, and Britain will remain a Member of the EU until negotiations are finished and the WT enters into force. The outcome of these negotiations, and the impact for both the EU and the UK are heavily debated, and Jean-Claude Piris, former Director General of the Legal Service of the Council of the European Union, presented 7 different scenarios of a possible outcome of the WT.
Consequences for economic relations
In these 7 scenarios, Piris examines how the relationship between Britain and the EU could be in the future. He first analyses the commonly expressed wish of the UK having a special membership, or a half-membership within the EU. The Treaties do not provide such a possibility and would thus need to be amended. As Treaty modifications concern all Member States of the EU, this would entail a ratification process according to each Member State’s constitutional requirements, which would require a referendum in some Member States. Piris argues that such a modification comes with political difficulties, and given the little leverage the UK has in such a scenario, he dismisses the scenario of a possible half- or special membership as highly unlikely. It is in the UK’s interest to keep access to the EU’s internal market, since over 50% of its export go to the rest of the EU, and this access would be at the heart of any agreement between Britain and the EU.
Piris further analyses seven different scenarios of a withdrawal, reaching from custom-made arrangements, joining the EEA (The European Economic Area), joining the EFTA (European Free Trade Agreement), follow the “Swiss way”, an own Free Trade Agreement between the UK and the EU, a Customs Union, and, lastly, the possibility of no economic relations, a complete Brexit. According to Piris, none of these scenarios are favourable for the UK, and only differ in the amount of damage taken to the national economy. Given the huge intertwinement and interdependence of UK trade and the internal market of the EU, the UK will still need to follow the standards of the EU in order to continue its export in the European Union, but will not be able to be part of the decision making process. Ironically, instead of returning to more national sovereignty, a Brexit would thus lead to less sovereignty for the UK.
Consequences for the UK
No matter what way the negotiations go and how economic relations will change between the European Union and Britain, Brexit would have a large set of consequences for the UK. Firstly, the UK would not be bound to EU law anymore, such as regulations, directives, the four freedoms, international treaties and so forth. This would entail policy fields such as fisheries, agriculture, justice, competition, etc. At the same time, other countries will not be bound to respect these laws towards the United Kingdom. The British government would thus need to adopt new laws, and evaluate inherited national law in order to see whether they want to keep it, modify it, or abrogate it; a process that could take years.
Secondly, a Brexit would have consequences for trade relations of the UK, not only with the EU, but also world wide. Being part of the EU for the past decades, Britain benefited from different trade agreements the EU has entered with different countries and regions in the world. The UK would thus need to renegotiate any of these agreements, and Piris argues that the UK’s external trade would be negatively affected for a few years to say the least.
Thirdly, a Brexit would also have consequences for individuals. Since the UK would lose its access to the four freedoms and other EU legislation, UK citizens would also lose their EU citizenship. Given the fact that more than two million British nationals live, study, or work abroad, this could have direct impact for these citizens. Until an agreement between the UK and the EU has been found, this would impact citizens directly and could entail consequences such as visa requirements, or in extreme cases people would even be forced to leave the countries. As all Member States are bound to the EU, no unilateral agreement could be found between different the UK and single Member States. Instead, a common legal framework for citizens is needed.
After having analysed possible scenarios for a Brexit, Piris concludes that “none of the seven options available to the UK, if it were to decide to withdraw from the EU, is attractive. Brexit would be negative for the UK.” He further argues that no matter what decision is taken, one of two overall scenarios will occur. Either the UK will become a sort of “satellite” of the EU, or to have serious negative impact on its economy, needing to renegotiate trade agreements from scratch. In any way, the discourse of Brexit leading to more autonomy is misleading, and a withdrawal from the EU would seriously harm the UK in the long term, and provide for economic instability in the short term. Both the EU and the UK government should thus take a more active role before 23rd June to avoid Brexit, to avoid that internal politics go all wrong and affect both the EU and Britain.
Picture: David Cameron at the European Council in December 2015. Credit: The European Union.
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(Marc-Olivier Jodoin/Unsplash)
Spiritual Beliefs Are Linked to a 'Protective' Effect Against Depression in The Brain
10 FEB 2019
Religious beliefs, or a sense of spirituality, may cushion some people's brains against depression, according to new research.
study has found a curious link between our personally held beliefs and the thickness of white matter in our noggins.
Today, we know that depression is, at least to some extent, a consequence of our genes. There is quite a bit of research to suggest that if one or both parents are depressed, it can increase a child's risk of depression by double, maybe even quadruple the average amount.
But while these studies strongly suggest a genetic component, depression doesn't affect everyone with a depressed parent, and can also show up in people without any family history whatsoever.
This means there have to be some other factors at play, and a person's intrinsic worldview may be one of them.
Among adults with a high family risk for depression, a firm belief in religion or spirituality - never mind attendance at church or other pious acts - seemed to have a protective effect, shielding some patients from a recurrence of major depressive disorder (MDD).
White matter is the pale tissue that makes up the brain's cortex, and it contains the circuitry that brain cells need to communicate with each other.
"We found that belief in the importance of [religion or spirituality] was associated with thicker cortices in bilateral parietal and occipital regions," the authors conclude.
"As we had previously reported cortical thinning in these regions as a stable biomarker for depression risk, we hypothesised that the thicker cortices in those reporting high importance of [religious or spiritual] beliefs may serve as a compensatory or protective mechanism."
As interesting as these connections are, for the time being, that's all they can be. Until we can say for sure the effect that religion has on white matter, let alone depression, this study and numerous others will need to be replicated, validated and stretched across greater time spans.
When it comes to the human brain, there's no simple answer.
This study has been published in Brain and Behaviour. | http://sciencealert2014.com/spiritual-or-religious-beliefs-may-act-like-a-buffer-against-depression-in-the-brain | isPartOf: CC-MAIN-2019-09
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Predisposed to Depression?
Depression, primarily major depressive disorder (MDD), is the leading cause of disability in adults. MDD is primarily familial, prompting research to the nature-nurture origins of the disease. How is depression tied genetically or shaped by environmental factors in individuals?
The exact mechanisms by which depression affects the brain are fairly unknown. We know there are brain abnormalities and differences, but some studies have shown it to be hard to discern if the brain differences were causes or effects of depression.
Peterson et al looked at a three generation cohort of individuals, assessing those with and without major depressive disorder in two successive generations. The results of their research appear in last week's Proceedings of the National Academy of Sciences issue (epub ahead of print). Peterson et al, found that people at risk for depression (those with a family history in 2 generations) had 28% more cortical thinning in the right hemisphere of their brains than those not at risk for depression. The thinning occured in gray matter, the core processing brain center (the neurons) as opposed to in white matter, information transport system (the myelinated axons). 28% is a significant amount of difference, and correlates to similar magnitudes of structural changes seen in Alzheimer's disease, frontotemporal dementia (FTD), and schizophrenia (although in different brain regions).
The right hemisphere of the brain is responsible for most of the tasks of attention and visuospatial memory. Inattention and slight memory impairment occur symptomatically in individuals with depression, and was found to be higher in the high risk individuals as compared to the low risk individuals in Peterson et al.'s study. The authors note that inattention could also be produced for social and emotional stimuli, thus producing depressive symptoms or MDD.
It might be too early to state any translational or policy implications from this study, however more light is now shed upon the physiological differences in those at risk vs. not at risk for depression. These results might be of interest for those with a family history of major depressive disorder who are curious about assessing their future risk of depression. Check your cortical thickness. Or don't...and hope your positive environment will reduce your risk.
Peterson BS, Warner V, Bansal R, Zhu H, Hao X, Liu J, Durkin K, Adams PB, Wickramaratne P, & Weissman MM. Cortical thinning in persons at increased familial risk for major depresssion. Proc Natl Acad Sci USA. 2009 Apr 14;106(15):6273-8
1 comment:
Aaron said...
I have been told that I have a thick cortex. I try not to brag. | http://healthylifecourse.blogspot.com/2009/04/predisposed-to-depression.html | robots: classic
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Thinning Tissue in Right Half of Brain Signals Increased Risk of Inherited Depression
Science Update
MRI brain map of tissue thickness
In cases of familial depression, changes in tissue thickness in key brain structures in the right half of the brain may increase a person's risk for developing depression, according to NIMH-funded researchers. Similar changes in the left half of the brain were linked to the severity of a person's existing depression or anxiety symptoms. Based on their findings, the researchers proposed a possible mechanism for how these brain changes affect depression risk in the April 14, 2009, issue of the Proceedings of the National Academy of Sciences.
Some types of depression run in families, and certain changes in brain structure and function have been observed in people with the disorder. However, until recently, scientists have been unclear on the exact relationship between these brain changes and depression.
Building on previous research with a three-generation study population, Myrna Weissman, Ph.D., and Bradley Peterson, M.D., both of Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, and colleagues used magnetic resonance imaging (MRI) to assess brain changes in 131 people, ages 6-54. Roughly half of these participants were considered at high risk for major depressive disorder (MDD), due to having at least one parent or grandparent in the study diagnosed with the illness. The other half, considered at low risk, had no family history of the illness.
Results of the Study
From pre-scanning interviews, the researchers found that people in the high-risk group were more likely than those in the low-risk group to report having MDD or an anxiety disorder at some point in their lives. MRI scans showed that, on average, those in the high-risk group had 28 percent thinner brain tissue across a broad range of brain structures in the right half of the brain. These changes were observed in young children in the high-risk group and in older high-risk individuals who had never suffered from MDD or an anxiety disorder themselves.
The brain areas most affected by this thinning govern attention and the ability to process emotional or social cues (such as faces or family pictures). In tests involving these right-brain tasks, the researchers found that thinner tissue in these areas was linked to greater inattention and poorer performance in immediate and delayed visual memory.
Similar patterns of tissue thinning in the left half of the brain appeared to be related to the severity of a person's existing MDD or anxiety disorder symptoms in both the high- and low-risk groups. This thinning was not as pronounced as the thinning in the right half of the brain, and the difference in tissue thickness between the high- and low-risk groups was not statistically significant.
The findings strongly suggest that changes in tissue thickness in the right half of the brain directly affect a person's inherited risk for developing MDD. The pattern of tissue thinning appears to be related to problems with attention and processing of emotional or social signals. Such problems may increase a person's vulnerability to developing mood or anxiety disorders, according to the researchers.
That the thinning was present in people at high risk, but who had never had MDD or an anxiety disorder, as well as in high-risk children who had not been diagnosed with depression, shows that these brain changes likely come before illness onset and that they occur very early in life, possibly before birth, say the researchers. Furthermore, while thinning in the right half of the brain contributes to risk, thinning in the left half of the brain appears to be required in order for a person to show symptoms of these illnesses.
What's Next
More research is needed to determine if the inherited risk for MDD is purely genetic, if there are specific environmental factors necessary for triggering genetic risk, or whether there is a combination of factors involved. Increased understanding of how risk translates into developing MDD or other mental disorders may lead to new methods of diagnosing, treating, or preventing these illnesses.
MRI brain map of tissue thickness with proposed disorder model
Top: Color coded MRI brain maps of differences in tissue thickness between study participants at high- vs. low-risk for familial depression. Left half of brain is shown on the left and right half on the right. Cool colors (blue and purple) denote thinner areas in the high-risk group; warm colors (yellow, orange, and red) are significantly thicker areas; green areas show little to no difference in tissue thickness.
Bottom: Flowchart represents a proposed model for how some MDD or anxiety disorders develop. Double-headed arrows indicate factors that may influence each other and jointly contribute to disease risk. Block arrows show the hypothetical progression from inherited risk to development of symptoms.
Peterson BS, Warner V, Bansal R, Zhu H, Hao X, Liu J, Durkin K, Adams PB, Wickramaratne P, Weissman MM. Cortical thinning in persons at increased familial risk for major depression . Proc Natl Acad Sci U S A. 2009 Apr 14;106(15):6273-8. PMID: 19329490 | http://www.nimh.nih.gov/news/science-news/2009/thinning-tissue-in-right-half-of-brain-signals-increased-risk-of-inherited-depression.shtml | robots: classic
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Thick Cortex Could Be Key in Down Syndrome
brain images show reduced cortical surface area and increased cortical thickness in Down Syndrome
June 19, 2015
New brain-imaging research published in the journal Cerebral Cortex and led by Nancy Raitano Lee, PhD, an assistant professor at Drexel University, has found that the cortex is thicker on average in youth with Down Syndrome than in typically developing youth, even though the overall volume of the cortex is lower in those with Down Syndrome.
The cerebral cortex is the outer layer of brain tissue, a folded region about 2-4 millimeters thick, that is involved in many important aspects of brain function including sensory and cognitive processes.
Lee, a psychologist in Drexel’s College of Arts and Sciences, conducted the research with colleagues at the National Institute of Mental Health who perform structural magnetic resonance imaging (MRI) of the brains of children and youth to better understand aspects of brain development. They compared MRI measurements from 31 youth with Down Syndrome and 45 typically developing peers.
Lee is particularly interested in brain development in youth with Down Syndrome, the most common genetic cause of intellectual disability (occurring in 1 in 700 live births), because there is surprisingly little known about childhood brain development in this condition. What has been established is that the brain volume of the cortex is lower on average in people with Down Syndrome than in people who are typically developing.
“Volume is a gross measure that can mask differences between thickness and surface area in the cortex,” said Lee. “We wanted to learn more about how the brain is different in Down Syndrome compared to typical development, so we measured surface area and thickness, which both contribute to cortical volume but are determined by different genetic factors.”
She wasn’t surprised to find that the cortex’s surface area was lower in the youth with Down Syndrome because surface area is a component of the total volume, which was lower.
“The part that was surprising was our finding that the thickness of the cortex was greater in many regions in the group with Down Syndrome,” she said.
The cause of the increased cortical thickness in Down Syndrome is still uncertain, but one possibility is that the brain in Down Syndrome doesn’t prune excess neural connections as effectively as in typical development, a process believed to occur during childhood and young adulthood as part of reaching cognitive maturity.
Some of the brain regions with increased cortical thickness were nodes in the Default Mode Network (DMN), the part of the brain that is active when a person is at rest. Because deterioration in the DMN has been associated with Alzheimer’s Disease, Lee said the difference found between Down Syndrome and typical development in youth could turn out to be an early indicator of susceptibility to Alzheimer’s later in life. Individuals with Down Syndrome are more likely to develop early-onset Alzheimer’s disease than the general population.
Lee hopes that her finding will highlight the importance of the cortex for understanding developmental processes in Down Syndrome and spur further research on animal models. Such studies could more clearly draw the connection of how genetic abnormalities cause brain abnormalities—knowledge that could inform potential biomedical treatment approaches for intellectual disability.
Media Contact
Rachel Ewing | http://drexel.edu/coas/news-events/news/2015/June/Down-Syndrome-Cortex/ | robots: classic
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} | 392 | Thick cortex could be key in Down syndrome
Posted on June 23, 2015
New brain-imaging research published in the journal Cerebral Cortex and led by Nancy Raitano Lee, PhD, an assistant professor at Drexel University, has found that the cortex is thicker on average in youth with Down Syndrome than in typically developing youth, even though the overall volume of the cortex is lower in those with Down Syndrome. The cerebral cortex is the outer layer of brain tissue, a folded region about 2-4 millimeters thick, that is involved in many important aspects of brain function including sensory and cognitive processes.
Lee, a psychologist in Drexel's College of Arts and Sciences, conducted the research with colleagues at the National Institute of Mental Health who perform structural magnetic resonance imaging (MRI) of the brains of children and youth to better understand aspects of brain development. They compared MRI measurements from 31 youth with Down Syndrome and 45 typically developing peers.
Lee is particularly interested in brain development in youth with Down Syndrome, the most common genetic cause of intellectual disability (occurring in 1 in 700 live births), because there is surprisingly little known about childhood brain development in this condition.
What has been established is that the brain volume of the cortex is lower on average in people with Down Syndrome than in people who are typically developing.
She wasn't surprised to find that the cortex's surface area was lower in the youth with Down Syndrome because surface area is a component of the total volume, which was lower. "The part that was surprising was our finding that the thickness of the cortex was greater in many regions in the group with Down Syndrome," she said.
The cause of the increased cortical thickness in Down Syndrome is still uncertain, but one possibility is that the brain in Down Syndrome doesn't prune excess neural connections as effectively as in typical development, a process believed to occur during childhood and young adulthood as part of reaching cognitive maturity. Lee hopes that her finding will highlight the importance of the cortex for understanding developmental processes in Down Syndrome and spur further research on animal models. Such studies could more clearly draw the connection of how genetic abnormalities cause brain abnormalities--knowledge that could inform potential biomedical treatment approaches for intellectual disability.
Source material from Drexel University
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} | 318 | New Leads for Understanding Down Syndrome
Nancy Lee Raitano
By Rachel Ewing
New brain-imaging research led by psychology prof Nancy Raitano Lee, PhD, and published in the journal Cerebral Cortex, could unlock answers about intellectual development in youths with Down syndrome. It could also provide new insight into why individuals with this genetic neurodevelopmental disorder are more likely to develop early onset Alzheimer’s disease than the general population.
The cerebral cortex is the outer layer of brain tissue, a folded region about 2–4 millimeters thick, which is involved in important brain functions including sensory and cognitive processes. Lee’s study found that the cortex is thicker on average in youths with Down syndrome than in typically developing youths, even though the overall volume of the cortex is lower in those with Down syndrome.
Though the cause of the increased cortical thickness is still uncertain, one possibility is that the brains of those with Down syndrome do not prune excess neural connections as effectively as in typical development, a process believed to occur during childhood and young adulthood as part of reaching cognitive maturity.
Lee’s research also noted particularly pronounced differences in the cortex of youths with Down syndrome in several brain regions thought to belong to the Default Mode Network (DMN), the part of the brain that is active when a person is at rest. Because deterioration in the DMN has been associated with Alzheimer’s disease, Lee says these differences could provide clues about the early neural underpinnings of Alzheimer’s susceptibility in this group.
Surprisingly little is currently known about childhood brain development in those with Down syndrome. Lee hopes her finding will highlight the importance of the cortex for understanding developmental processes in this condition and spur further research. Such studies could more clearly illustrate how genetic abnormalities cause brain abnormalities — knowledge that could inform potential biomedical treatment approaches for intellectual disability.
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} | 347 | During the second and third trimester of pregnancy, the outer layer of the embryo's brain, the cortex, assembles itself into six distinct layers. But in autism, according to new research, this organization goes awry—marring parts of the brain associated with the abilities often impaired in the disorder, such as social skills and language development.
Eric Courchesne, director of the Autism Center of Excellence at the University of California, San Diego, and his colleagues uncovered this developmental misstep in a small study that compared 11 brains of children with autism who died at ages two through 15 with 11 brains of kids who died without the diagnosis. The study employed a sophisticated genetic technique that looked for signatures of the activity of 25 genes in brain slices taken from the front of the brain—an area called the prefrontal cortex—as well as from the occipital cortex at the back of the brain and the temporal cortex near the temple.
The researchers found disorganized patches, roughly a quarter of an inch across, in which gene expression indicated cells were not where they were supposed to be, amid the folds of tissue in the prefrontal cortex in 10 of 11 brains from children with autism. That part of the brain is associated with higher-order communication and social interactions. The team also found messy patches in the temporal cortices of autistic brains but no disorder at the back of the brain, which also matches typical symptom profiles. The patches appeared at seemingly random locations within the frontal and temporal cortices, which may help explain why symptoms can differ dramatically among individuals, says Rich Stoner, then at U.C. San Diego and the first author of the study, which appeared in the New England Journal of Medicine.
Courchesne's earlier research had shown that the brains of children with autism have more neurons in the prefrontal cortex as well as flawed genetic signaling in this region. The absence of markers for cells that should have formed in the second and third trimester strongly suggests a time frame for the developmental error—and for future preventive interventions. | https://www.scientificamerican.com/article/disorganized-brain-cells-help-explain-autism-symptoms/ | robots: classic
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Image: Markers for four different genes were combined into a single image to visualize the selective labeling of differerent cortical layers
Markers for four different genes were combined into a single image to visualize the selective labeling of different cortical layers. When examined together, clear regions of abnormal labeling, termed "patches," can be seen spanning multiple layers of cortex in autistic brain. Courtesy UCSD / UCSD
A detailed study of brain samples of children with autism who died young shows remarkably clear changes in their brains, researchers reported on Wednesday.
The differences are seen both on the genetic level and in the physical structure of the brain, and strongly support what scientists have been saying for years — that autism starts with disrupted genes that somehow interfere with brain development.
The changes look like patches of arrested development deep in the brain, says Eric Courchesne of the University of California, San Diego’s Autism Center of Excellence.
"They are actually jam-packed with brain cells," Courchesne told NBC News. Not only are there too many cells, but they are not developed properly. "Brain cells are there but they haven’t changed into the kind of cell they are supposed to be. It's a failure of early formation."
It supports the idea that the changes that cause autism are happening in the second and third trimester of pregnancy, Courchesne said.
But the findings also raise as many questions as they answer about the condition, which has been diagnosed with increasing frequency in the U.S. and elsewhere.
The physical changes suggest that something is causing autism that scientists had not identified before, but they don’t shed much light on what that new mechanism might be, Courchesne and colleagues wrote in their report, published in the New England Journal of Medicine.
Autism is becoming more and more common among U.S. kids, and researchers don’t quite understand why. The last survey by the Centers for Disease Control and Prevention showed 2 percent of U.S. children have been diagnosed with an autism spectrum disorder, which can range from the relatively mild social awkwardness of Asperger’s syndrome to profound mental retardation, debilitating repetitive behaviors and an inability to communicate.
There’s no cure and no good treatment.
Genetics are a large factor — if one twin has autism the other twin is very likely to — but genes don’t explain it all. Better diagnosis doesn’t explain all of it, either, and many scientists are looking at what happens in pregnancy. Some studies suggest that infections such as influenza during pregnancy may play a role.
Courchesne said his team's findings support the idea that both genes and some outside influence are working together to disrupt brain development. "It has to be something that involves mom, something that she is exposed to or that is happening to her," he said.
It’s already known that kids with autism have larger-than-normal brains. One hypothesis is that the growing brain of a child with autism doesn’t “prune” unneeded connections properly, and the resulting overgrowth of nerve connections sends the brain into overdrive.
For the latest study, Courchesne and colleagues got brain samples from 11 children with autism who died young, mostly from accidents such as drowning, when aged 2 to 15. They compared their samples to brain tissue of 11 kids without autism who also died suddenly.
To their surprise, they found extremely similar changes in 10 out of the 11 children with autism. They found “patches” of abnormal development in the tissue taken from the brain regions important for social development, communication and language. The visual cortex was unaffected.
"That means it’s common. That points to a common time, a common place. And that is startling," Courchesne said.
And the changes were deep in the brain, suggesting that they happened early in development.
“Building a baby’s brain during pregnancy involves creating a cortex that contains six layers,” Courchesne said. The defects were deep among these layers. "It's kind of like looking back in time," he said.
“Numerous brain imaging studies have revealed that ASD (autism spectrum disorder) can affect how the brain functions, but this study takes us to a new level by homing in on changes in the brain’s fundamental building blocks,” said David Smith, head of discovery research at Autism Speaks, which helps fund Courchesne’s work.
What flummoxed the researchers was that the 11 children with autism had a range of symptoms. Many couldn’t speak well and one did not speak at all. Some liked to watch videos quietly, while others showed the repetitive behavior that is one of the hallmarks of severe autism.
Yet the pattern of changes in their brains was very similar. It could be that autism is caused by specific genetic damage, and where that damage occurs affects behavior, the researchers said.
"One of the remarkable things about children with autism is even at young ages, many of them will have very similar degrees of social and language impairment, but some get better and some don't," Courchesne told NBC News.
"So it's always been a big mystery what's the basis for getting better and not getting better," he added. Maybe the brain can re-wire itself, depending on where the patches of damage are, he said.
"This also further reinforces the understanding that autism is caused by genetic factors, and the need to identify autism as early as possible, so that treatment can be started when they have the greatest potential," said Dr. Paul Wang, head of medical research at Autism Speaks.
And Dr. Deborah Fein of the University of Connecticut, who was not involved in the study, said the study shows why it's so important to donate tissue and organs for scientific study.
Hayley Goldbach, the 2013–14 Stanford–NBC News Global Health and Media Fellow, Senior Medical Producer Erika Edwards and Senior Nightly News Researcher Judy Silverman contributed to this story. | http://www.nbcnews.com/health/kids-health/brain-study-suggests-autism-starts-birth-n62681 | robots: classic
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} | 309 | Autism Could Begin Before Child Is Born
Autism Could Begin Before Child Is Born
New clues suggest autism could be detected before birth.
"Researchers found unusual cell development in parts of children's brains that develop during pregnancy. The abnormalities were found in areas that control social functioning, emotions, and communication." (Via CBS)
The findings were published in the New England Journal of Medicine. Researchers studied brain tissue from 11 children who died young and also had autism.
The study revealed patches of disorganization of neurons near the cortex of the brain, a thin layer of cells that control learning and memory.
One of the researchers told NBC the cells didn't develop properly. "Brain cells are there but they haven't changed into the kind of cell they are supposed to be. It's a failure of early formation."
These are signs that the changes causing autism likely happen while a child is still in the womb. (Via KCNC)
But according to a writer for Wired, these latest findings will only add to the uncertainty of autism research, where the neuroscience and genetics are already conflicted.
"The researchers found these abnormalities in ... areas with roles in language and cognition that are - in a very broad and hand-wavey sort of way - relevant to the symptoms of autism. They did not see them in the occipital cortex, a region primarily associated with vision, which isn't typically disrupted in autism."
While these researchers do believe their findings are a step forward in early detection of autism, some doctors say to be cautious about any findings.
A geneticist at UCLA told NPR he'd like to know the results from hundreds of brains, rather than just 11. "What fraction of all the kids with autism are going to have these small patches? I think the jury's out on that."
Currently, autism affects 1 in 50 U.S. children. No cure has been discovered. | http://www.aol.com/article/2014/03/27/autism-could-begin-before-child-is-born/20857958/?icid=acm50footerlogo | robots: classic
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CHICAGO (Reuters) - Children with autism appear to have too many cells in a key area of the brain needed for communication and emotional development, helping to explain why young children with autism often develop brains that are larger than normal, U.S. researchers said Tuesday.
Their study suggests the condition starts in the womb because brain cells in this area known as the prefrontal cortex typically develop during the second trimester of pregnancy.
The findings could help narrow the search for a cause of autism, which affects one in every 150 children born today in the United States, or about 1 percent of the population.
"We found a really remarkable 67 percent increase in the total number of brain cells in the prefrontal cortex," said Dr. Eric Courchesne of the University of California San Diego Autism Center of Excellence, whose study appears in the Journal of the American Medical Association.
Courchesne and colleagues carefully counted the number of brain cells in tissue from seven boys with autism who had died and six boys who did not have autism at the time of their deaths.
They focused on the prefrontal cortex, a part of the brain which is thought to grow too large and too fast in children with autism.
"It's a part of the brain that's important for social, emotional and communication functions, and it composes about 25 to 30 percent of the cerebral cortex," Courchesne said in a telephone interview.
His team was first in 2003 to link rapid growth in head circumference in the first year of birth with autism.
He said the finding of excess brain cells in the prefrontal cortex explains brain overgrowth in autism, and hints at why brain function in this area is disrupted.
"This isn't just a simple increase in neurons. It means a huge increase in potential connections and, therefore, a potential for miswiring which would lead to abnormal function," Courchesne said.
Scientists have found dozens of genes that may raise the risk of autism. But genetic causes only explain 10 percent to 20 percent of cases, and recent studies have pointed to environmental factors, possibly in the womb, as a potential trigger.
"For years, it's been a big puzzle from the standpoint of evidence. Where is the evidence that autism has a prenatal origin?" Courchesne said.
"For the first time, we have something really solid," he said.
The team found excess brain cells in each child with autism they studied, Courchesne said. And the brains of the autistic children also weighed more than those of typically developing children of the same age.
Lizabeth Romanski of the University of Rochester Medical Center said the findings show that the origins of autism occur very early.
"The generation of new neurons, what we call proliferation, occurs prenatally during the second trimester," said Romanski, who was not involved in the study. "That is when these neurons are being born."
She said the finding of a large number of these neurons in children with autism suggests something occurred during this period to change the way the brain develops.
The researchers acknowledge that their study is small.
Courchesne said it is difficult to find brain samples from young people with autism, and his study included some from very young children, ranging from ages 2 to 16.
"This really says prenatal life is a very important time to study and mechanisms there will eventually lead to our understanding of how autism comes about," he said.
SOURCE: http://bit.ly/4hwz7 Journal of the American Medical Association, online November 8, 2011.
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Study: Autism May Start in the Womb
New research reported in the Journal of the American Medical Association (JAMA) suggests that autism may originate in utero, not toddlerhood, as many have long believed. Scientists at the University of California, San Diego, found that autistic children have about 67 percent more nerve cells than do other kids in the prefrontal cortex, a part of the brain that is involved in processing language, social behavior, and decision-making, reports
In this small, preliminary study, researchers looked at postmortem brain tissue from seven boys with autism and six without it, ranging in age from 2 to 16 when they died (from drowning or other accidents; determining how many neurons are in the brain can only be done after death). Researchers were surprised by their findings of an excess of neurons, given that deficits in social skills, like those typically exhibited by children affected by autism, are generally linked to less nerve tissue.
Plus: Parents’ Experience with Autism
“When we think of the inability to handle complicated information, we usually think of too little in the way of connections or brain cells,” said lead researcher Eric Courchesne, PhD, a professor of neurosciences at the UC-San Diego School of Medicine and director of the Autism Center of Excellence. “But this is just the opposite.”
Dr. Courchesne explained that autistic children may have insufficient nerve connections because the excess of neurons may have created difficulty in their ability to connect and communicate with each other.
Plus: Age-By-Age Guide to Autism Spectrum Disorders
These findings are important because neurons or nerve cells start developing in the prefrontal cortex at the end of the first trimester of pregnancy—but do not continue after birth, meaning that events after birth couldn’t have created such an oversupply of neurons. (Neurons are generated after birth in just two parts of the brain: in the hippocampus and in the olfactory bulb.)
Plus: Prenatal Vitamins May Reduce Risk of Autism
Although this was a small study, “Knowing that we have a specific type of defect that occurs very early in development really helps us to focus and sharpen the next steps in research to determine what caused the excess,” said Dr. Courchesne. | http://www.parenting.com/blogs/show-and-tell/melanie-parentingcom/study-autism-may-start-womb?cid=relblogposts | robots: classic
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Study: Autism May Start in the Womb
New research reported in the Journal of the American Medical Association (JAMA) suggests that autism may originate in utero, not toddlerhood, as many have long believed. Scientists at the University of California, San Diego, found that autistic children have about 67 percent more nerve cells than do other kids in the prefrontal cortex, a part of the brain that is involved in processing language, social behavior, and decision-making, reports
In this small, preliminary study, researchers looked at postmortem brain tissue from seven boys with autism and six without it, ranging in age from 2 to 16 when they died (from drowning or other accidents; determining how many neurons are in the brain can only be done after death). Researchers were surprised by their findings of an excess of neurons, given that deficits in social skills, like those typically exhibited by children affected by autism, are generally linked to less nerve tissue.
Plus: Parents’ Experience with Autism
“When we think of the inability to handle complicated information, we usually think of too little in the way of connections or brain cells,” said lead researcher Eric Courchesne, PhD, a professor of neurosciences at the UC-San Diego School of Medicine and director of the Autism Center of Excellence. “But this is just the opposite.”
Dr. Courchesne explained that autistic children may have insufficient nerve connections because the excess of neurons may have created difficulty in their ability to connect and communicate with each other.
Plus: Age-By-Age Guide to Autism Spectrum Disorders
These findings are important because neurons or nerve cells start developing in the prefrontal cortex at the end of the first trimester of pregnancy—but do not continue after birth, meaning that events after birth couldn’t have created such an oversupply of neurons. (Neurons are generated after birth in just two parts of the brain: in the hippocampus and in the olfactory bulb.)
Plus: Prenatal Vitamins May Reduce Risk of Autism
Although this was a small study, “Knowing that we have a specific type of defect that occurs very early in development really helps us to focus and sharpen the next steps in research to determine what caused the excess,” said Dr. Courchesne. | http://www.parenting.com/blogs/show-and-tell/melanie-parentingcom/study-autism-may-start-womb?src=soc&dom=googleplus | robots: classic
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} | 432 | This increased quantity of nerve cells must result from something that occurred prenatally, like an infection or genetic abnormality
A small study looking at the brains of children with autistic spectrum disorder who have died has shown that the autistic children have more neurons in a certain region of the brain than their normally-developing peers. This region, called the prefrontal cortex, is known to be involved in social, emotional, and thinking skills.
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Since the number of cortical neurons is determined before birth, this increased quantity of nerve cells, the researchers maintain that it must have resulted from something that occurred prenatally. An infection, a toxic exposure, a genetic abnormality, a dysregulation of cell growth, or other mechanism may be the agent responsible.
In a painstaking process, the researchers studied the brains of seven autistic children and six non-autistic children who had died. They measured the weights of the brains, examined the brain tissue, and counted the neurons in the brain regions of interest. The diagnosis of autism in the deceased children was established by a rigorous questionnaire administered to a parent or guardian of the child.
The brains of the autistic children were on average 17 percent heavier than brains of typically-developing, same-aged peers. Looking at the two main areas of the prefrontal cortex, the researchers also found there were 79 percent more neurons to the sides in the back (dorsolateral area) of the prefrontal cortex of autistic children compared to the controls. There were 29 percent more neurons in the middle (medial) area of the prefrontal cortex. These are substantial differences. These same brain regions are larger in living autistic children when their brains are examined by MRI scans.
During fetal brain development, brain cells proliferate and then die off in a programmed way, in a process called apoptosis. If too many brain cells develop, or if not enough die off, the result is an excess of neurons at birth. The location, number, and type of extra cells will determine the child's clinical appearance and developmental outcome.
This new research sheds light on a prenatal brain growth abnormality in the prefrontal cortex that seems to be associated with autism. This information supports previous investigations that have found differences in head size and brain weight in autistic children and may help focus future studies on the causes of autism. The study was published in the November 9 issue of the Journal of the American Medical Association (JAMA).
Image: Lightspring/Shutterstock.
This article originally appeared on, an Atlantic partner site. | http://www.theatlantic.com/health/archive/2011/11/an-over-abundance-of-neurons-linked-to-autism-in-children/248749/ | robots: classic
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} | 323 | Faulty genes may trigger early autistic brain growth
Autism seems to be inherited, but until now, little has been known about the genetics behind the disorder. In a study at the University of California, San Diego School of Medicine, researchers have linked specific genetic changes with the abnormal early brain growth seen in children with autism. The brain seems to grow too quickly, and then starts to lose connections between brain cells. This is particularly in an area of the brain known as the prefrontal cortex, which is associated with social, communication and cognitive development, which ties in with the symptoms of the syndrome.
By carrying out analyses of the DNA in samples from this area of the brain from children and young people and comparing it with adults with autism syndrome disorder, they found changes in the genes that regulate the number of cells and the patterns of cells in the young people with autism. In the adults with autism, this part of the brain had changes in signaling. Both groups also had lower levels of the genes that coordinate cell repair.
"Our results indicate that gene expression abnormalities change across the lifespan in autism, and that dysregulated processes in the developing brain of autistic patients differ from those detected at adult ages," said Eric Courchesne, Ph.D., director of the Autism Center of Excellence at UCSD. "The dysregulated genetic pathways we found at young ages in autism may underlie the excess of neurons--and early brain overgrowth--associated with this disorder."
Autism seems to be a recurring theme in biomarker research at the moment, with researchers moving closer to blood-based or imaging-based tests for this distressing developmental disorder. Finding the biomarkers, targets and processes underlying autism could help find better ways to identify and treat--or even maybe to prevent--the abnormal brain growth that seems to be a common factor in the disorder.
- read the press release
- see the abstract
- check out the article in Scientific American | https://www.fiercebiotech.com/medical-devices/faulty-genes-may-trigger-early-autistic-brain-growth | isPartOf: CC-MAIN-2021-49
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} | 3,387 | Opening a Window to the Autistic Brain
• Kendall Powell
• Published: August 17, 2004
• DOI: 10.1371/journal.pbio.0020267
At first glance, the preschool classroom on the other side of the two-way mirror looks like any other—brightly colored rugs, scattered toys, and tiny chairs. But almost immediately an observer notices differences in the Team Toddle students here at the Neuropsychiatric Institute of the University of California at Los Angeles (UCLA) (Los Angeles, California, United States).
A therapist instructs a toddler on his colors, flashing a rapid sequence of blocks at him. When the toddler starts rocking in his chair and repeatedly touching his forehead, the therapist physically restrains his hands, placing them back on the tabletop until he stops the repetitive behaviors and focuses once again on her face and the blocks. During playtime, a two-year-old girl sits by herself in the corner, fixated on some picture cards, oblivious to a group of other children playing with a racetrack and to the therapist who tries to draw her out to join the group.
These children lack some of the key social skills that normal toddlers pick up naturally—looking to others for reassurance or cues, focusing on faces, and playing together. Social and communication impairment is a hallmark of autism and can show up as early as 12–18 months of age. But with an unknown cause, and genetic linkages still hazy, there is little consensus among researchers on how the disorder develops in children and how it causes a broad spectrum of social, language, and behavioral deficits.
Following one line of research, David Amaral's laboratory at the M.I.N.D. Institute at the University of California at Davis Medical Center in Sacramento (California, United States) has recorded, in autistic brains, a brain volume increase in a specific structure, the amygdala, which is thought to be important for social behavior. A similar study at the University of Washington in Seattle (UW) (Seattle, Washington, United States) has reached the same conclusion. “There are so few facts about autism, to have two labs come up with the same data is phenomenal,” says Amaral. “We feel confident this is a real finding, but what does it mean to these kids?”
On another research track, using functional imaging, Ralph-Axel Müller, a cognitive neuroscientist at San Diego State University (San Diego, California, United States) sees a scattering of brain activation in autistic brains that he views as an indication of a more general brain development problem underlying the disorder (Figure 1). He has hypothesized that the early-developing basic functions may require more brain area in autism, pushing out and disturbing the later specialization for more complex functions. “I'm sure this is wrong,” he says, “but it will allow us to look in a more hypothesis-driven way at animal studies of how the cerebral cortex develops specialization.” Animal models may, in turn, yield clues about normal and abnormal brain development in humans.
Figure 1. Brain Activation Scattering in Autism
Autistic individuals show less activity, during a movement task, in areas that are normally activated (premotor and superior parietal cortex; blue areas), but unusually increased activity around these normal sites of activation (red areas). Images courtesy of Ralph-Axel Müller.
“Since there is no major hypothesis as to cause [of autism], there are many plausible ideas,” says Amaral. “If we go after all of them, we will waste all of our resources. [We have to] come to some consensus about which are most plausible.” At least two levels of pursuit exist for tracing brain problems associated with autism—the exploration of the general developmental disruptions that result in an autistic brain, and the examination of more specific problems in particular brain structures that produce symptoms. Although scientists still debate how autism evolves in a patient, the field has begun in the last decade to replicate findings and make science-based arguments for interventions. Progress has come in small steps, with advances in neuroimaging and more rigorous experimental designs.
Research focuses have shifted from “curing” autism to finding better diagnostics for early intervention, improving behavioral therapies, and gaining insight into the development and function of the autistic brain. Both advocacy groups and government programs have started to bring together neuroscience and genetics experts, clinicians, and families to sharpen the focus of studies and ensure progress in what has often been a messy field.
A World Apart
Autism spectrum disorder strikes between one and six out of every 1,000 children around the world, but diagnosis and treatment are currently limited to developed countries. Autism is four times more prevalent in boys than girls, but makes no racial, ethnic, or socioeconomic distinctions. It is characterized by three main symptoms: impaired language, social and communicative deficits, and repetitive and stereotyped behaviors, such as hand flapping, rocking, and unusual responses to sensory stimuli. Autism spectrum disorders can be broken down into other categories, such as low-functioning autism (IQ below 70), high-functioning autism (IQ above 70), and Asperger syndrome (similar to high-functioning autism but with no language deficit).
Researchers suspect that there are even more distinct subsets of autism patients. For example, some patients also have epilepsy, and it has been suggested that there is a regressive form of autism—children who, at two or three years of age, appear to regress and lose developmental milestones they had already achieved. Researchers say that sorting out these different profiles—or phenotypes—of autism will be especially important in sorting out which genes or which brain abnormalities are implicated for particular deficits. This sorting should also help clarify the mounds of contradictory data that have dogged the field, by tamping down the experimental “noise” in studies. Boosting the number of children studied and following them from early infancy through adolescence and beyond will also be key components of future studies.
“There is not going to be rapid progress in autism research unless we subtype,” Amaral says. He predicts that “brain differences in kids with a regressive form of autism will be different than those of kids with the more congenital type of autism.” He and others are teaming up in an autism phenotyping project that will characterize 600 children into categories of autism (comparing them to 600 children with mental retardation and 600 controls). Splitting autism into subtypes will boost both neurobiology and genetics studies (Box 1) to find real effects related to specific traits.
Facing Up to Autism
A key area of research explores the brain's response to human faces at a young age. Studies at the UW Autism Center have shown that unlike typically developing three-year-olds, autistic children do not show a differential brain response to their mother's face compared to that of a stranger. While dysfunctional face recognition may be one of the more devastating symptoms for caregivers, it is also one of the most promising avenues for research to determine how autistic brains process their world differently.
Sara Webb, a child psychologist at UW, has followed about 70 autistic children since the age of three for a longitudinal study that will test many parameters until they reach age nine. Her work has already shown that autistic three-year-olds process seeing a strange toy differently from seeing a favorite toy, in the same way a normal child does. But activity in their brains—measured through a network of electrodes placed on the scalp—is similar whether the face is familiar (for example, mom) or strange. This, Webb says, led to two hypotheses: either the brain area for face processing is not set up correctly in autistic children, or the way these children incorporate experiences from their environment is so different that the brain area develops improperly.
“We think the latter is a more likely explanation at this point,” says Webb. “By the time they are adolescents or adults, they are showing the [proper] response for familiar faces.” Indeed, a functional MRI (fMRI) study by UW neuroimaging researcher Elizabeth Aylward showed that the brains of high-functioning adolescents and adults did activate the face-recognition center, the fusiform gyrus, when shown a very familiar face. However, the same subjects did not activate the center when viewing strange faces. This points to the possibility that greater experience seeing the familiar face (i.e., on a daily basis for many years) can eventually influence the appropriate brain areas.
“You need the biological wiring set up properly, but you also need experience for it to function normally,” says Aylward. “We're guessing what is missing is the experience.” To test that idea, one of her graduate students will “train” half of the autistic patients in face recognition—something most children pick up on their own—by having them study, manipulate, and match faces using computer games. Then fMRI scans will be done again to see if the fusiform gyrus might now be activated when viewing strange faces, as it is in control subjects. Intense training of a similar type for reading has already been shown to effect change in brain activation in as little as three weeks for children with dyslexia.
In their model, it is as if “all the parts are there, ready to go, but somehow they haven't gotten the ignition turned on,” says Aylward. At the 2004 annual meeting of the American Association for the Advancement of Science (Washington DC, United States), the UW center director Geraldine Dawson explained that this tackling of specific deficits will help researchers attach them to particular “mind modules” in the brain and will ultimately lead to the genes that control the development or function of those modules. That modular view, however, is not shared by many of her colleagues elsewhere, who argue that autistic behaviors are the result of a system-wide perturbation of early brain development and connectivity.
Structural Support
For example, Müller points to structural studies that seem to uphold his theory of overall disorganization of the brain's cortex. Work by Manuel Casanova and colleagues at the University of Louisville (Louisville, Kentucky, United States) shows that the “minicolumns” of neurons that make up the cortex are narrower and more numerous in autistic brains. Normally, these organized bundles appear very early in the developing fetal brain. In postmortem studies of autistic brains, Casanova found that the minicolumns had the same number of neurons, but smaller margins between the bundles. The margins, Casanova says, may act like “a shower curtain of inhibition that prevents information from flooding adjacent minicolumns.”
Reducing those margins, he hypothesizes, could mean that an autistic brain has too much positive feedback, acting like a noisy amplifier. “For an autistic individual who is trying to piece together too much information from a face, maybe it's like looking at the sun,” he says.
More general studies of adult autistic neuroanatomy have given conflicting results—most likely from diversity in the study populations—that make functional inferences difficult, if not impossible. But recent studies that focus on developing autistic brains earlier in life have revealed intriguing differences from normally developing children.
Several studies have shown that from ages two to four, autistic children have larger overall brain volumes (and correspondingly larger head circumferences) than normal children, but that the difference had disappeared by about age six or seven. Since autism is usually diagnosed around age two or three, when the brain is already abnormally large, Eric Courchesne and colleagues at University of California, San Diego (San Diego, California, United States) hypothesized that brain overgrowth must occur earlier, before signs of autism appear.
In an elegant retrospective study, the team analyzed head circumference and brain volume measurements of autistic children that started at birth and continued until 14 months of age. The study revealed that at birth, autistic children's head size is much smaller than healthy children, in the 25th percentile, but by 6–14 months, their head size had increased to the 84th percentile, an excessive growth rate. The increase correlated with increased brain volumes of both gray and white matter regions measured by structural imaging between ages two to five.
The Courchesne study strongly suggests that with autism, significant unregulated brain growth occurs in the first year of life. The team also found an association between greater increases in brain size in infancy and a later age for first word, worse repetitive behavior, and a trend toward more severe autistic symptoms later, at diagnosis. The rapid growth of autistic brains may produce too many connections too quickly, without the opportunity to be shaped by the experience and input that a typically developing child accumulates over many years. At age six or later, when the growth slows, the already derailed connections may no longer be able to incorporate experiences. “By that time,” write Courchesne et al., “the period of plasticity that allows the exquisite and graceful complexity of the human brain to emerge will have passed.”
Playing Well with Others
This idea that autistic brains are developing at warp speed, to their detriment, fits intriguingly well with what is known about treatment of autism—the earlier and more intense behavioral therapy an autistic child receives, the better the outcome will be. That's why the toddlers at UCLA get one-on-one training by therapists, who fire rapid questions and physically repeat tasks until they sink in.
Stephanny Freeman, co-director of the Early Childhood Partial Hospitalization program at UCLA (Los Angeles, California, United States), says these methods would be alien to, and lost on, typically developing two-year-olds, who would be bewildered by such a highly structured environment. Her colleague and co-director, Tanya Paparella, chimes in, “It as if we are opening a window or door to the autistic brain.” Keeping that door open as long as possible in very young autistic patients seems to give them a better prognosis than older children, who are more difficult to treat.
But while most agree that early and intense therapy is good for autistic children, until recently, little research on intervention methods existed. Connie Kasari, an educational psychologist at UCLA, along with Freeman and Paparella, has run one of the first randomized, controlled trials on therapies designed to teach autistic kids social skills. The group tested two skills in particular—sharing attention with others and pretend playing (Figure 2). The team hypothesizes that these skills, which normal children pick up easily and early, lay important groundwork for language development.
Figure 2. Pointing as an Example of Joint Attention
A child with autism (three years old) pointing to the fish in an aquarium. Photo courtesy of Connie Kasari.
The team's results show that autistic children can learn these skills from intense training. At least anecdotally, some of these children have gone on to function in normal school classrooms, even making a few friends, although they are still a bit socially awkward. Whether or not improvements in those skills will correlate with language improvements will require further testing. But Kasari notes that this work is not universally accepted in the autism therapy community, and that many more controlled studies will have to be published before a system-wide change in autism preschool education can occur.
Funding the Search
In the last decade, National Institutes of Health funding for autism research has increased from $10 million to $80 million, and much of that has been funneled into large, multidisciplinary research projects. Advocacy groups such as Cure Autism Now (Los Angeles, California, United States) and the National Alliance for Autism Research (Princeton, New Jersey, United States) greatly influence which autism research projects get funded, both through their own grant programs and also by lobbying Congress for increased federal grants. Some question whether it is wise to let emotions and the desire to find a cure drive research agendas. In the past, tensions between government programs and advocacy programs have run high.
Casanova, for one, criticizes the disproportionate flow of money to what he calls imaging and genetic “fishing expeditions” and says more should go to neuropathology studies. He points out that only about 40 postmortem, mostly adult, autistic brains have been studied so far, a tiny fraction compared to those studied in other neuropathological disorders like Alzheimer's disease or schizophrenia.
But Daniel Geschwind, a neurogeneticist at UCLA, defends this approach, saying that a well-planned fishing expedition that uses the right technology and looks in the appropriate places can result in a “freezer full of fish.” He also says that parent organizations keep the field honest by “constantly reminding us to keep an eye on the ball and don't get distracted.” Geschwind, Amaral, and other top experts have recently been recruited by advocacy groups or by friends with autistic children to shift some of their research questions to examining autism.
As more researchers in genetics and neuroscience have become involved, Amaral says, the tensions between the parent groups and the National Institutes of Health have eased. “The parents communicated to the scientists the tremendous need for research and the scientists convey back to them which [research projects] make sense to fund,” he says. He adds that advocacy groups have been indispensable to research, setting up large genetic and brain tissue banks and enlisting families to participate in those efforts.
So, researchers say, the goals of the National Institutes of Health programs and the advocacy programs have started to come together to focus on well-executed studies that might lead to better diagnostics and earlier, proven interventions. The work of Courchesne et al. suggests that children at risk for autism might easily be diagnosed by head circumference measurements as early as the first few months of life. Imaging studies combined with training programs, such as the work at UW on face recognition, may one day be able to verify that behavioral interventions are effective at activating target brain areas. As researchers work to untangle the causes and effects of brain dysfunctions in autism, Aylward notes, there is good reason to be hopeful: “Although this is a genetic disorder, we know there is plasticity in the young brain.”
Box 1. Genetic Power-Up
Evidence abounds that autism results from multiple gene mutations. Identical twins share an autism diagnosis 60%–95% of the time, and a younger sibling of an autistic child is 50 times more likely to have autism. There are also four times as many autistic males as females, indicating a possible sex chromosome difference in inheritance. Genetics researchers estimate that autism is the result of mutations in anywhere from 2 to 20 genes.
By studying the commonly inherited pieces of chromosomes in autistic siblings, geneticists have identified a handful of chromosome hotspots. However, each region contains hundreds of individual genes, and narrowing down to specific mutations will require studies that either involve thousands of families or tackle specific phenotypes. Daniel Geschwind, a neurogeneticist at UCLA, has already completed such a study. It reveals a linkage—the probability that a region contains a gene or genes linked to the disorder—between language deficits and a hotspot region on Chromosome 7. His team looked at a more homogenous group of autistic patients, all of whom had a similar language delay measured quantitatively by time to first spoken word.
“Endophenotypes measure something that underlies the disorder in a significant way and [therefore probably] also underlies a genetic component,” says Geschwind. “We're trying to identify characteristics that really underlie the genetic peaks of interest.” Another such study, by Margaret Pericak-Vance and colleagues at Duke University Medical Center (Durham, North Carolina, United States), used the characteristic of “insistence on sameness”—a subset of stereotyped behaviors such as resisting change in routine or environment, and compulsions. By running a genetic analysis on a group of patients with the highest “insistence on sameness” scores from diagnostic tests, the Duke team increased the linkage score and further narrowed the hotspot region on Chromosome 15.
Further Reading
1. 1. Alarcón M, Cantor RM, Liu J, Gilliam C, Geschwind DH (2002) Evidence for a language quantitative trait locus on chromosome 7q in multiplex autism families. Am J Hum Genet 70: 60–71.
2. 2. Amaral DG, Bauman MD, Schumann CM (2003) The amygdala and autism: Implications from non-human primate studies. Genes Brain Behav 2: 295–302.
3. 3. Casanova MF, Buxhoeveden D, Gomez J (2003) Disruption in the inhibitory architecture of the cell minicolumn: Implications for autism. Neuroscientist 9: 496–507.
4. 4. Courchesne E, Carper R, Akshoomoff N (2003) Evidence of brain overgrowth in the first year of life in autism. JAMA 290: 337–344.
5. 5. Dawson G, Carver L, Meltzoff AN, Panagiotides H, McPartland J, et al. (2002) Neural correlates of face and object recognition in young children with autism spectrum disorder, developmental delay, and typical development. Child Dev 73: 700–717.
6. 6. Müller R.-A, Kleinhans N, Kemmotsu N, Pierce K, Courchesne E (2003) Abnormal variability and distribution of functional maps in autism: An fMRI study of visuomotor learning. Am J Psychiatry 160: 1847–1862.
7. 7. Shao Y, Cuccaro ML, Hauser ER, Raiford KL, Menold MM, et al. (2003) Fine mapping of autistic disorder to chromosome 15q11-q13 by use of phenotypic subtypes. Am J Hum Genet 72: 539–548. | http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.0020267 | robots: classic
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Continue reading the main story
''If you put 100 people with autism in a room, the first thing that would strike you is how different they are,'' said Dr. Fred Volkmar, a professor of child psychiatry at Yale and an expert on autism. ''The next thing that would strike you is the similarity.''
Some children attend regular schools, others are so disabled they require institutional care. Some children speak fluently, others are mute. Some are completely withdrawn; others successfully navigate a path through the outer world.
In fact, studies show that many children with autism can improve with treatment, and some -- from 15 to 20 percent, experts say -- recover completely, holding jobs and living independent lives.
Yet the realization that autism takes many forms has also made its diagnosis more complicated. In 1994, psychiatrists added a new diagnostic category -- Asperger's syndrome -- to the psychiatric nomenclature, to take account of children who displayed some features of autism but did not meet the full diagnostic criteria.
Many researchers view Asperger's as distinct from autism. But the differences become blurred in cases where children have normal or above normal I.Q.'s. In such instances, experts say, whether Asperger's or autism is diagnosed is often arbitrary.
''I don't think anyone's got good evidence for a clear distinction between people with high-functioning autism and Asperger's,'' said Dr. Tony Charman, a researcher in neurodevelopmental disorders at University College London.
The Disconnect
Calculations, Yes; Eye Contact, No
As a child, Donald Jensen lay in bed at night, tracing numbers in the air with his finger. He memorized lottery numbers. He was riveted by the pages of the calendar.
Now 19, his facility with mathematical calculation seems magical. Given any date -- Jan. 7, 1988, for example -- he can, in an instant, identify the day of the week it fell on. (It was a Thursday.) He virtually never makes mistakes.
Yet even in childhood, there were signs that Donald was exceptional in other ways. He was mesmerized by the washing machine, becoming upset if the laundry was finished before he got up in the morning. He started talking late. Once, when his grandmother slipped on some ice in the yard and fell, he continued to chatter about numbers, seemingly oblivious to her plight.
Problems in school led doctors to diagnose autism when Donald was 6, his uncle, Glen Jensen, said. As an adult, Donald's gifts -- he is among the 1 to 10 percent of people with autism known as autistic savants -- connect him to the world. ''What day were you born?'' he asks visitors.
But the things that Donald cannot do also separate him from other people. He rarely makes eye contact. Ask him how he calculates dates or what numbers mean to him and the inquiries are met with silence. His ability to empathize with other people has grown over the years -- ''John was angry today, and that was upsetting to me,'' he will say -- but unexpected events disturb him, and his conversations sometimes take the form of asking questions over and over.
What lies at autism's core? Over the decades, researchers have come up with a variety of theories. But most were based on what clinicians observed, not on what might be going on in the brain. Only recently have sophisticated technologies allowed researchers to begin bridging the gap between the consulting room and the laboratory.
Dr. Ami Klin, an associate professor of child psychology and psychiatry at Yale, and his colleagues began with the observation that people with autism often have a great deal of intellectual knowledge, but lack ''street smarts,'' and are unable to use what they know in social situations.
''Many of our clients know the currencies of all countries in the world, but they cannot go to McDonald's and buy a burger and count the change,'' Dr. Klin said. ''They know all the bus ramps, but can't take a bus.''
In a series of experiments to find out why it is so difficult for someone with autism to function in the world, the Yale team , including Warren Jones, a research associate, developed a device for tracking eye movements that could be mounted on the brim of a baseball cap. Then they had subjects, who either had autism or did not, watch a video clip from the 1967 film ''Who's Afraid of Virginia Woolf'' and monitored their gaze.
The normal subjects closely tracked the social interactions among the actors in the films, focusing especially on the actors' eyes. In contrast, people with autism focused on objects in the room, on various parts of the actors' bodies and on the actors' mouths.
In one scene, Richard Burton and Elizabeth Taylor kiss. The subjects without autism looked at the actors' embrace; the autistic subjects' eyes went elsewhere: one man stared at a doorknob in the background.
Such research suggests that from birth, the brains of autistic children are wired differently, shaping their perception of the world and other people. ''In normal development,'' he said, ''being looked at, being in the presence of another, seeking another -- most of what people consider important emerges from this mutually reinforcing choreography between child and adult.''
If this duet cannot take place, Dr. Klin said, ''development is going to be derailed.''
Studies using brain scanning techniques like fast M.R.I. lend weight to the idea that for people with autism, perception molds behavior.
''There is a deep relationship between what we see and what we know,'' said Dr. Robert Schultz, an associate professor at Yale's Child Study Center.
Researchers have long known, for example, that people with autism have difficulty recognizing faces. In non-autistic subjects, a brain area called the fusiform gyrus is activated in response to the human face. But when pictures of unfamiliar faces are shown to children or adults with autism, studies show, the region is less active.
Dr. Schultz said that autistic people appear to identify faces the way other people identify objects, by piecing features together. While most people are better at recognizing images of faces when they are right-side up, autistic subjects identify them faster when they are upside-down.
A recent study, presented at the annual meeting of the American Association for the Advancement of Science in Seattle this month, illustrates this. Dr. Dawson, of the University of Washington, and a colleague reported that when autistic adolescents and adults were shown pictures of faces, another brain area involved with object recognition was activated, while the fusiform gyrus remained quiet. Yet when the researchers showed photos of the subjects' mothers, the fusiform brain did light up.
Work by Dr. Isabel Gauthier, an assistant professor of psychology at Vanderbilt University, suggests that, in fact, the fusiform gyrus is not programmed to react to faces per se but to things that people care about and learn to distinguish in detail.
Dr. Gauthier trained people to become experts on ''greebles,'' a class of simply-drawn imaginary beings. When the subjects became adept at telling one greeble from another, she found, the fusiform gyrus lighted up in response to pictures of the creatures. Similarly, when car experts were asked to identify different car models, the region was activated, Dr. Gauthier reported last year in the journal Nature.
The research suggests that children with autism can be trained to become better at face recognition -- something that scientists at Yale and other universities are trying. But the seeming indifference to the human face that often accompanies autism has led the Yale resarchers to propose that the fusiform gyrus may be a component of the social brain, intimately tied up with basic emotional responses like fear, anxiety and love.
In fact, some studies have found abnormalities in the amygdala, a brain region involved with emotion and social awareness. But the findings are inconclusive, and differences in autistic brains have been found in structure, including the temporal lobes and the cerebellum.
The Physical
A Telling Find: Bigger Brains
In his early description of autism, Dr. Kanner noted that heads of the children were larger than normal. Modern researchers have confirmed this observation, finding that for some period of time during childhood, autistic children have bigger brains than their non-autistic counterparts. In 2001, Dr. Eric Courchesne, a professor of neuroscience at the University of California at San Diego, and his colleagues found that 4-year-olds with autism showed increases in the volume of the brain's gray matter, where the cell bodies of neurons are located, and white matter, which contains nerve fibers sheathed with an insulating substance called myelin.
In a 2003 study in The Journal of the American Medical Association, Dr. Courchesne reported that at birth, the heads of infants with autism were smaller than normal, but then showed ''sudden and excessive'' growth in size from 1 to 2 months and from 6 to 14 months. By adolescence, however, the children's brains were the same size as those of other children or slightly smaller.
Dr. Martha Herbert, an instructor in pediatric neurology at Harvard, has begun to zero in on precisely where this growth spurt occurs. At the annual meeting of the Society for Neuroscience in October, she reported that in autistic children, the outer zones of white matter became enlarged compared with normal brains beginning after age 6 months and continuing into the second year of life. Those outer zones, Dr. Herbert said, are insulated later in development than the areas of white matter deeper in the brain.
''It seems that something is going on that gets more intense,'' Dr. Herbert said.
In another study, Dr. Manuel Casanova, a professor of neurology and neuropathology at the University of Louisville, found an increase in autistic brains in the stacks of neurons known as mini-columns that extend through the layers of the neocortex. The brains of people with autism not only had more mini-columns, Dr. Casanova found, but the neurons that made up the columns were less variable in size than in normal brains.
Such findings are intriguing, but their meaning is not clear.
One possibility is that the enlargement in white matter reflects an overabundance of myelin, which could disrupt the timing of communication signals throughout the brain. But this growth in volume, Dr. Herbert said, could also represent an increase in nerve fibers, the migration of other types of cells or some type of inflammation.
Dr. Casanova, for his part, theorizes that the proliferation of mini-columns might result in a deluge of stimulation, or as he puts it, ''way too much information.''
''The sound of rain on a roof might seem like driving nails into a tin roof, a fluorescent light might become extremely perturbing,'' Dr. Casanova said.
Dr. Nancy Minshew, a professor of psychiatry and neurology at the University of Pittsburgh, argues that autism's core lies in higher brain areas, rather than in deeper structures that govern emotion.
''When I started about 20 years ago, I looked at autism and said this disorder is in the cortex of the brain,'' Dr. Minshew said. ''It's the classical disorder of cognition.''
The Genetics
Child Rearing Not at Fault
In 1964, Bernard Rimland, a British psychologist with an autistic son, put forward the view, then controversial, that genes, not faulty child rearing, lay behind the disorder.
Most experts now agree that autism is strongly determined by heredity. Studies indicate, for example, that if parents have one child with autism, the chance that they will have a second autistic child is 2 to 6 percent -- about 100 times the general risk.
Twin studies also argue for a large genetic component. Identical twins, the studies suggest, run a 60 to 85 percent chance of having autism or a similar disorder if their twins have it. For fraternal twins, the chances are 10 percent.
Two very rare forms of autism -- one associated with the congenital disease known as tuberous sclerosis and the other with fragile X syndrome -- are known to be caused by chromosomal defects.
But in most cases, autism is thought to have a more complex genetic origin, involving multiple genes acting together.
''The bulk of people with autism develop it because they have inherited a particular genetic predisposition,'' said Dr. Anthony Bailey, a professor of psychiatry at Cambridge.
Finding those genes, however, is a difficult task. The disorder is relatively uncommon, and most people with autism do not have children, making it difficult to track successive generations of a family.
To get around these obstacles, some researchers are studying families having two or more members with autism and searching for similarities in the genome that could provide the crucial link to the disorder.
Cure Autism Now, an advocacy group based in Los Angeles, has started a program to collect DNA samples from such families and use them for research.
Large-scale studies are in progress at a variety of institutions in the United States and other countries. DeCode Genetics, an Icelandic company that last year identified a gene that may contribute to schizophrenia, announced in January that it would use the Icelandic population to search for genes underlying autism and similar disorders like Asperger's.
Some researchers are also hunting for genes that may underlie specific aspects of autism.
Dr. Daniel Geschwind, director of the neurogenetics program at the University of California, Los Angeles is hoping, in a study of autistic children and their families, to find genes that contribute to the delayed development of language.
No specific gene for autism has yet been pinpointed. But promising areas have been identified on a variety of chromosomes, including the 2, 3, 7, 13, 15 and the X chromosome.
''My sense is that we are close to the tipping point in this illness,'' said Dr. Insel of the National Institute of Mental Health, ''and that over the next couple of years we will have, not all of the genes, but many of the genes that contribute.''
At the same time, the disorder is not entirely genetic, indicating that some environmental influences, either during a mother's pregnancy or in the first years of life, have roles in setting off the disorder, perhaps by changing the way genes function without actually altering DNA.
Over the years, many candidates have been proposed, including German measles during pregnancy; yeast infections; the sedative drug thalidomide; childhood vaccines; viruses; the labor-inducing drug Pitocin; and dietary, hormonal or immune system changes during pregnancy.
But so far, researchers say, solid evidence for any single factor has not emerged. Still, several research groups are trying to address the issue of environmental triggers. A study based at Columbia University, for example, will follow 100,000 pregnancies in Norway, examining a variety of environmental influences, including infections, vaccinations, mercury exposure and prenatal stresses.
Experts disagree about the importance of environmental influences. But there is a consensus that autism probably has more than one cause, its symptoms the common end point of different biological pathways.
Yet it may be some years, experts say, before scientists are able to link the findings from genetic studies and brain research with the outer signs of the perplexing world that people with autism inhabit.
When it comes to autism, said Dr. David Amaral, a professor of psychiatry at the University of California at Davis,''In many respects, we're still in the dark ages.''
Correction: February 27, 2004, Friday An article in Science Times on Tuesday about scientists' growing understanding of autism misstated the nationality of Dr. Bernard Rimland, a psychologist whose 1964 assertion that the disorder was rooted in genetics, not parental failings, is now widely accepted. He is American, not British.
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} | 2,874 | 1741-7007-8-42 1741-7007 Question and Answer <p>Video Q&A: What is autism? - A personal view</p> RaffMartinm.raff@ucl.ac.uk
MRC LMCB, University College London, Gordon Street, London WC1E 6BT, UK
BMC Biology 1741-7007 2010 8 1 42 http://www.biomedcentral.com/1741-7007/8/42 2038503410.1186/1741-7007-8-42
84201012420101242010 2010Raff; licensee BioMed Central Ltd.
Hope of Progress Wiring the Brain Question & Answer Question and answer
Martin Raff talks on autism
<p>Martin Raff talks on autism</p>
Click here for file
Martin Raff trained in Medicine at McGill University and was a Resident in Neurology at Massachusetts General Hospital when in 1969 he became fascinated by the nascent field of cellular immunology and abandoned medicine to join the laboratory of Avrion Mitchison at Mill Hill, London and subsequently at University College London, where he made seminal contributions in the biology of T and B lymphocytes. Later, he turned to developmental neurobiology, which occupied him until his retirement from active research in 2003.
It was only after his retirement that he became interested in the biological basis of autism, when it affected his own family. In this interview, he talks, as a biologically knowledgeable grandparent, about how he sees the disorder and where he thinks research on the condition is leading.
Edited transcript
Your research has been in immunology and neural development. What got you interested in autism?
I have a grandson who's autistic, and that's the immediate reason. But I did train in neurology many years ago and what's interesting is that in those three years I never saw a patient with autism, which was very rare then. And then I was a developmental neurobiologist for 25 years and I never heard a talk on autism, even though it was thought to be a brain development problem: there wasn't a single talk in 25 years, which is quite remarkable. Now autism has increased greatly in prevalence and is frequently in the news. But it was my grandson, who is now 8, who got me interested in the subject.
What are the defining features of autism?
The three core features are a problem with social interactions, which is often the heart of the matter; a problem with language; and a tendency to have restricted interests and repeated, stereotypic motor behaviors. That is the so-called autistic triad, and you need to have two of the three and to develop them by the age of 3 to be considered autistic.
Is autism just one thing? - Isn't it a spectrum?
It is a spectrum, and probably the reason, or at least one important reason, for the apparent increase in autism is that the diagnostic criteria have expanded enormously. At the bad end of the spectrum are the classic autistic kids, and at the best end of the spectrum are Asperger kids, who have much less trouble with language and are often very smart. But there is also everything in between. I'm sure you have many colleagues with some features of autism.
You have an unorthodox view of how autism develops - What is it?
I'm not so sure it's unorthodox. It starts from the need to explain the basis of the autistic triad: why do these features occur together in this way? Besides the three core features, there are also often other associated features - seizures in 30%, intellectual impairment in 50% and behavioral abnormalities such as temper tantrums and feeding and sleeping disorders, and so on, which are often found in addition to the core triad.
So I think a major question is what binds the core triad together? There is no part of the brain that I'm aware of where an abnormality would explain this triad while leaving so much else intact.
Is there any evidence for this view?
Yes. If a monkey is separated from its mother and other monkeys at birth, it becomes autistic: it doesn't develop normal vocalizations or social skills and shows restricted interests and repetitive motor activities such as rocking. If a child is born deaf, for example, and it is a year or two or three before that's picked up, the child has an increased likelihood of developing autistic features; or if a child is born blind and this is missed, that too is often associated with autistic features. And children who are brought up in orphanages, particularly the big orphanages where you don't get one-on-one care at all, as occurs in some Romanian orphanages, for example, these kids often develop what's called institutional autism. So I think it's pretty clear that if you interfere with the child-parent interaction (and other social interactions), this can lead to the autistic triad.
Are you saying it's all the parents' fault?
Kanner, when he first described autistic behavior in 1943, noted in his report that the parents of these children were cold and didn't seem to have an interest in people; you can see that he was thinking of blaming the parents. Then Bettelheim picked up on the idea and argued that it really is the parents' fault and talked about refrigerator mothers. So during the 1950s and 1960s, it was commonly felt that autism was an emotional disorder and parents were to blame.
Do you think they were wrong?
I think they were right in pointing to the child-parent relationship as a problem, but they were pointing to the wrong part of the relationship. It is the child that is abnormal, largely for genetic reasons. Autism is the most genetic of the neuropsychiatric disorders. So the child seems genetically impaired in his or her ability to interact, and the question is what is the nature of the impairment. There are lots of ideas about this. One is that autistic children don't process faces normally, which interferes with their interactions with people. Another is that they don't have the special interest in biological as opposed to inanimate things that normal children have. And another idea is that they can't figure out what's going on in somebody else's mind - called mind blindness or a 'theory of mind problem'.
Is there evidence for 'sticky attention'?
I think the best evidence for that comes from Landry and Bryson. They published a paper in 2004 on a study of 5-year-old toddlers - 30 autistic, 30 Down syndrome, and 30 neurotypical, matched for IQ, who were taught to focus on an image on a central computer screen. The images were just abstract shapes falling through space. Then a different abstract image was put up on one of two lateral screens, and the child's eye movements were tracked electronically to see how they quickly looked at the new image. If the image on the focus screen was removed at the same time as the new image was put up, the autistic kids performed as well as the other two groups, but if the focus image was left on when the new image appeared on a lateral screen, then 20% of the autistic children didn't look at the new image at all, and, of those that did, many were slow to do so, compared with the other two groups. In these experiments, there were no people, no faces and no social interactions, suggesting a fundamental problem with attention, and, specifically, a problem shifting attention from one thing to another.
My grandson had this problem in spades. He developed quite normally for a year and a half and then, starting halfway through his second year, over a period of weeks, he dramatically regressed: he stopped looking at you, stopped talking, and you could no longer get his attention. He could be looking at a wheel spinning or a train going round a track or water falling, and you could poke him in the arm, flash a light in his eyes, yell in his ears - but you just couldn't get his attention. It's not that he wasn't paying attention - he just wasn't paying attention to you.
There is a lot of interest in the genetic analysis of autism - What do you think genetics has to offer?
Well, as I said, it's the most genetic of the neuropsychiatric conditions, and so genetic studies are likely to be the best route to understanding the underlying neurobiology. There are already about 15 genes that have been implicated in autism. At the extremes, there are two classes of genetic influences in multifactorial diseases like autism. There are polymorphisms, which are common genetic variants that increase your risk a bit, usually less than 1.5-fold. These are generally identified by genome-wide association studies using SNPs (single-nucleotide polymorphisms) and, for the most part, have not been very informative in autism.
The other class consists of rare mutations that greatly increase your risk and are much more informative. Thomas Bourgeron, for example, was the first to identify neuroligin mutations in some individuals with autism. He guessed that there might be abnormalities in synapses in autism, and so he looked at two genes, neuroligin 3 and neuroligin 4, which encode proteins that work only at synapses, sequencing the protein-coding regions of these genes in more than 100 autistic individuals in multiplex families (that is, with 2 or more autistic members), as well as in a comparable number of neurotypical individuals. He found two Swedish families - one with a neuroligin 3 mutation and the other with a neuroligin 4 mutation: in each case, one brother was autistic and the other was diagnosed with Asperger syndrome. That was the first direct evidence that a mutation that affects a protein that works only at synapses can lead to an autism spectrum disorder and that the same mutation in the same family can lead to both ends of the spectrum. This was a giant step forward. Subsequently, mutations in genes that encode proteins that interact with neuroligins at synapses, including neurexin and shank proteins, have been found to predispose to autism and other neuropsychiatric disorders. I suspect that synaptic defects may be at the heart of the problem in many of these disorders and that defects in many different genes can probably contribute to different disorders.
There are some single-gene disorders, like Rett's syndrome, fragile X, and tuberous schlerosis, in which autism is part of a more complex neurological syndrome. These are therefore called syndromic forms of autism. There are very good mouse models of these, which are proving to be very informative. It seems to me that a promising way forward in autism, and in neuropsychiatric disorders generally, is to start with a big-effect mutation in individuals with the disorder and then try to model the disease in an experimental animal such as a mouse. Then you can make use of the powerful tools available in mice to try to find out what is responsible for the abnormal phenotype: which part of the brain, which types of neurons, which synapses, and which circuits.
Could the very widely publicized connection between vaccination and autism account for the increase in incidence?
This of course has been an enormous public concern, particularly for parents or grandparents who have autism in the family. Interestingly, in the UK the concern is with MMR (mumps, measles, rubella) vaccination, whereas in the US the concern is with the mercury compound (thermasol) in the vehicle.
I should have said earlier that dramatic regression occurs in about 30% of autistic kids (although minor regression occurs much more commonly): they develop apparently normally for a year and then in their second year they lose what they had and become classically autistic. After that, they may slowly recover to a variable extent, and some may recover completely. So you can imagine that, if you have a child that's fine but then, two or three weeks after a vaccination, he or she stops looking at you and stops talking, it will be difficult to convince you that this has nothing to do with the vaccination.
So the question remains why there has been such a large increase since 1990. It is still unclear if there has been a real increase, because there are a number of other possible explanations that could account for much of the increase. One is that the diagnostic criteria have broadened enormously since 1990. Another is that parents, teachers, and doctors are much more aware of autism today than they were before, which is a big factor. Another is that, in the 1990s in America, many states provided special educational support for autistic children, so that parents were keen to have the diagnosis confirmed to take advantage of these services, which no doubt contributed to the increased prevalence, as well as to a decrease in the stigma associated with autism, which, in itself, would greatly increase the number of diagnoses.
To go back to genetics - How do you get from a rare mutation to the cause of the disorder in the common cases?
Now that you can sequence DNA increasingly cheaply and quickly, it is feasible to sequence the genomes of large numbers of autistic individuals, which almost certainly will uncover increasing numbers of rare, big-effect mutations that contribute to the disorder. Once such a mutation is identified, one can try to produce the condition, or a part of it, in an experimental animal such as a mouse, where you can analyze the neurobiological basis of the problem. Once this has been done, which could take years, it will be necessary to go back to the humans with the same genetic problem to find out if the same cells, the same brain regions, the same synapses, and so on are involved.
One way to do this is to make induced pluripotent stem cells (iPSCs) - first from the mouse and then from autistic individuals with the same genetic problem. iPSCs closely resemble ES (embryonic stem) cells, in that they can proliferate indefinitely in culture and be induced to differentiate into almost any type of cell in the body, including into different types of neurons. Fortunately, developmental neurobiologists are rapidly figuring out how to get many different types of neurons from such pluripotent stem cells. Once you have figured out how to get the appropriate types of neurons, you can let them form the synapses and circuits, either in a culture dish or after transplantation into a developing mouse brain, to show that you can reproduce the physiological defects that you found in the mouse mutant. Then you would be ready to produce iPSCs from the autistic humans and use what you had learned studying the mouse iPSCs about how to produce the relevant types of neurons, synapses, and circuits that you think are affected, to see if you can reproduce the same type of physiological abnormalities. If you succeed, you can screen for drugs that can correct the problem and see if they can ameliorate the clinical problem. All of this will be difficult and very time-consuming, and it may not work, but, if it did, the payoff could be great, both in terms of new drugs and what it could potentially tell us about how the normal human brain works. I am optimistic, especially as many of the mouse models of the syndromic forms of autism have been shown to be at least partially reversible by treatments given to adult mice; this suggests that many of the clinical problems may result from reversible functional defects in the adult brain, rather than from irreversible anatomical defects that many believed to be the problem.
Where can I find out more?
See reference list: 123456.
<p>The story of Rett syndrome: from clinic to neurobiology</p>ChahrourMZoghbiHYNeuron20075642243710.1016/j.neuron.2007.10.00117988628<p>Identification and evaluation of children with autistic spectrum disorders</p>JohnsonPCMyersSMAmerican Academy of Pediatrics, Council on Children with DisabilitiesPediatrics20071201183121510.1542/peds.2007-236117967920<p>Reversing neurodevelopmental disorders in adults</p>EhningerDLiWFoxKStrykerMPSilvaAJNeuron20086095096010.1016/j.neuron.2008.12.007271029619109903<p>Impaired disengagement of attention in young children with autism</p>LandryRBrysonSEJ Child Psychol Psychiatry2004451115112210.1111/j.1469-7610.2004.00304.x15257668<p>Mutations of the X-linked genes encoding neuroligins NLGN3 and NLGN4 are associated with autism</p>JamainSQuachHBetancurCRåstamMColineauxCGillbergICSoderstromHGirosBLboyerMGillbergCBourgeronTParis Autism Research International Sibpair StudyNat Genet200334272910.1038/ng1136192505412669065<p>New routes into the human brain</p>RaffMCell201013912091211 | http://www.biomedcentral.com/content/download/xml/1741-7007-8-42.xml | robots: classic
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} | 1,748 | Autism: The Pervasive Developmental Disorder
No disorder captures the attention of the nation like Autism. David G. Amaral, Ph.D., University of California Davis Health System, explains what exactly Autism is, and where the most promising research on the subject is currently located.
Plot chart
Figure 1: From Redcay and Courchesne, When Is the Brain Enlarged in Autism? A Meta-Analysis of All Brain Size Reports, Biological Psychiatry, 2005;58:1–9
Whether it is a young boy with autism on a news magazine cover, or Claire Danes collecting an Oscar for her portrayal of Temple Grandin, the animal science professor whose writings about her life provide rare insights into the autistic mind, or the debate in the U.S. Congress about special research funding, autism appears to have our full attention. Thanks to brave parents, their foundations, and more recently the NIH, the investments in autism research have helped define the spectrum of developmental disorders that constitute autism.
The numbers of children diagnosed with autism have increased dramatically, from less than 1 in 2000 people in the 1980’s to around 1 out of 110 children in the United States today. No one is sure to what extent this increase is due to better awareness and diagnostics or a substantive rise in the disorder, but many observers consider autism a national health emergency.
A Short Primer on the Basics of Autism
Autism spectrum disorders cross all racial, ethnic and socioeconomic levels and all national boundaries. The essential criteria for diagnosis include age under 3 years, impairments of social interaction, difficulties with verbal and nonverbal communication, and repetitive or highly focused behaviors. Autism is four times more common in boys than girls, and is sometimes accompanied by severe developmental delays. Individuals with autism commonly have one or more additional—called “co-morbid”—problems including epilepsy, anxiety, and gastrointestinal distress, and food allergies. The range of severity of the core symptoms of autism and with these other problems has led to the term “autism spectrum disorders”, but as the terminology is currently undergoing revision, I will use the term autism as shorthand for all forms of autism spectrum disorders I write about here.
The Story So Far in the Genetics of Autism: Things are Complicated
Several decades of twin and family studies show that genes make a substantial contribution to the causes of autism. In monozygotic twins, who have identical genetic makeup, if one twin is diagnosed with autism, in about 60 percent of the cases the other twin will also be autistic. In dizygotic twins, who share half of their genetic makeup, the probability that both siblings will have autism is closer to 10 to 20 percent—about the same risk for a child who has an older sibling with autism. These findings indicate that genetic susceptibility is one important factor in determining who will be afflicted with autism. But what genetic changes lead to autism? The story is not simple. More than 100 genetic differences have now been ascribed as increasing risk for autism, but none account for more than 1–2% of the cases – a marked contrast to Huntington’s Disease or even Rett syndrome where a single gene defect may lead to the disorder. In families with only one autistic child, small structural alterations in the child’s DNA result in an abnormal number of copies of the sections of one or more genes, so-called “copy number variations,” or CNVs, that may not occur in the mother or father. Analysis of CNVs is fast becoming an integral part of an autism diagnosis.
Many of the genes associated with autism contribute to signal processing at the synapse, the specialized junction where neurons communicate chemically. Understanding exactly how synaptic transmission is altered in autism could spark the development of new drug therapies. For example, in fragile X syndrome—the most common genetic form of mental retardation—about 30% of diagnosed individuals also have autism. The fragile X gene encodes a protein (Fragile X Mental Retardation Protein - FMRP) that helps regulate one form of synaptic transmission. By understanding how FMRP acts at the synapse, new drugs have corrected the brain and behavior problems in animal models of fragile X, and are now in human clinical trials.
The bottom line from the current genetics of autism is that it is very complex. It is now clear that there will not be an “autism gene” or even a small number of genes that consistently cause autism. So, despite the fact that autism appears to be highly genetic, the mechanisms through which genetic risk translates to cause is an area of active research.
Unusual Brain Growth is an Important Correlate of Autism
While the behavior of children with autism is often dramatically impaired, it is ironic that, at first blush, their brains look remarkably normal. They have no hallmark pathology like the plaques and tangles of Alzheimer’s disease nor does any single transmitter system seem to be markedly impaired, as happens with the dopamine pathology of Parkinson’s disease. In this respect, autism resembles other psychiatric disorders, such as schizophrenia, where the neuropathology underlying the disorder is subtle. While the lack of adequate postmortem brain material has hobbled efforts to understand the cellular pathology of autism, increasingly sophisticated magnetic resonance imaging studies of greater numbers of younger and younger children with autism are making headway in defining abnormal trajectories of brain development in autism. An important view has emerged that altered rates of brain maturation, rather than the brain’s condition at any one point in time, are most characteristic of autism.
This figure presents the results of several studies of head circumference (HC) and magnetic resonance image (MRI) measurements of total brain volume in individuals with autism at different ages. The dotted line at “0” represents normal development and green circles represent the percent difference from normal development observed in different studies. Overall, autistic children, in general, have a 6 to10% greater brain volume around age 2-3 which then decreases as the subjects age.
Many children with autism have large heads (macrocephaly), and magnetic resonance imaging (MRI) studies during the last 10 years have confirmed that the brains (particularly the frontal and temporal lobes) of some children with autism are also larger than children their age without autism. Around 6 months of age, the growth of the autistic brain appears to accelerate beyond the non-autistic children by as much as 6 to10% by age 2-3 (Figure 1). While not all parts of the autistic brain undergo this precocious growth, one area that consistently does is the amygdala, an almond shaped nucleus deep within the temporal cortex that detects danger in the environment. Individuals with autism exhibit an adult sized amygdala much earlier than non-autistic children. These differences in brain volume tend to disappear as the children get older (either by non-autistic counterparts catching up, or individuals with autism undergoing an increased rate of normal regressive processes at their age - cell loss and connectional pruning). The fate of the brain in the aging adult with autism needs much more investigation.
Because some parts of the autistic brain grow too fast, the connections between normally developing and rapidly developing brain regions may not be formed properly. Many autism researchers believe that there is an imbalance between the grey and white matter (the long distance connections) of the brain. Sophisticated analyses of the brain networks responsible for social behavior or language show that their activity is less coordinated than in the non-autistic brain.
An obvious question is: What leads to the increased size of the brain or of the amygdala in autism? We don’t know because young autistic brains have not been studied. Ironically, postmortem analysis of older autistic brains find fewer neurons than expected in the amygdala and temporal lobe, while some brains demonstrate patterns characteristic of brain inflammation, suggesting activation of the brain’s special immune cells, called microglia. These findings probably represent only the tip of the iceberg of the neuropathology of autism and only the analysis of a greater number of brains throughout the lifespan of individuals with autism will solve the riddle.
Autism Treatments: Drug therapies are still to come, but effective behavioral therapies are here now.
There are currently no pharmacological treatments for the core symptoms of autism. The U.S. Food and Drug Administration has approved the antipsychotic drug Risperdal as a treatment for irritability in autistic children and adolescents, but the most successful current interventions for the core symptoms of autism are behavioral therapies (Applied Behavior Analysis). These interventions, which are commonly provided to children for 20-40 hours per week by trained practitioners, have unequivocally shown benefit in a substantial percentage of children with autism, and the earlier they are implemented the better. Unfortunately, neuroscientific understanding of the effectiveness of these therapies remains scant. Meanwhile, because drugs are considered medical interventions and behavior therapy is considered psychological or educational therapy, parents are battling medical insurance providers who resist covering the cost of prescribed behavioral therapies even though they are the most effective current treatment.
While progress in understanding the causes of autism has been substantial, many mysteries remain. Why do so many different genes increase risk for autism? Why do the implicated genes link to autism in some individuals and schizophrenia in others? Why is autism so much more common in boys than in girls? Are there environmental causes of autism that are independent of genetic risk? Why are autistic features so commonly associated with syndromes of intellectual disability? Is it perhaps that autism is a disorder of the most complex cognitive functions of the human brain and any genetic or environmental factor that diminishes cognitive capacity often leads to the symptoms of autism?
We are poised to begin answering these questions. The field of autism research has matured dramatically over the last decade with increasingly sophisticated scientists entering the quest for information with increasingly sophisticated tools. The community of families with autism and individuals with autism have become willing and enthusiastic partners in efforts to understand the causes of autism and finding ways to decrease disability. Working with affected individuals, we also understand now, better than at any time before, that autism can bring benefits along with disabilities. Acceptance, rather than treatment, may be the wiser course of action in some cases. The research holds the prospect of providing not only relief to individuals and families with a serious neurodevelopmental disability, but also insight into the brain organization and functions that distinguish humans from all other species.
Content Provided By
The Dana Foundation
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} | 5,219 | Disorders usually first diagnosed in
infancy, childhood, or adolescence.
Autistic Disorder--
and repetitive behavior, all exhibited before a child is three years old. These characteristics distinguish autism from milder
autism spectrum disorders (ASD).
Heritability contributes a large fraction of the risk of a child's developing the disorder, although the genetics of autism are
complex, and it is generally unclear which genes are responsible.[1] In rare cases, autism is strongly associated with agents that
cause birth defects.[2] Other proposed causes, such as the exposure of children to vaccines, are controversial and the vaccine
hypotheses are unsupported by convincing scientific evidence.[3][4] Most recent reviews estimate a prevalence of one to two
practice; the question of whether prevalence has increased is unresolved.[5]
Autism affects many parts of the brain; how this occurs is poorly understood. Parents usually notice signs in the first year or two
of their child's life. Early intervention may help children gain self-care and social skills, although few of these interventions are
supported by scientific studies; there is no cure.[6] With severe autism, independent living is unlikely; with milder autism, there
are some success stories for adults,[7] and an autistic culture has developed, with some seeking a cure and others believing
that autism is a condition rather than a disorder.[8]
Autism is a developmental disorder of the human brain that first shows signs during infancy or childhood and follows a steady
course without remission or relapse.[9] Impairments result from maturation-related changes in various systems of the brain.[10]
Autism is one of the five pervasive developmental disorders (PDD) or autism spectrum disorders (ASD), which are characterized
Of the other four autism spectrum disorders, Asperger's syndrome is closest to autism in signs and likely causes; Rett syndrome
and childhood disintegrative disorder share several signs with autism, but may have unrelated causes; pervasive developmental
disorder not otherwise specified (PDD-NOS) is diagnosed when the criteria are not met for a more specific disorder.[11] Unlike
autism, Asperger's has no substantial delay in language development.[12] The terminology of autism can be bewildering, with
autism, Asperger's and PDD-NOS sometimes called the autistic disorders,[1] whereas autism itself is often called autistic
sometimes use autism to refer to autistic disorders or even ASD. ASD, in turn, is a subset of the broader autism phenotype
Autism's manifestations cover a wide spectrum, ranging from individuals with severe impairments—who may be silent, mentally
approaches, narrowly focused interests, and verbose, pedantic communication.[14] Sometimes the syndrome is divided into low-
, medium- and high-functioning autism (LFA, MFA, and HFA), based on IQ thresholds,[15] or on how much support the individual
with physical symptoms, such as tuberous sclerosis.[16] Although individuals with Asperger's tend to perform better cognitively
than those with autism, the extent of the overlap between Asperger's, HFA, and non-syndromal autism is unclear.[17]
stagnation. The validity of this distinction remains controversial; it is possible that regressive autism is a specific subtype.[18][19]
eating, are also common but are not essential for diagnosis.[20]
Social development
Autistic people have social impairments and often lack the intuition about others that many people take for granted. Noted
autistic Temple Grandin described her inability to understand the social communication of neurotypicals as leaving her feeling
"like an anthropologist on Mars".[21]
deviance; for example, they have less eye contact and anticipatory postures and are less likely to use another person's hand or
body as a tool.[19] Three- to five-year-old autistic children are less likely to exhibit social understanding, approach others
attachments to their primary caregivers.[22] They display moderately less attachment security than usual, although this feature
disappears in children with higher mental development or less severe ASD.[23] Older children and adults with ASD perform
worse on tests of face and emotion recognition.[24]
tantrums. Dominick et al. interviewed the parents of 67 children with ASD and reported that about two-thirds of the children had
periods of severe tantrums and about one third had a history of aggression, with tantrums significantly more common than in
children with a history of language impairment.[26]
gestures, diminished responsiveness, and the desynchronization of vocal patterns with the caregiver. In the second and third
to simply repeat others' words (echolalia)[18][28] or reverse pronouns.[29] Autistic children may have difficulty with imaginative
play and with developing symbols into language.[18][28] They are more likely to have problems understanding pointing; for
example, they may look at a pointing hand instead of the pointed-at object.[19][28]
In a pair of studies, high-functioning autistic children aged 8–15 performed equally well, and adults better than individually
overestimate what their audience comprehends.[30]
Repetitive behavior
categorizes as follows:
* Stereotypy is apparently purposeless movement, such as hand flapping, head rolling, body rocking, or spinning a plate.
dressing ritual.
injury at some point affected about 30% of children with ASD.[26]
No single repetitive behavior is associated with autism, but only autism appears to have an elevated pattern of occurrence and
severity of these behaviors.[31]
Other symptoms
As many as 10% of individuals with ASD show unusual abilities, ranging from splinter skills such as the memorization of trivia to
the extraordinarily rare talents of prodigious autistic savants.[32]
that sensory symptoms differentiate autism from other developmental disorders.[33] The responses may be more common in
children: a pair of studies found that autistic children had impaired tactile perception while autistic adults did not. The same two
studies also found that autistic individuals had more problems with complex memory and reasoning tasks such as Twenty
Questions; these problems were somewhat more marked among adults.[30] Several studies have reported associated motor
indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur;[26] this does not appear
to result in malnutrition. Some children with autism also have gastrointestinal (GI) symptoms, but there is a lack of published
rigorous data to support the theory that autistic children have more or different GI symptoms than usual.[35]
children with ASD are more likely to have even more sleep problems than those with other developmental disabilities; autistic
awakenings. Dominick et al. found that about two-thirds of children with ASD had a history of sleep problems.[26]
Causes of autism
Although many genetic and environmental causes of autism have been proposed, its theory of causation is still incomplete.[36]
Some researchers argue this is because autism is not a single disorder, but rather a triad of core aspects (social impairment,
communication difficulties, and repetitive behaviors) that have distinct causes but often co-occur.[37]
Genetic factors are the most significant cause for autism spectrum disorders. Early studies of twins estimated heritability to be
more than 90%; in other words, that genetics explains more than 90% of autism cases.[1] This may be an overestimate; new twin
data and models with structural genetic variation are needed.[38] When only one identical twin is autistic, the other often has
be as high as 30%,[39] much higher than the risk in controls.[40]
The genetics of autism is complex.[1] Linkage analysis has been inconclusive; many association analyses have had inadequate
power.[38] For each autistic individual, mutations in more than one gene may be implicated. Mutations in different sets of genes
candidate genes have been located, most of which encode proteins involved in neural development and function.[41] However,
cannot be traced to a Mendelian (single-gene) mutation or to a single chromosome abnormality such as fragile X syndrome or
22q13 deletion syndrome.[16][42]
(array CGH), a technique for detecting CNVs, one study found them in 10% of families with one affected child.[44] Some of the
autism is not present in the parental genome. The fraction of autism traceable to a genetic cause may grow to 30–40% as the
resolution of array CGH improves.[43] The Autism Genome Project database contains genetic linkage and CNV data that
connect autism to genetic loci and suggest that every human chromosome may be involved.[45]
Teratogens (agents that cause birth defects) related to the risk of autism include exposure of the embryo to thalidomide,
valproic acid, or misoprostol, or to rubella infection in the mother. These cases are rare.[46] All known teratogens appear to act
affected later, it is strong evidence that autism arises very early in development.[2] Other possible contributors to autism include
gastrointestinal or immune system abnormalities, allergies, and the exposure of children to drugs, vaccines,[4] infection, certain
foods,[47] or heavy metals; the evidence for these risk factors is anecdotal and has not been confirmed by reliable studies,[3]
and extensive further searches are underway.[46] Parents may first become aware of autistic symptoms in their child around the
time of a routine vaccination. Although there is overwhelming scientific evidence showing no causal association between the
measles-mumps-rubella vaccine and autism, and there is no convincing evidence that the vaccine preservative thiomersal helps
cause autism, parental concern has led to a decreasing uptake of childhood immunizations and the increasing likelihood of
measles outbreaks[48] such as the measles cases in Britain during summer 2007.[49]
structures and behaviors.[10]
physical damage.[42] Neuroanatomical studies and the associations with teratogens strongly suggest that autism's mechanism
includes alteration of brain development soon after conception.[2] Many major structures of the human brain have been
implicated. Consistent abnormalities have been found in the development of the cerebral cortex; and in the cerebellum and
related inferior olive, which have a significant decrease in the number of Purkinje cells. Brain weight and volume and head
circumference tend to be greater in autistic children; the effects of these are unknown.[50] It may be due to poorly regulated
growth of neurons.[10]
neurodevelopment depends on a balanced immune response. Several symptoms consistent with a poorly regulated immune
response have been reported in autistic children. It is possible that aberrant immune activity during critical periods of
neurodevelopment is part of the mechanism of some forms of ASD.[51] Given the lack of data in this area, it is still hard to draw
conclusions about the role of immune factors in autism.[52]
these lead to structural or behavioral abnormalities is unclear.[10]
actions, intentions, and emotions.[53] Several studies have tested this hypothesis by demonstrating structural abnormalities in
MNS regions of individuals with ASD, delay in the activation in the core circuit for imitation in individuals with Asperger's, and a
correlation between reduced MNS activity and severity of the syndrome in children with ASD.[54]
and synchronization, along with an excess of low-level processes.[55] Evidence for this theory has been found in functional
neuroimaging studies on autistic individuals[30] and by a brain wave study that suggested that adults with ASD have local
overconnectivity in the cortex and weak functional connections between the frontal lobe and the rest of the cortex.[56] Other
association cortex.[57]
empathizing by handling events generated by other agents.[15] It extends the extreme male brain theory, which hypothesizes
empathizing.[58] This in turn is related to the earlier theory of mind, which hypothesizes that autistic behavior arises from an
inability to ascribe mental states to oneself and others. The theory of mind is supported by autistic children's atypical responses
to the Sally-Anne test for reasoning about others' motivations,[59] and is mapped well from the mirror neuron system theory of
results in part from deficits in flexibility, planning, and other forms of executive function. A strength of the theory is predicting
stereotyped behavior and narrow interests;[60] a weakness is that executive function deficits are not found in young autistic
children.[24] Weak central coherence theory hypothesizes that a limited ability to see the big picture underlies the central
disturbance in autism. One strength of this theory is predicting special talents and peaks in performance in autistic people.[61] A
operations in autistic individuals.[62] The latter two theories map well from the underconnectivity theory of autism.
the nonsocial theories have difficulty explaining social impairment and communication difficulties.[37] A combined theory based
on multiple deficits may prove to be more useful.[8]
Parents are usually the first to notice unusual behaviors in their child.[63] As postponing treatment may affect long-term
outcome, any of the following signs is reason to have a child evaluated by a specialist without delay:
* No babbling by 12 months.
* No gesturing (pointing, waving goodbye, etc.) by 12 months.
* No single words by 16 months.
* No two-word spontaneous phrases (not including echolalia) by 24 months.
* Any loss of any language or social skills, at any age.[20]
The American Academy of Pediatrics recommends that all children be screened for ASD at the 9-, 18-, and 30-month well-child
doctor visits, using autism-specific formal screening tests.[64] In contrast, the UK National Screening Committee recommends
against screening for ASD in the general population, because screening tools have not been fully validated and interventions
lack sufficient evidence for effectiveness.[65]
Genetic screening for autism is generally still impractical. As genetic tests are developed several ethical, legal, and social issues
complexity of autism's genetics.[66]
imaginative play. The disturbance must not be better accounted for by Rett syndrome or childhood disintegrative disorder.[67]
ICD-10 uses essentially the same definition.[9]
assess severity of autism based on observation of children.[19]
differential diagnosis for ASD at this stage might also consider mental retardation, hearing impairment, and a specific language
disorder[68] such as Landau-Kleffner syndrome.[69] In the UK the National Autism Plan for Children recommends at most 30
ASD can sometimes be diagnosed by age 14 months,[70] but a 2006 U.S. study found the average age of first evaluation by a
qualified professional was 48 months and of formal ASD diagnosis was 61 months, reflecting an average 13-month delay, all far
above recommendations.[71]
delay diagnosis.[72] It is particularly hard to diagnose autism among the visually impaired, partly because some of its diagnostic
criteria depend on vision, and partly because autistic symptoms overlap with those of common blindness syndromes.[73]
locations to claim disability living allowances or other benefits.[74]
Autism therapies
The goal of treatment is to manage and improve symptoms and functioning. No single treatment is best and treatment is typically
tailored to the child's needs. Intensive, sustained special education programs and behavior therapy early in life can help
children acquire self-care, social, and job skills.[75][76] Among the available approaches, applied behavior analysis (ABA) has
cognitive functioning;[76] ABA focuses on teaching tasks one-on-one using the behaviorist principles of stimulus, response and
reward.[77] Several programs are based on ABA. Some focus on discrete trial teaching; more-comprehensive ones use multiple
assessment and intervention methods individually and dynamically.[78] Cognitive therapies based on comprehensive programs
in treatment centers are a common alternative: for example, TEACCH focuses on structuring the physical environment and using
visual supports for language development tasks.[76] A 2005 California study found that early intensive behavior analytic
provided in many programs,[77], but a 2007 British study found that home-based early intensive behavioral interventions,
another ABA form, was no more effective than nursery-based eclectic programs.[79] The limited research on the effectiveness
of adult residential programs shows mixed results.[80]
Medications are often used to treat problems associated with ASD. More than half of U.S. children diagnosed with ASD are
antipsychotics.[81] In the United States, the antipsychotic risperidone is approved for treating symptomatic irritability in autistic
children and adolescents.[82] Other drugs are prescribed off-label, which means they have not been approved for treating ASD.
For example, serotonin reuptake inhibitors and dopamine blockers can sometimes reduce some symptoms.[10] However, there
is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.[83] A
medication relieves autism's core symptoms of social and communication impairments.[63]
Many other therapies and interventions are available. Few are supported by scientific studies.[6][24][84][85] Treatment
predictive validity and real-world relevance.[25] Scientific evidence appears to matter less to service providers than program
marketing, training availability, and parent requests.[86] Even if they do not help, conservative treatments such as changes in
diet are probably harmless aside from their bother and cost.[47] Dubious invasive treatments are a much more serious matter:
for example, in 2005, botched chelation therapy killed a 5-year-old autistic boy.[48]
Treatment is expensive;[87] indirect costs are more so. A U.S. study estimated the average additional lifetime cost due
exclusively to autism to be $3.2 million in 2003 U.S. dollars for an autistic individual born in 2000, with about 10% medical care,
30% nonmedical care such as child care and education, and 60% the lost economic productivity of individuals and their parents.
[88] A British study estimated an average lifetime cost of ₤2.4 million in 1997–1998 British pounds.[89] Legal rights to treatment
are complex, vary with location and age, and require advocacy by caregivers.[85] Publicly supported programs are often
likelihood of family financial problems.[90] After childhood, key treatment issues include residential care, job training and
placement, sexuality, social skills, and estate planning.[85]
No cure is known for autism. Most children with autism lack social support, meaningful relationships, future employment
opportunities or self-determination.[25] Although core difficulties remain, the severity of symptoms often becomes less marked in
later childhood.[91] Few high-quality studies address long-term prognosis. Some adults show modest improvement in some
symptoms, but some decline; no study has focused on autism after midlife.[92] Acquiring language before age 6, having IQ
above 50, and having a marketable skill all predict better outcomes; independent living is unlikely with severe autism.[93] A 2004
needed high-level hospital care.[7] A 2005 Swedish study of 78 adults that did not exclude low IQ found worse prognosis; for
example, only 4% achieved independence.[94] Changes in diagnostic practice and increased availability of effective early
intervention make it unclear whether these findings can be generalized to recently diagnosed children.[5]
location.[95] Most recent reviews tend to estimate a prevalence of 1–2 per 1,000 for autism and close to 6 per 1,000 for ASD;[5]
PDD-NOS is the vast majority of ASD, Asperger's is about 0.3 per 1,000 and the atypical forms childhood disintegrative disorder
and Rett syndrome are much rarer.[96] A 2006 study of nearly 57,000 British nine- and ten-year-olds reported a prevalence of
The risk of autism is associated with several prenatal and perinatal risk factors. A 2007 review of risk factors found associated
and hypoxia during childbirth.[98]
genetic syndrome,[39] and ASD is associated with several genetic disorders.[99] Autism is associated with mental retardation: a
association is much weaker: the same study reported about 94% of 65 children with PDD-NOS or Asperger's had normal
intelligence.[100] ASD is also associated with epilepsy, with variations in risk of epilepsy due to age, cognitive level, and type of
language disorder.[101] Boys are at higher risk for autism than girls. The ASD sex ratio averages 4.3:1 and is greatly modified
no association with socioeconomic status, and have reported inconsistent results about associations with race or ethnicity.[5]
assessed systematically.[102]
Autism's incidence, despite its advantages for assessing risk, is less useful in autism epidemiology, as the disorder starts long
focused mostly on whether prevalence is increasing with time. Earlier prevalence estimates were lower, centering at about 0.5
Reports of autism cases grew dramatically in the U.S. in 1996–2005. It is unknown how much, if any, growth came from changes
in autism's prevalence.
in autism's prevalence.
[103] though as-yet-unidentified contributing environmental risk factors cannot be ruled out.[3] A widely cited 2002 pilot study
concluded that the observed increase in autism in California cannot be explained by changes in diagnostic criteria,[104] but a
substitution had occurred.[105] It is unknown whether autism's prevalence increased during the same period. An increase in
prevalence would suggest directing more attention and funding toward changing environmental factors instead of continuing to
focus on genetics.[46]
* References provided upon request. | http://myoutofcontrolteen.com/DSM-IV-ad.html | robots: classic
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Autism Spectrum Disorder (ASD)
Autism Spectrum Disorder (ASD)
Autism spectrum
Autism spectrum or autistic spectrum describes a range of conditions classified as neurodevelopmental disorders in the fifth revision of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5). The DSM-5, published in 2013, redefined the autism spectrum to encompass the previous (DSM-IV-TR) diagnoses of autism, Asperger syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), and childhood disintegrative disorder. Features of these disorders include social deficits and communication difficulties, stereotyped or repetitive behaviors and interests, sensory issues, and in some cases, cognitive delays.
A revision to autism spectrum disorder (ASD) was proposed in the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5), released May 2013. The new diagnosis encompasses previous diagnoses of autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and PDD-NOS. Compared with the DSM-4 diagnosis of autistic disorder, the DSM-5 diagnosis of ASD no longer includes communication as a separate criteria, and has merged social interaction and communication into one category.
Rather than categorizing these diagnoses, the DSM-5 has adopted a dimensional approach to diagnosing disorders that fall underneath the autism spectrum umbrella. Some have proposed that individuals on the autism spectrum may be better represented as a single diagnostic category. Within this category, the DSM-5 has proposed a framework of differentiating each individual by dimensions of severity, as well as associated features (i.e., known genetic disorders, and intellectual disability).
Another change to the DSM includes collapsing social and communication deficits into one domain. Thus, an individual with an ASD diagnosis will be described in terms of severity of social communication symptoms, severity of fixated or restricted behaviors or interests, and associated features. The restriction of onset age has also been loosened from 3 years of age to “early developmental period”, with a note that symptoms may manifest later when demands exceed capabilities.
Autism forms the core of the autism spectrum disorders. Asperger syndrome is closest to autism in signs and likely causes, unlike autism, people with Asperger syndrome have no significant delay in language development, according to the older DSM-4 criteria. PDD-NOS is diagnosed when the criteria are not met for a more specific disorder.
Autism, Asperger syndrome, and PDD-NOS are sometimes called the autistic disorders instead of ASD, whereas autism itself is often called autistic disorder, childhood autism, or infantile autism. Although the older term pervasive developmental disorder and the newer term autism spectrum disorder largely or entirely overlap, the former was intended to describe a specific set of diagnostic labels, whereas the latter refers to a postulated spectrum disorder linking various conditions. ASD is a subset of the broader autism phenotype (BAP), which describes individuals who may not have ASD but do have autistic-like traits, such as avoiding eye contact.
Under the DSM-5, autism is characterized by persistent deficits in social communication and interaction across multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities. These deficits are present in early childhood, and lead to clinically significant functional impairment. There is also a unique form of autism called autistic savantism, where a child can display outstanding skills in music, art, and numbers with no practice.
Asperger syndrome was distinguished from autism in the DSM-4 by the lack of delay or deviance in early language development. Additionally, individuals diagnosed with Asperger syndrome did not have significant cognitive delays. PDD-NOS was considered “subthreshold autism” and “atypical autism” because it was often characterized by milder symptoms of autism or symptoms in only one domain (such as social difficulties). In the DSM-5, both Asperger syndrome and PDD-NOS have been incorporated into autism spectrum disorder.
Developmental course
Autism spectrum disorders are thought to follow two possible developmental courses, although most parents report that symptom onset occurred within the first year of life. One course of development is more gradual in nature, in which parents report concerns in development over the first two years of life and diagnosis is made around 3–4 years of age. Some of the early signs of ASDs in this course include decreased looking at faces, failure to turn when name is called, failure to show interests by showing or pointing, and delayed pretend play.
While there is conflicting evidence surrounding language outcomes in ASD, some studies have shown that cognitive and language abilities at age 2 1/2 may help predict language proficiency and production after age 5. Overall, the literature stresses the importance of early intervention in achieving positive longitudinal outcomes.
While specific causes of autism spectrum disorders have yet to be found, many risk factors have been identified in the research literature that may contribute to their development. These risk factors include genetics, prenatal and perinatal factors, neuroanatomical abnormalities, and environmental factors. It is possible to identify general risk factors, but much more difficult to pinpoint specific factors. In the current state of knowledge, prediction can only be of a global nature and therefore requires the use of general markers.
Genetic risk factors
The results of family and twin studies suggest that genetic factors play a role in the etiology of autism and other pervasive developmental disorders. Studies have consistently found that the prevalence of autism in siblings of autistic children is approximately 15 to 30 times greater than the rate in the general population. In addition, research suggests that there is a much higher concordance rate among monozygotic twins compared to dizygotic twins. It appears that there is no single gene that can account for autism. Instead, there seem to be multiple genes involved, each of which is a risk factor for components of the autism spectrum disorders.
Prenatal and perinatal risk factors
Vaccine controversy
Perhaps the most controversial claim regarding autism etiology was the “vaccine controversy”. This conjecture, arising from a case of scientific misconduct, suggested that autism results from brain damage caused either by (1) the measles, mumps, rubella (MMR) vaccine itself, or by (2) thimerosal, a vaccine preservative. No convincing scientific evidence supports these claims, and further evidence continues to refute them, including the observation that the rate of autism continues to climb despite elimination of thimerosal from routine childhood vaccines.
A 2014 meta-analysis examined ten major studies on autism and vaccines involving 1.25 million children worldwide; it concluded that neither the MMR vaccine, which has never contained thimerosal, nor the vaccine components thimerosal or mercury, lead to the development of ASDs.
In general, neuroanatomical studies support the concept that autism may involve a combination of brain enlargement in some areas and reduction in others. These studies suggest that autism may be caused by abnormal neuronal growth and pruning during the early stages of prenatal and postnatal brain development, leaving some areas of the brain with too many neurons and other areas with too few neurons. Some research has reported an overall brain enlargement in autism, while others suggest abnormalities in several areas of the brain, including the frontal lobe, the mirror neuron system, the limbic system, the temporal lobe, and the corpus callosum.
In neuroanatomical studies, when performing Theory of Mind and facial emotion response tasks, the median person on the autism spectrum exhibits less activation in the primary and secondary somatosensory cortices of the brain than the median member of a properly sampled control population. This finding coincides with reports demonstrating abnormal patterns of cortical thickness and grey matter volume in those regions of autistic persons’ brains.
Mirror neuron system.
The mirror neuron system (MNS) consists of a network of brain areas that have been associated with empathy processes in humans. In humans, the MNS has been identified in the inferior frontal gyrus (IFG) and the inferior parietal lobule (IPL) and is thought to be activated during imitation or observation of behaviors. The connection between mirror neuron dysfunction and autism is tentative, and it remains to be seen how mirror neurons may be related to many of the important characteristics of autism.
Temporal lobe
Mitochondrial dysfunction
It has been suggested that ASD could be linked to mitochondrial disease, a basic cellular abnormality with the potential to cause disturbances in a wide range of body systems. A recent meta-analysis study, as well as other population studies have shown that approximately 5% of children with ASD meet the criteria for classical mitochondrial disease (MD). It is unclear why the mitochondrial dysfunction occurs considering that only 23% of children with both ASD and MD present with mitochondrial DNA (mtDNA) abnormalities.
Vitamin D and serotonin regulation
Malfunction of the serotonergic system may be present in some individuals with an ASD. One study showed a link between ASD and vitamin D regulation of serotonin in the brain and gut.
Evidence-based assessment
ASD can be detected as early as eighteen months or even younger in some cases. A reliable diagnosis can usually be made by the age of two. The diverse expressions of ASD symptoms pose diagnostic challenges to clinicians. Individuals with an ASD may present at various times of development (e.g., toddler, child, or adolescent), and symptom expression may vary over the course of development. Furthermore, clinicians must differentiate among the different pervasive developmental disorders, and may also consider similar conditions, including intellectual disability not associated with a pervasive developmental disorder, specific language disorders, ADHD, anxiety, and psychotic disorders.
Considering the unique challenges in diagnosing ASD, specific practice parameters for its assessment have been published by the American Academy of Neurology, the American Academy of Child and Adolescent Psychiatry, and a consensus panel with representation from various professional societies. The practice parameters outlined by these societies include an initial screening of children by general practitioners (i.e., “Level 1 screening”) and for children who fail the initial screening, a comprehensive diagnostic assessment by experienced clinicians (i.e. “Level 2 evaluation”).
After a child fails an initial screening, psychologists administer various psychological assessment tools to assess for ASD. Among these measurements, the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) are considered the “gold standards” for assessing autistic children. The ADI-R is a semi-structured parent interview that probes for symptoms of autism by evaluating a child’s current behavior and developmental history. The ADOS is a semi structured interactive evaluation of ASD symptoms that is used to measure social and communication abilities by eliciting several opportunities (or “presses”) for spontaneous behaviors (e.g., eye contact) in standardized context. Various other questionnaires (e.g., The Childhood Autism Rating Scale, Autism Treatment Evaluation Checklist) and tests of cognitive functioning (e.g., The Peabody Picture Vocabulary Test) are typically included in an ASD assessment battery.
Autism spectrum disorders tend to be highly comorbid with other disorders. Comorbidity may increase with age and may worsen the course of youth with ASDs and make intervention/treatment more difficult. Distinguishing between ASDs and other diagnoses can be challenging, because the traits of ASDs often overlap with symptoms of other disorders, and the characteristics of ASDs make traditional diagnostic procedures difficult.
The most common medical condition occurring in individuals with autism spectrum disorders is seizure disorder or epilepsy, which occurs in 11-39% of individuals with ASD. Tuberous sclerosis, a medical condition in which non-malignant tumors grow in the brain and on other vital organs, occurs in 1-4% of individuals with ASDs.
Intellectual disabilities are some of the most common comorbid disorders with ASDs. Recent estimates suggest that 40-69% of individuals with ASD have some degree of an intellectual disability, with females more likely to be in the severe range of an intellectual disability. A number of genetic syndromes causing intellectual disability may also be comorbid with ASD, including Fragile X syndrome, Down syndrome, Prader-Willi and Angelman syndromes, and Williams syndrome.
Learning disabilities are also highly comorbid in individuals with an ASD. Approximately 25-75% of individuals with an ASD also have some degree of a learning disability.
Various anxiety disorders tend to co-occur with autism spectrum disorders, with overall comorbidity rates of 7-84%. Rates of comorbid depression in individuals with an ASD range from 4–58%. The relationship between ASD and schizophrenia remains a controversial subject under continued investigation, and recent meta-analyses have examined genetic, environmental, infectious, and immune risk factors that may be shared between the two conditions.
Deficits in ASD are often linked to behavior problems, such as difficulties following directions, being cooperative, and doing things on other people’s terms. Symptoms similar to those of Attention Deficit Hyperactivity Disorder (ADHD) can be part of an ASD diagnosis.
Sensory processing disorder is also comorbid with ASD, with comorbidity rates of 42–88%.
There is no known cure for autism, although those with Asperger syndrome and other high-functioning forms of autism are more likely to experience a lessening of symptoms over time. The main goals of treatment are to lessen associated deficits and family distress, and to increase quality of life and functional independence. In general, higher IQs are correlated with greater responsiveness to treatment and improved treatment outcomes. Although evidence-based interventions for children with autism vary in their methods, many adopt a psychoeducational approach to enhancing cognitive, communication, and social skills while minimizing problem behaviors. It has been argued that no single treatment is best and treatment is typically tailored to the child’s needs.
Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, social, and job skills. Available approaches include applied behavior analysis, developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy. Among these approaches, interventions either treat autistic features comprehensively, or focus treatment on a specific area of deficit.
There has been increasing attention to the development of evidence-based interventions for young children with ASD. Two theoretical frameworks outlined for early childhood intervention include applied behavioral analysis (ABA) and the developmental social-pragmatic model (DSP). Although ABA therapy has a strong evidence base, particularly in regard to early intensive home-based therapy. ABA’s effectiveness may be limited by diagnostic severity and IQ of the person effected by ASD. The Journal of Clinical Child and Adolescent Psychology has deemed two early childhood interventions as “well-established”: individual comprehensive ABA, and focused teacher-implemented ABA combined with DSP.
Another evidence-based intervention that has demonstrated efficacy is a parent training model, which teaches parents how to implement various ABA and DSP techniques themselves. Various DSP programs have been developed to explicitly deliver intervention systems through at-home parent implementation.
A multitude of unsearched alternative therapies have also been implemented. Many have resulted in harm to people with autism and should not employed unless proven to be safe.
In October 2015, the American Academy of Pediatrics (AAP) proposed new evidence-based recommendations for early interventions in ASD for children under 3. These recommendations emphasize early involvement with both developmental and behavioral methods, support by and for parents and caregivers, and a focus on both the core and associated symptoms of ASD.
Reviews tend to estimate a prevalence of 6 per 1,000 for autism spectrum disorders as a whole, although prevalence rates vary for each of the developmental disorders in the spectrum. Autism prevalence has been estimated at 1-2 per 1,000, Asperger syndrome at roughly 0.6 per 1,000, childhood disintegrative disorder at 0.02 per 1,000, and PDD-NOS at 3.7 per 1,000. These rates are consistent across cultures and ethnic groups, as autism is considered a universal disorder.
While rates of autism spectrum disorders are consistent across cultures, they vary greatly by gender, with boys affected far more frequently than girls. The average male-to-female ratio for ASDs is 4.2:1, affecting 1 in 70 males, but only 1 in 315 females. Females, however, are more likely to have associated cognitive impairment. Among those with an ASD and intellectual disability, the sex ratio may be closer to 2:1. Prevalence differences may be a result of gender differences in expression of clinical symptoms, with females showing less atypical behaviors and, therefore, less likely to receive an ASD diagnosis.
Controversies have surrounded various claims regarding the etiology of autism spectrum disorders. In the 1950s, the “refrigerator mother theory” emerged as an explanation for autism. The hypothesis was based on the idea that autistic behaviors stem from the emotional frigidity, lack of warmth, and cold, distant, rejecting demeanor of a child’s mother. Naturally, parents of children with an autism spectrum disorder suffered from blame, guilt, and self-doubt, especially as the theory was embraced by the medical establishment and went largely unchallenged into the mid-1960s. The “refrigerator mother” theory has since continued to be refuted in scientific literature, including a 2015 systematic review which showed no association between caregiver interaction and language outcomes in ASD.
Society and culture
Families who care for an autistic child face added stress from a number of different causes. One study found that half of parents who had a child with any kind of developmental disability were still caring for their child by age 50, while only 17% of parents that age would typically be caring for children.
Autism Rights movement
The autism rights movement (ARM) is a social movement within the neurodiversity movement that encourages autistic people, their caregivers, and society to adopt a position of neurodiversity, and to accept autism as a variation in functioning rather than a mental disorder to be cured. The ARM advocates for several goals, including a greater acceptance of autistic behaviors, therapies that teach autistic individuals coping skills rather than therapies focused on imitating behaviors of neurotypical peers the creation of social networks and events that allow autistic people to socialize on their own terms and the recognition of the autistic community as a minority group.
Autism rights or neurodiversity advocates believe that the autism spectrum is genetic and should be accepted as a natural expression of the human genome. This perspective is distinct from two other likewise distinct views: (1) the mainstream perspective that autism is caused by a genetic defect and should be addressed by targeting the autism gene(s) and (2) the perspective that autism is caused by environmental factors like vaccines and pollution and could be cured by addressing environmental causes.
The movement is controversial. A common criticism leveled against autistic activists is that many are high-functioning or have Asperger syndrome, and therefore do not represent the views of all autistic people | https://resurrection-clinics.eu/autism-spectrum-disorder-asd/ | isPartOf: CC-MAIN-2020-05
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} | 3,345 | Monday, April 30, 2012
I feel like a rather terrible mom right now. Why is bedtime the hardest time of day? I'm sure it has something to do with putting a toddler to bed who really misses Daddy (who is working evenings for another 3 weeks) and trying to get a newborn on a semi-schedule. It seems that every day is different, but bedtime is still hard. Kenny never has a problem going back to sleep in the middle of the night, but he fights going down a little bit, and with James gone, I just don't want to cluster feed every hour. (I want to be online, or reading a book, or anything else, really!) But this too, shall pass.
Friday and Saturday we watched a mini series called Neverland. It was actually pretty good, though not something I'd go out and buy. It was entertaining and relatively clean. It tells the "before" story of Peter Pan, though not the same story found in Peter and the Star Catchers. 4 hours of a mini series? Not bad for the price of only 1 Redbox movie.
Our luck wasn't as good with yard sales this weekend. Joseph was very grumpy. For some reason, he's completely obsessed with basketballs and hoops, and every time we drive by one, he gets all excited and wants to go play basketball. (By the way, there are only about a million of those in suburbia!) Never mind that this not even 3 foot tall toddler would never make a basket. Heck, I don't make baskets very easily, only when I get lucky.
We went on a walk to check out more of Nampa's greenbelts. We've been to at least part of all of them now. I still like the one by our house the best. It has the perfect blend of shade, wildlife, and rich people's backyards.
Sunday was pretty relaxing despite my giving a talk and a lesson. Both went well, and I really wasn't very nervous. Still, it's good to have the talk out of the way. It was a beast to find the time to prepare it. My heart goes out to any mom trying to get through school! Writing one talk is like a short paper, and that's the only assignment I did last week...
James's dad suggested blessing Kenny when we go to Rexburg in 2 weeks for Kenneth's wedding reception (yes, the guy we named Kenny after!). It won't be Fast Sunday, but it will be Mother's Day. :) It will only be my 2nd as a mother, because I was 37 weeks pregnant 2 years ago.
Despite bedtime, I really do love having a newborn again. Sure, there are tons of diapers and feedings, but he's just so darn cute. He's starting to get pretty chunky, too. Life is a little more complicated than it was, but things will get easier with time. Poor Joseph is a little jealous that I don't spend as much time with him. I'm trying to think of how to do that, but I'm never going to be able to give him my undivided attention again. He loves his brother, but I don't think he really understands yet that he hasn't been replaced, and that I still love him! Poor little guy.
Friday, April 27, 2012
It's a Good Day
I feel really optimistic today. It hasn't been the easiest or shortest week, but I have a lot to be happy about!
1. A clean house. Since Friday is vacuum/laundry day, it makes everything seem really clean, even if it doesn't last long. Joseph has already destroyed the living room. :)
2. Kenny's double chin: a sure sign that he's getting enough to eat!
3. 4-hour stretches of sleep at night. There's a big difference between having to wake up 2 or 3 times. 2 times = a pretty normal day. 3 times = a slightly tired and on edge day.
4. Kenny's 1st real bath this week. He smells so good (for the moment)!
5. The fact that Kenny knows the difference between night and day. That's such a blessing in itself. He's actually been awake some during the last few days. It's exciting.
6. Pacifiers. Whoever invented them was a genius.
7. Good food. I've really lucked out on Pinterest this week and have found several really tasty, meatless meals that are easy and cheap. I've gone without meat for 5 days now, and I don't miss it at all. It's not that I don't like it; I just don't crave it when I'm not eating it. I'll report more on that later.
Monday, April 23, 2012
Grumpy Days
Saturday was my grumpy day. Why? Well, I think it started on Friday night when I ate lots of junk food, therefore giving myself a headache that wouldn't go away. Kenny wanted to eat every hour for several hours, which was only really annoying because I was trying to watch Sherlock, which is one of those shows you really have to pay close attention to! Kenny then spit up a lot, wanted more food, and wouldn't go to sleep till 10:30 (which is late for him) because I was all out of food. Thankfully, he slept until 1:40!
We've passed the threshold of "perfect" into "too hot" weather. I feel sticky, gross, and smell like sour milk. (This AC is going to get used a lot. I don't care about the bill!) I'm totally wimpy, because it's really only 80 out. I used to live in Florida, where it was hotter than that for 9 months of the year, plus 100% humidity. Never again. :)
Saturday was reasonably good, despite my complaints. We checked out a few yard sales, and I got Kenny a few 3-6 months size sleepers, the only thing he's lacking. James also got some nice shirts for school/work. We also went on a nice walk later on in the day. Nampa has a good variety of greenbelts. It's our goal to check out all of them. So far, not all of them are created equal! I actually really love the one closest to our house the best so far, but we'll see. Boise also has a 20-something mile greenbelt. Maybe one day, we will do the whole thing on bikes.
James works a lot this week, so I will have plenty of time to write my talk and prepare another lesson for Sunday. 18 kids. That's how many were in our class. A few of them weren't even there! Yeah, holy cow. The lesson went pretty well, though, I think. Still, it was totally intimidating, because most of those kids look older than I do.
Friday, April 20, 2012
Is the weekend here already? I can't believe it! It's such a contrast to last week, which seemed to drag on forever. Although James is gone all evening, I've found a few things to fill my time and be less bored once the boys are in bed. One of those is the Mormon Channel! I wish I'd found it sooner, because there's a ton of good stuff on there. I will never have time to listen to it all, but I've started with the Relief Society program. It's awesome.
I've also been preparing my Sunday School lesson for my first time teaching the 16-18 year olds. I'm so nervous, probably because I don't like the person that I was at that age. I hope that what I teach brings the Spirit, because I don't know how I can otherwise reach this age of kids. (Thinking of myself again at this age, I was pretty hard-headed when it came to Sunday School lessons.) James taught the class for the last 2 weeks, so it's my turn to go to our ward while he catches Sacrament meeting in the other ward. I will do it next week too, because I have a talk that I haven't even started yet. Oops.
I can't believe that Kenny is 2 weeks old already. Not being able to seriously work out gets lamer all the time, since I feel so darn good. Kenny is a wonderful sleeper, however, so I have no reason to even nap (knock on wood). He's been doing 4-5 hour stretches at night. Although that is often preceded by cluster feeding, I will totally take it. I'm glad it's not hot yet, because I've been able to stay hydrated. That will be a different story once it hits 80-85. Kenny is getting chubbier already, and he's quite handsome, I think. :) I need to give him a real bath, because his cord fell off, but I just haven't yet. When I do, I'll take a pic of his cuteness.
Monday, April 16, 2012
Twice the Fun
I think I can safely say that I'm past the weepy stage of recovery! Hurrah! There's nothing worse than the first week of being home, really, because everything is a bigger deal than it should be. Plus, there's the cute little stranger that you're not quite used to who keeps waking you up in the middle of the night.
Kenny is doing really well. He has his PKU lab today and now weighs 8 lbs. He sleeps for 2-3-4 hours at a time. 4 hours at night is AWESOME. I don't think Joseph did that until he was at least a couple of weeks old. I like it. I really don't mind getting up 3X a night, because I get enough sleep not to need a nap. I'm plenty tired by the end of the day, so I crash at 10:00! That's not really anything new, though, because I'd been doing that during pregnancy already. We are sort of settling into a routine. James is subbing a couple days this week. Night school is from 4-9 Mon. through Thurs. I really miss him in the evenings, because he's only every been gone during the day before, pretty much ever since we've been married. It's an adjustment, but night school only goes for another 5 weeks, and then I can have him back in the evenings. Who's counting, though?
I look forward to being able to take Kenny out in public. We've been on some beautiful walks and to the dr. a couple of times for checkups, but it gets a little old being limited in what we can do. I've been to Sacrament meeting in a different ward for 2 weeks now, so the next 2 weeks I will go to my own ward, give my talk, and teach the class that I've never met. I'll admit that I have some anxiety over teaching 16-18 year olds. I was horrible at that age.
Spring in Nampa = perfection.
on the Boise greenbelt
So life continues on. Everything is still very uncertain about the fall. I really hope to stay here, but I guess we'll see. It's fun having 2 boys so far. Though Kenny doesn't do a whole lot besides sleep and eat, he's starting to be awake for a little while each day. I like looking at him and trying to figure out who he'll become. It's been an adventure to see Joseph grow up into a little boy, so I'm excited that I'm doing it again. I'd definitely forgotten just how angelic a newborn is and how cute it is to see one stretch!
Tuesday, April 10, 2012
Recovering from childbirth is not the easiest thing in the world. However, even a week later, I'm beginning to feel like a normal person again! There's a lot to be said for hot showers/baths, good food, a clean house, and sleep. I was sad when Mom and Carmel left, because they were a big help.
The emotional adjustment is a lot easier this time around. I'm already a full-time mom, and I'm not switching from being a full-time student. Sure, I've had my weepy moments, but a couple of really crappy things have happened in the last week, completely unrelated to the baby, like
1. Our dishwasher broke. As I speak, we are finally getting a new one.
2. The kitchen sink also broke. The handle is really loose, and it keeps getting loose every time we use it (even though we know how to tighten it!) It gets stuck on either all hot or all cold water, and then it's really hard to turn off. This problem is complicated by #1, because it makes it a real pain to wash any dishes!
3. Our debit cards expired. It's totally lame to have to rely on checks while we wait for the new ones to come. Apparently, they were sent to the wrong address in February, and then the bank deactivated them since no one used them. Hello, bank? Why didn't you tell us this so we could change our address for you?
4. James's schedule is completely reversed from how it was during student teaching. Though not an inherently bad thing, it's tough to completely flip flop my own schedule AND throw in a newborn, who is entirely unpredictable right now!
It's really not as bad as it seems. Baby Kenneth has reminded me of all the things that weren't easy with Joseph, but that I forgot about (like cluster feeding!). Apparently, I wasn't scarred for life from going through it before. Kenneth is really healthy so far, calm, content, and just cute. He's already an ounce heavier than at birth, which is really unusual for a baby only 4 (now 5) days old. Of course, he doesn't really have a schedule, but I've learned that the sleeplessness doesn't last. If I make it until 2 a.m., then I always get long stretch of 3 hours. As long as I go to bed early, I can get enough sleep, since Joseph wakes up by 7:30.
Since James is working at night now, we're going to eat lunch together. I'm making what I used to make for dinner, for lunch. Today was really the first day that I cooked a real meal, and it felt good. Life is good, even though it's so unpredictable right now! James is still applying for jobs all over Utah and Idaho, plus a few elsewhere. We have faith that it will all work out, but it's still tough to be without anything permanent yet. Still, it's amazing how much the Lord has taken care of us and our family. He is good.
Thursday, April 5, 2012
Kenneth James Head
*Nothing graphic, I promise!*
This week has been full of blessings. Monday rolled around, and still no baby. However, James was able to apply for insurance, since he's graduating and won't have any between now and a job in the fall. It turns out that he applied just in time! If we'd been busy with a baby, he might be in trouble right now, or at least after April 16th, when his coverage ends.
All in all, Monday was a reasonably calm day. Tuesday was hard to get through. I'd made up my mind not to be induced already, but it was still hard to justify waiting when everyone's coming to visit me!
Wednesday morning, I woke at 3 a.m. with contractions 10 minutes apart. They were just barely painful enough to keep me awake, so I read for a while. With Joseph, I'd also started labor at 3 a.m. and had gone to the hospital at 7 a.m. This time, I waited.
The day passed uneventfully. I ate regular meals, because I had no nausea. I also went on a walk, took a couple of naps, and enjoyed a couple of warm baths. I even thought about working out, but I was too tired. At my dr. appointment at 2 p.m., she told me to go to the hospital at 6 a.m. the next morning if I wanted to get Pit for augmenting my labor. I agreed, because I knew I'd need to show up at the hospital before that.
By 7 p.m., a warm bath wasn't helping anymore with the pain. We checked in at the hospital. I got an epidural right away and relaxed until about midnight. That's when the real pain hit. Epidurals (for me) don't even come close to getting rid of all feeling. I thought mine was broken, because I felt like I was going to die from 1:00 on. Thank goodness, Kenneth James was finally born at 2:15 on April 5th, 2012. He was 7 lbs., 8 oz., and 21 inches long.
Mostly, he's been sleeping, but he's also been eating here and there. I think he looks a lot like James and not a lot like what Joseph looked like as a newborn. He's gotten quite a few compliments on his head full of blond hair. We love him and can't wait to take him home tomorrow!
I'm really glad that I just waited it all out. I saved myself a ton of pain by not using Pit, and I felt a whole lot better due to the fact that I'd eaten and slept all day instead of starving, puking, and being in misery strapped to a bed, which is what happened with Joseph. If the epi had worked better at the end, I'd say that I had a very ideal delivery (for me, at least, because who thinks that 24 hours of labor is ideal?!)
I really like this hospital. They have good, healthy food, and I get a whole menu to look at for each meal. The bed is comfy, though of course I've been sweating to death...totally normal for recovery, especially since I'm sitting on a plastic pad thingy. There is also wireless! Hence the blog post...
James slept here last night/this morning and doesn't have work again today, so the time has really flown by. I've been dozing, eating, and holding my precious baby. Mom and Carmel will bring Joseph to visit again. I don't think he dislikes Kenny, but he isn't sure what to think of me being in the hospital. He doesn't like being told not to play with the buttons on the bed!
I can't believe that I have 2 boys now.
Sunday, April 1, 2012
The Roller Coaster
Yes, this week has been quite an emotional roller coaster for me. It's a lot like it was the week before Joseph was born. I don't know if this happens to everyone, but I've narrowed it down to the cycle of crazy feelings week 39 and on. Each lasts for a couple of days.
Stage 1: Excited! I'm almost done! My baby could be born at any time now.
Stage 2: Fear. What if he's never actually born? What if Mom shows up and he isn't here? What if I end up super late, have to get induced, and then end up with a C-section because it went badly?
Stage 3: The Blues. I'll be fat, tired, and achy FOREVER. I simply cannot do it anymore, or I'll go completely insane. I hate being pregnant. I want my body back.
Stage 4: Resignation. It will all work out just fine. It might not be on my timing, but it will happen soon. The Lord is mindful of my situation and desires, and He will make sure that this precious baby arrives safe and sound.
I'm due tomorrow. By this point with Joseph, I had been in labor for a long almost 20 hours. I was feeling totally miserable, but at least I was in labor! Of course, anything can happen between now and tomorrow, and it's totally possible to have another baby on his due date. That would actually be really cool. I just don't want an induction, because Pitocin is no fun. I have no reason to do so, because I have great blood pressure, etc. I haven't even gained as much weight as I did with Joseph.
I'm currently feeling Stage 4. I want to stay that way, even if it's for another couple of days.
I'm excited to meet this little guy, no matter when he decides to show up.
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Pregnancy/Delivery Recovery
I never got to write much about how I was doing after Landon was born because I was so preoccupied with how he was doing. I had been dreading the delivery recovery process- any message board I stumbled upon talked about 4th degree tears, pain for months, etc. I was also dreading the arduous return to my pre-pregnancy weight. My mom insisted that she felt great after having me and my two siblings, but she's something of a freak of nature in all things physical- she's weighed the exact same since she was 18 (think head cheerleader/prom queen type figure), eats a large popcorn drowning in butter every time we go to the movies, and even though she gained over 50 lbs when she was pregnant with me, she was back in her tiny jeans in two weeks. So yeah... I wasn't exactly taking her word for it.
Anyway, it turns out that I felt pretty darn good after getting that baby out as well. Yeah I was sore, swollen, and stitched up, but you just wear those pad-like ice packs (loved those), take the ibuprofen regularly (I never had to take the narcotic that I was allotted- I was sore, but not in pain), use your peri-bottle every time you go to the bathroom, and exercise care when transitioning from standing to sitting. I also bought those moist cottonelle wipes to use instead of toilet paper and that made a big difference. Since we were in the NICU all day, it was hard to keep using my peri bottle so I just stuck those wipes in my purse. I was lucky with my tearing- I just had one first degree tear and another one too small to even get a degree designation. I think my skin is quite stretchy because I didn't get stretch marks either. I was very sore for about 3 days, rather sore for another 3-4, and honestly felt pretty great after that. By the time we took Landon home from the NICU (12 days post-partum), I had been feeling totally normal for several days. I do wonder if my recovery was quicker because I didn't have a baby to take care of. When we weren't visiting him, I was resting in my hospital bed, and even when we were with him, I was just sitting in a chair next to his isolette. There's also nothing like worrying about someone else to make you forget or minimalize your own pain. So having a baby in the "Special Care Nursery" (Northwestern's euphemism for the NICU) is probably a positive thing for your physical recovery- not that I'd recommend it or ever want to use that method again.
As far as the weight goes, I was at +41 lbs the day I went into labor. I'm now +11. It's amazing how much of that weight must have just been fluid. My wedding rings fit the day after delivery and I tried on every single pair of shoes last week and they all fit (thank goodness!). I'm pretty much wearing normal tops and maternity bottoms- it's very comfy and I'm really not that excited about trying on my old jeans again. I've grown quite attached to the cute jeans with the stretchy waist band. Sitting in the library was so much more comfortable with those on- they were like jean PJ pants. My stomach is still quite squishy and I find it unbelievable that it will ever return to its original size, but we'll see. Luckily, I have all of Fall, Winter, and Spring before I even have to think of wearing a bikini again.
Sunday, July 29, 2007
Full-Time Parenting
Landon's been home for 3 nights now. My mom left yesterday (she's coming back in 2 weeks, otherwise I might have refused to drive her to the airport), so last night was JP and my first night on our own. All in all things are going really well. We love having him here- we spend a lot of time just sitting and smiling at him while he sleeps in his papasan chair. He was always swaddled in the NICU and we've found he really prefers to sleep that way (prefers as in, he won't sleep unless he's swaddled) so we swaddle him and then stick him in the papasan chair. He's quite cozy and sleeps a solid 4 hours between meals that way.
The first night was rough- he had been on Enfamil with Iron in the nursery and chose Thursday night to stop tolerating it, get gassy, and cry any second he wasn't being held and bounced. My mom stayed up with him until 2:30am, I stayed with him from 2:30-5:30, and JP was with him from 5:30 until he left for work. Luckily we already had a pediatrician appointment for Friday morning (preemies have to be seen within 48 hours of leaving the NICU) and she suggested soy formula. I really like our pediatrician- she's obviously very knowledgeable, but she seems quite practical as well. She introduced herself to Landon (sounds silly, but I liked it) and he behaved much better for her than he did for us the night before! He has put some weight back on (he's back up to 7 lbs. 1 oz after getting down to 6 lb 10 oz) and he has a follow up appointment Tuesday to check his weight again. He's been doing great on the soy formula and Friday night my mom stayed up with him anytime he woke up so that we could get a solid's night rest before we were on our own- she must be exhausted, but we really appreciated it! He seems to have his nights and days confused- his deep sleep is during the day and his lighter sleeping and awake time are at night. Now that he's able to eat more he's sleeping better at night- he still likes to be held, but we just put him on our chest and sleep in the recliner. Today we went on our first walk and his eyes were wide open the whole time. It was a beautiful day in Chicago and hopefully we can get his "awake time" to be during daylight hours!
I've already watched more TV and movies in the past 2 days than I did all summer. The Godfather I, II, and III were on TV Friday so my mom and I watched the whole trilogy. Last night JP and I watched the Bourne Identity and Supremacy (mom's babysitting when she comes back so that we can go see the Ultimatum). I'm filling out his baby book and going through all the pictures we've taken over the past few days. I look at him and still find it rather amazing that I made him and that he's ours forever- I'm pretty adjusted to the fact that I have a newborn, but the idea that I'll also have a toddler, young child, and teenager surprises me. JP's already concerned that Landon is growing up too fast (he's very attached to his baby boy), but I'm excited to see who he becomes as he grows. I wonder how much of ourselves we'll see in him.
Thursday, July 26, 2007
He's Home
After 12 days in the NICU, Landon is finally home with us! He and his daddy are napping on the couch while my mom and I wait for our dinner to be delivered. It's been tough 12 days, but we have amazing family and friends (and blogging friends) that have really helped us get through it. He's slept in his papasan chair, drank from his first non-hospital bottle, and been changed on his snazzy changing table. It's strange not being able to turn to a nurse for approval for each step, but I think we'll get along okay. And I don't think two parents have ever been so excited about getting up for a nighttime feeding :)
Wednesday, July 25, 2007
Tuesday, July 24, 2007
There's Talk of Going Home!
Yesterday Landon had a day full of eating, sleeping, and being ridiculously cute without one de-sat! I just talked to his night nurse and last night was de-sat free as well, so we're now on Day 3 of 5 and it looks like we'll get to take him home on Thursday! I spoke with his doctor yesterday and she's so happy with his progress- she started talking about the steps we'll take before he's discharged. I could barely pay attention because I was so excited to hear the word "discharge" again- they stopped saying it for a few days there. Today he'll be circumcised and Wednesday he'll get his Hepatitis shot and have his car seat check (they put all preemies in their car seat for one hour to make sure they tolerate it well and are fully supported).
It's been a long 10 days, but hopefully we're nearing the end!
Monday, July 23, 2007
Emotional Meltdown
After hearing and reading so many stories of other parents whose babies had to stay in NICU for any amount of time, I started to think it was odd I hadn't cried yet. Pretty much every email I get tells me of a mother who cried all night when she came home babyless, but I haven't shed a tear- or even felt a need to. He improves a little everyday, and while it sucks that he's in NICU, that's where he needs to be and there's not a whole lot we can do about it except enjoy every second we're with him.
And then yesterday, in the Foodlife restaurant of Water Tower Place mall, over a plate of chicken and mashed potatoes, I lost it. With almost no warning tears just started running down my face- totally alarming JP. I think that now that Landon is doing better, (he had no de-sats yesterday or last night!) I could let myself break down and feel upset, angry, sad, and cheated over the fact that he'll have been in the NICU for nearly two weeks before he gets to come home and we get to really be his parents. I allowed myself to think about what it would have been like to bring him home last Tuesday when we were discharged- it seems like he's already changed so much from the day he was born, and I feel like we're missing it. He still barely feels like he's mine- I look to the nurse for permission to pick him up even though I don't have to. Yesterday I found myself wondering that if there were 100 babies all lined up, would I know which one was mine? JP seems like such a natural at everything- he's so comfortable with Landon's diaper changes, feeding, burping, and swaddling- and is perfectly happy to spend hours by his crib just looking at him. I feel bad that I get bored after a while and need breaks.
Looking back, it's been a tougher week than I thought while going through it.
Sunday, July 22, 2007
One Week
It alternates between being amazing to me that it's already been a week and that it's only been a week since Landon was born. It doesn't seem like very long ago that I was still pregnant and counting down the days until his due date, but JP and I are such NICU regulars now that it feels like we've been spending our days there forever. We have an assigned locker, we know everyone at the front desk, we have our favorite nurses, we know the shift change schedule, and we know the names (and cries) of all the babies in his nursery. Landon and one other baby boy are the only ones who remain from our first night- the other 4 beds have been changed up. I try not to get too jealous when I see another couple bring in their car seat to take their baby home.
Yesterday, like the few before it, was a day of progress and set-backs. His bilirubin levels went back up, so he's back on the blue bililights. However because he's getting so active and eating so well, they gave him the glow worm bililight that just goes on his back under his t-shirt. So this time we can still pick him up and hold him as much as we want (under the big bililights he could only be out of his crib 1 hour a day). He had a few de-sats over Friday night and into Saturday morning and a big de-sat yesterday afternoon- he went down to about 70% and turned very blue/grey. It took some stiff reminders to get him to breathe, although he was able to return to 86% without the oxygen mask. So I think we're now pushed back to at least Thursday for when he can come home- we're now just thinking anytime before the end of next weekend is pretty good.
On the plus side, his doctor said she felt that he sounded better without his nasal cannula in- that the amount of oxygen he's getting is so low that it may be getting in the way of his breathing more than it's helping him. So at 2pm the cannula were taken out and we got to see his handsome face free of tubes for the first time! I just talked to the nurse this morning and she said he had a few small de-sats last night, but each time he came up on his own and didn't require any hands-on intervention like he did yesterday afternoon. He's eating like a champ and has brief periods where he's so awake and active- we have so much fun just sitting and staring at him all day.
JP is going back to work tomorrow. He'll be working reduced hours and hopefully leaving by 4pm (he's an investment banker- that's very reduced), but I think that's going to make things quite a bit harder. So far we've been doing fine with it just being the two of us- we sit in awe of his cuteness, keep each other company while he's sleeping, and take breaks to walk around outside together when we need it. He's so in love with his little boy- he keeps me from getting down about the fact that we're still in the NICU because he's so excited to see Landon whenever we're there, the circumstances of how we're seeing him just don't matter very much to him. My mom arrives on Wednesday. We thought we were timing her arrival to be after Landon comes home and right around when JP goes back to work. Now it looks like she'll be hanging out in the NICU with me and I'm so glad she'll be there.
At least I have my Harry Potter book to keep me company while Landon is sleeping. Amazon is supposed to delivery my pre-ordered copy, but we're never home and don't have a doorman so I knew it would be a while before I actually got my hands on it. I bought another copy at the hospital book store and I'm reading it slowly to savor the last of Harry Potter's magical world. I've talked to Landon about the basic plot line and I'm sure he's looking forward to hearing more details when he's older and we can read all the books together.
Friday, July 20, 2007
Day 6: Bumps in the Road
Like I did the other day, here's the e-mail I just sent out to family/friends to update them on Landon's progress. I'm off to bed, but I know there are people reading the blog to find out what he's doing, so I wanted to keep you in the loop as well. It's so comforting to know there are so many people out there thinking and praying for us- even so many that I've never met! The internet can be such a lovely thing.
Hello all,
Yesterday we were concerned about Landon's episodes of de-saturation (de-sats) where his oxygen saturation would go down and he'd turn blue until the nurse put the oxygen mask near his face. Every time he has an "episode", the clock restarts for five days until he can come home. We were hoping yesterday would be the end of them, but when we called his nurse at 8am we found out that he had several episodes over last night and one already this morning. Obviously, this was incredibly disappointing- we were so encouraged by his progress the past few days- I think that was keeping us going. We headed out for the NICU to spend another day by his isolette feeling a little down- it was starting to sink in that it could be many more days of driving back and forth and leaving him each night.
Luckily there was some good news. We spoke with the doctor after we arrived and she didn't seem worried about his de-sats. She felt they were just bumps along the road of him learning how to breathe on his own- apparently he hasn't quite figured out that breathing is not optional and that yes, he must do it all the time. It's tough learning all these rules of surviving in the outside world! He de-satted twice this morning while he was sleeping, but each time he only needed a little nudge to remind him to take a deep breath (no oxygen mask required). This afternoon he did great- no de-sat episodes, even during his feedings and some pretty deep sleeping. We'll call his nurse again to hear how he's doing before we go to bed.
Other bits of progress: he was moved out of his isolette and into a regular crib this morning. His temperature stayed regulated so the isolette was officially taken away! He also had his IV removed (it was turned off yesterday, but they left it in just in case) so he has one less attachment. He's getting quite squirmy so I'm sure he's enjoying his increased freedom. JP and I spend most of the day just sitting by his crib watching him move around in his sleep- he's getting so much more active, it's incredibly entertaining. Now that he's doing so much better and is off the bilirubin lights, we get to be a lot more involved in his care- we fed him his bottles, burped him (our favorite photo ops), and changed his diapers throughout the day. We also spend far too much time staring at the numbers on his monitor, holding our breath every time the oxygen saturation number starts to go down. The nurse threatened to turn off the monitor if we didn't stop watching (she has her own viewer), so we're trying not to fixate on it.
JP actually just called the night nurse and he's doing great- no de-sat episodes! Hopefully we'll hear the same when we call in the morning, but as he's shown us since the moment he decided to arrive- Landon is pretty much in charge of his own timeline. As always we're thankful that we're just waiting for when he's ready to come home and not worrying about the if. Send thoughts of 96% saturation his way!
Thursday, July 19, 2007
Two Steps Forward, One Step Back
Today was a little tougher than yesterday. The separation and the driving home from the NICU without Landon are starting to wear on me. He's still doing great- he was taken down to Level 1 of breathing assistance, the bilirubin lights are gone because his jaundice is under control, his IV was turned off, and he's drinking quite a lot of formula. On the downside, the bradycardia episodes he had the other night, the ones we were hoping to blame on the CPAP machine, happened again- this time without a CPAP machine as a scapegoat. He also had two "de-sats" where his oxygen saturation levels plummeted and he started to turn blue- the nurse put an oxygen mask near his face and the levels quickly returned to normal, but it was still a little scary (it happened once while I was holding him). He has to go five full days without any episodes of bradycardia or de-saturation before he'll be discharged, so it was sad to have another day tacked on to his stay. However, if he's randomly turning blue, we definitely want him in the NICU and not in our apartment. I can picture us hovering over him with a flashlight at night to check his coloring- hell, we may be doing that anyway.
Alright, on to me... My milk came in Tuesday night. Very Bizarre- instantly rock hard, Pamela Anderson sized, supremely sensitive boobs. I've been living in a sports bra with breast pads and holding bags of frozen food to my chest while I sleep. There have been several varieties of frozen foods: I had purchased frozen peas for this event, but JP was so tired that first night when I asked him to grab them for me that I ended up sleeping with one bag of frozen peas and one bag of frozen chopped onions. I woke up smelling quite flavorful. Last night I somehow ended up with a bag of frozen peas and a bag of Trader Joe's vegetable fried rice. Who knows what frozen delicacies I'll clutch to my chest tonight.
The recovery hasn't been too bad. I was very sore and swollen for the first 2-3 days, but I was obsessed with those pad-like ice packs that the hospital had and they helped so much. Now I feel fine when I'm up and walking around- the only thing that is still uncomfortable is when I transition from sitting to standing and vice versa. My stomach is quite jiggly, but it's so much smaller than it was at 8 months pregnant that I feel almost skinny (despite not being anywhere close to fitting into my old jeans).
I got an exciting e-mail today- Chicago Firm has decided to pay me my summer associate salary through August 3rd (my anticipated last day)! I only worked there for 2 weeks, but I'm getting paid for 5! I was stunned- I never expected that. We were kind of counting on having that money available over the next year, so there was a lot of relief mixed in with the shock and happiness.
It's so strange to not be pregnant anymore, but not have a baby at home. I feel like a half-parent. JP and I are by his isolette all day in NICU, but we have nice lunches together and get lots of sleep at night. I came to terms with the fact that he wasn't coming home with us, but the days don't go by near quick enough. Every little set back is so hard to take- the nursery is all ready now and we just can't wait until he's here with us. Overall he's progressing so well- we're just trying to stay positive and hold on to that. We're really very lucky- we know he's going to be fine- there's no if, only when.
Landon Update- Day 4
The following is an e-mail I just sent out to family and friends regarding Landon's progress- there's more I'd like to say in this blog post (for example, my milk came in last night- quite an interesting experience), but it's late and I'm exhausted, so I'll chat about that tomorrow.
Landon has had a fantastic last 2 days!! In the last email he was still on "Level 7" of breathing assistance and I wrote that the doctors were hoping to take him down to a 6 this morning. Well, he ended up going to a 6 last night and this morning jumped down to a 4- this means he was taken off the giant CPAP machine (that he Hated) and just has nasal cannula instead (little tubes in his nose- much less invasive). He was on the "high flow cannula" this morning and when we visited this afternoon he was already down to the "low flow cannula" and his oxygen volume had been decreased - he's now on Level 2! He also made the big step to taking formula from a bottle, so his stomach tube has been removed! He's turned out to be a voracious eater (much like his dad) so they've doubled his formula volume and, because he was getting so cranky having to wait 4 hours, he's now feeding "on demand". He still has his IV in place to supplement his bottle feedings, but the nurse felt it would be removed in the morning. He remained on the phototherapy all day for the jaundice (that's why some of the pictures have a bizarre blue tint to them), but that will be turned off tomorrow at 6am. He should also be moved out of his isolette and into a normal crib sometime tomorrow.
We visited him several times today. [JP] did the kangaroo time with him at noon and Landon was very busy looking around while laying on his daddy's chest. Now that he's doing so much better we can fully understand how bad he was doing those first two days when all he could do was heave his chest trying to breathe. Now he squirms around, stretches his arms and legs, and (finally!) opens his eyes to look around. We also heard him cry for the first time- I don't think we'll ever be that happy again to hear him wail. We went back to see him this evening and I got to give him the last few ounces of a bottle (I also had the honor of changing his diaper for the first time that morning). We stuck around for his next bottle and spent the 2.5 hours until then looking at him sleep, wake up, explore, and sleep again. It was wonderful to see him so active! We were there for his "hands-on check" at 9pm so we saw him get weighed (he's down to 6lb 14 oz, but that'll go up again now that he's on formula), measured, and have his diaper changed. I got to give him another bottle, which he devoured. He was then so exhausted that the burping process was kind of a lost cause- he just fell into a baby food coma and we eventually gave up and let him lay down. (The picture clearly shows his "Why won't you leave me alone and let me sleep?" opinion of the whole burping process).
So everything is going really well- his hopeful discharge date remains Monday because he had a few episodes of apnea and bradycardia (sharply decreased heart rate) last night. The doctors think that was just because of the CPAP machine (something with the tubes getting in the way of measurements), but they want to watch him for at least 4 nights to make sure it doesn't happen again before he's sent home to us. [JP] and I are doing fine- we're so thrilled about his progress each time we have to say goodbye that it makes the parting quite bearable. We'll be back in the NICU all day tomorrow- I get to kangaroo and [JP] will give him a bottle. I've added a bunch more pictures online as well as a few video clips. You can really see how active he's getting!
Thanks again for everyone's emails- the upside of leaving the NICU after each visit with Landon is that we get to check our email and read your messages :)
Wednesday, July 18, 2007
Law School Intrusion
Yesterday, in between midwife visits, vitals checks, and visiting the NICU, I received an email about my student loans for next year. Apparently I had screwed something up on the application (which I manage to do in some way every year) and had to reapply for all my loans. It was the first email I've gotten since Sunday from someone who didn't know I'd just had a baby- it was strange to realize that the rest of the world is just going about it's business. I corresponded with the very helpful financial aid advisor, re-filled out all my forms, and received confirmation that my tuition would be covered when classes begin in the Fall. Every time I replied to her I was tempted to mention that I was writing the email from a hospital bed, but I resisted. Besides, she may have seen my absolute failure to ever apply for loans properly as a bad indicator of my ability to care for another human being.
Home and Babyless, but Smiling
Today has been a great day for Landon. When I last posted I was about to go down for some Kangaroo time with him. It was amazing to have him on my chest like that- I could feel him relax as we lay there together. His arms were stretched out across me and his breathing stayed nice and slow... I'm not sure I've ever been so happy. I think it was the first time I really felt like his mother- I finally felt like I was doing something to help him intead of watching other people take care of him. He also got his first bit of formula- he still can't take a bottle because he's too busy breathing, but they used a syringe to put some in the tube going to his stomach. His little mouth opened and closed while the nurse was giving it to him- I think he knew he was getting something tastier than IV fluids. He'll continue getting three ounces every three hours through the tube until his breathing is much closer to normal.
I was discharged, so we went down to visit him at 4pm before we drove back to the apartment. We got more good news- his oxygen was at 21% (the lowest they'll put it at) and his breathing rate was in the range of normal (about 40-50 breaths a minute). The nurse thought the doctors might reduce him to a Level 6 today after all. It was a tough leaving the NICU to head home without him- I got a little choked up- but we'd had enough time to adjust to the idea and really we were just so excited over his progress that we couldn't stop smiling anyway.
We talked to his nurse at 9:30pm tonight and got even more good news- the doctors took him down to Level 6 and there's talk of taking him off the CPAP machine and just using the nasal cannula tomorrow- that's Level 4! We're still thinking it'll be next Monday when he can come home (no one's told us to adjust that expectation yet, and I'd rather be pleasantly surprised than disappointed), but he's a scrapper (as JP constantly says) and we're so excited that he's doing so well. We'll be back to visit in the morning and we get some more Kangaroo time at noon!
Tuesday, July 17, 2007
A Really Good Night
Last night JP and I went down to say goodnight to Landon at about 9:30pm. The nurse said he was doing better than expected and had a great afternoon. We asked when we could hold him again and she suggested Kangaroo Care. JP took off his shirt and they placed Landon, tubes and all, on his chest for some skin-to-skin cuddling contact. It was amazing. His breathing, which had been hovering at around 90-100 breaths per minute went down to 30-50 bpm. They were able to turn his oxygen percentage down from the 36% to 25% (after his bad first night it had been all the way up at 53)! It was incredible seeing him so calm and happy- it was our first time to see him without a heaving chest. We had a family picture taken and sat blissfully for nearly two hours. When we got back up to my room I got to take a shower for the first time- a truly glorious event.
It was a wonderful evening- seeing him do so well and getting to really hold him made our separation so much easier to bear. Now that we have had time to accept the fact he won't be going home with us, we're much better at just enjoying the time we spend with him and looking forward to his discharge day- whenever it arrives. We had a quick visit this morning- his respiration and oxygen numbers have continued to stay down (yay!), but his bilirubin levels have gone up due to some jaundice. He'll be under the blue lights for the next couple of days to help his body break down the bilirubin (his liver isn't quite up to the task yet and usually digesting food helps, but he's still purely on the IV). We'll go down again at noon and I get to be the kangaroo!
Monday, July 16, 2007
NICU update (updated)
~ 7am: We found out last night that Landon's lungs hadn't improved- he's basically walking the line between needing further intervention (intubation) or just staying on the respirator a little while longer before they can start weaning him off it. Even if he picks the good side right now, and they can start reducing the oxygen they're giving him, it'll be at least one week before he can come home and quite realistically two or more weeks. I'm really sad.
Update at 1pm: We visited Landon twice this morning- after the first visit it sounded like they were going to intubate because he had a difficult night and now needed 53% pure oxygen rather than the 20-22% he was on yesterday. After breakfast we went back down and were able to talk with the NICU attending. She said he was improving (now at 32% oxygen) and they were going to watch him very closely, but they had not made the decision to intubate at that time. If he makes it through this evening without that step then it probably means he's on the road to improvement (though it might be a long road- tubing him might actually make the recovery shorter but it's quite a bit more invasive so they want to avoid it). He's still breathing far too rapidly- over 100x/minute rather than the usual 30-60. You can see the dents in his chest from working so hard. We'll go visit again this afternoon- it's hard just seeing him a couple of times a day, but we're trying to balance our desire to see him with the fact that our visits get him worked up and breathing faster (although I know he likes holding our hand- which you can see in the picture- it's hard to get him to let go when we leave). Once his breathing has relaxed and he's really improving we can spend more time with him.
It's been tough- I only feel like half a parent. I think I'm still in a bit of shock that this whole thing happened and not having him around to constantly remind me that I'm a mother makes it even less real. He's being (well) cared for the NICU team and I'm just a visitor. I know the connection will grow when I can hold him and spend more time with him, but for now when I see him laying there I have to continually remind myself that he's my son. I think JP feels a stronger bond than I do- maybe because he wasn't able to be close to the baby until now. I had the little guy squirming around in my belly for eight months- he actually feels less "mine" now than he did before. The timeline for his homecoming is looking at just over a week- best case scenario. I'm glad he's in such good care, but I can't wait until he's in my care.
Sunday, July 15, 2007
Landon's Labor & Delivery Story
I really wanted to write down my labor story- mostly for my own memories, but also for anyone else wondering about one person's experience. It was just last night, but it already feels like so long ago. All the times are approximate and I may edit this as I remember more details.
Sat, July 14 - Sun, July 15
7:45pm: My water breaks in the Big Bowl chinese restaurant. I page my OB/midwife practice and get a phone call back telling me to come straight to the hospital. JP says something to the waiter about his wife being in labor and we jump in a cab.
8:20pm: We're in the Labor Evaluation Unit. My water is confirmed to have broken (and is in fact running down my legs and pooling in my shoes). I have no noticeable contractions and will be started on pitocin to get things going (once the water breaks you need to have the baby within about 24 hours). I am in some form of shock that this is actually happening right now- I'm quite hung up on the fact that I don't have a bag packed. JP is calm and excited.
8:40pm: I call a good friend of mine who lives nearby. She comes to sit with me while JP and her husband drive to our apartment to get my camera and a few other necessities. I get taken to my (huge) labor and delivery room. I'm now hooked up to penicillin (I hadn't made it to the 37-week appointment where they test you for Group B Strep), pitocin, and IV fluids. My contractions have started, but they pretty much just feel like cramps and are very irregular- I can (and do!) talk through them pretty easily. My midwife arrives and talks me through what might happen over the next several hours. I also meet my labor and delivery nurse who I really like.
10:00pm: JP gets back from our apartment and my friends leave. I can definitely feel the contractions now and they are getting more regular. I've already spoken with the anesthesiologist about getting an epidural when the pain gets too intense, so knowing that will be coming is very comforting.
11:45pm: I decide it's time for the epidural. My contractions are regular and intense- I can get through them, but I really can't imagine continuing to do so for an unknown number of hours. JP has to leave the room for the procedure, which is convenient since the dinner he ordered has finally arrived. I get the spinal/epidural block. It's totally painless except for the initial numbing shots and the relief is almost immediate. I can still feel and move my legs, and I'm still very aware that I'm having a contraction, but that painful edge is gone. I also get a catheter since I'm now confined to the bed until the baby is born- that process is completely painless and I actually start thinking that one of those would have been nice over the last few weeks when I was getting up every 2 hours at night to pee.
12:00am: I get my first internal exam- I'd been warned that my progress could be slow because my water broke without contractions and I was a first-time mother. But to everyone's surprise I'm 100% effaced and 6 cm dilated!
~2:00am: My contractions are getting downright painful, even through the epidural. I'm examined and it turns out I'm 9.5cm dilated already. We decide that I should get another dose of the epidural meds to get me through the last 0.5cm. This will also allow me to rest for a little while (you usually can't push right after getting a dose because your pain is numbed too much). JP falls asleep immediately and I try but spend most of the time in a semi-sleep-state dreaming about climbing up and falling back down a mountain.
4am-5am: I'm awake again and feeling more intense contractions, now with increasing rectal pressure because the baby's head is descending. The epidural is still doing it's job, but I'm definitely looking forward to the end- I want to meet my son and I really want to get some sleep. The contractions just won't stop- as soon as one ends I know another is beginning soon. I can't get comfortable. My midwife comes in- I'm a full 10 cm dilated and the head is engaged.
5:30am: Time to start pushing. This is really intense- the epidural seems to have disappeared. My L&D nurse is on my right, JP is on my left, and my midwife is in the middle. We leave the bed intact (most doctors shorten the bed and put your feet up in paddles), the lights down low, and everything is really quiet. My midwife talks me through the contractions and pushing, and JP and the nurse offer encouragement. JP was so amazing during the whole experience- he knew just how to encourage me without annoying me (tough at that point). Each push burns and stings more than anything has ever burnt or stung me before- my midwife called it pushing through a ring of fire and that sounds about right. I'm surprised to find that I feel discouraged even though it's only been about 15 minutes- this part is harder than I thought it would be. My midwife is encouraging me and JP tells me he can see the head. That motivates me again- I want this to be done and I'm so excited about meeting my baby. About 2 contractions later- with several pushes within each contraction- I hear my midwife say "keep pushing for the shoulders." At first I think she is just trying to encourage me (I must have missed everyone telling me the head was out), but the next thing I know there is a baby laying on my chest! It's incredible- absolutely incredible.
6:04 am: His official birth time. I get to hold him for a few moments and then he's taken away by the NICU team. I have two 1st degree tears my midwife is stitching up. I then deliver the placenta, which wouldn't hurt too much except that the thought of anything coming out of that area is somewhat horrifying. There's a little more pressure and then it's all over.
At about 8 am we meet our nurse from the recovery floor and stop by the NICU on our way up to the new room. Landon looks so tiny in his isolette all hooked up to different machines. We touch and comfort him the best we can and then go up to our new room and pass out.
Introducing Landon
Here he is! All 7 lbs. 7 ounces, 20.5 inches of him! I'm going to do a separate post about the labor and delivery, but it went really well (and really quickly!). They turned up my epidural so I could get some sleep before pushing- I got about 2 hours and then he was born at 6:04am. Unfortunately his lungs aren't fully matured so they whisked him off to NICU almost immediately after he was born. I was able to hold him briefly- I looked him in the eyes and couldn't believe he was mine and that he was who I had been carrying around for eight months.
He's still in NICU and will be there until at least Tuesday morning- and will possibly have to stay after we are discharged Tuesday afternoon. I really hope that doesn't happen- I'm sad that he isn't in the room with us. We head down to his nursery at 2pm- we've visited him several times, but this will be the first time we can try to hold him so we're really excited about that. He looks so lonely in the NICU bed, but his respirations are still really fast and I'm glad that he's being cared for down there.
I still can't really believe we have a baby- I'm so happy, nervous, exhausted, and happy again. It's been such a journey- the whole process is pretty incredible.
So JP and I attended our 8 hour "Great Expectations" class this morning. We learned all about the different stages of labor, various ways of managing pain, post-partnum recovery, and newborn basic care. We also got a tour of the hospital and learned what to expect on the big day. After the class, during which JP spent much of his time making fun of the people in the 80's era videos, we decided that since our parking was paid for the next 24 hours we might as well spend some time downtown. I'd been wanting to see the new Harry Potter movie and we managed to get tickets to a show starting in twenty minutes. The movie was good- though I thought the 3rd and 4th were better. We then walked to a chinese restaurant for dinner. We had just ordered our drinks and appetizers when suddenly I felt a gush of liquid. I went to the bathroom and saw that everything was soaked- and I now had liquid running down my legs. I went back to the table and calmly (through the shock) informed JP that my water had broken. I left the restaurant (there was now a lot of liquid running down my legs), left JP to explain what just happened to the waiter, and called my midwife. Because I'm a full four weeks early she said we needed to go directly to the hospital. JP ran out a few seconds later (apparently the restaurant wrote off our bill) and we hopped in a cab back to the place we had just left a few hours earlier.
So here I am in labor & delivery. I was admitted immediately as my water had most definitely broken, but I couldn't feel any contractions yet. I'm hooked up to a few IVs (one with pitocin) and am waiting for the contractions to become more regular so I can get my epidural. The last few have been quite intense (enough to where I'm thinking women who don't get epidurals are incredible- and possibly a bit insane), so that glorious event will probably be soon.
I'm pretty much in shock. This is early. He's officially premature (though only by 5 days, so he should be fine). I'm supposed to work for 3 more weeks- and get 3 more weeks of paychecks. His baby clothes are all over his bed. His mobile hasn't arrived. I never packed a hospital bag. I didn't read this chapter of my pregnancy books. But I'm also excited- we get to meet our son sometime in the next 24 hours! And in my next post- so will you!
Thursday, July 12, 2007
36 Weeks and a Kielbasa Update
Today I begin Week 37. Apparently my son can be born anytime between now and 6 weeks from now- don't you love the narrow window for such a huge event? We've got the nursery pretty much arranged. It has furniture (that has been assembled), lots of toys (including two train sets JP insisted on purchasing and spent last night "testing out"), and a large stuffed Bevo (UT's longhorn mascot). There are lots of clothes that I washed yesterday and am planning to put in bins today. We ended up purchasing the Trofast storage system from Ikea over the weekend. The baby's bedding is all primary colors and we were able to get blue, red, and green bins to go in the Trofast unit. It looks really cute and seems practical- I can just toss his onesies, socks, toys, etc. in a bin. When he gets older we'll buy a proper dresser and just use the bins for all the toys I'm sure he will possess by then (being the first grandchild on both sides and all). His sheets and mobile should arrive in the mail any day. We've got two brands of bottles ready to test out. There are diapers in the diaper stacker. The envelopes for the baby announcements are addressed and stamped. I'm dividing my leftover time between staring longingly at the August calendar and enjoying my time with JP in the new apartment (oh, and working at the Firm).
My Kielbasa toes and ankles look a bit better today. Last night they were of epic proportions and I was experiencing "pitting edema" where you poke your ankle and the indention remains for a few seconds. That freaked out JP and I was ordered to call my midwife. She asked me all the preeclampsia questions and said the swelling was most likely normal "4-weeks to go + July heat" type swelling, but if I get a headache I need to come in for a blood pressure check. I remain headache free, so I'm just trying to enjoy the fact that I get to wear rubber flip flops to the office. I've gained 38 lbs., which is more than I was hoping, but I think at least 3 lbs. of it is in each foot. JP refers to "the belly" as if it is an independent thing that just happens to accompany me everywhere, and a lot of the time, that's pretty much how I feel about it. It still surprises me to look down and see it sticking out like that. It's easy to forget how "natural" pregnancy is- a lot of it is really quite bizarre.
Wednesday, July 11, 2007
Honoring the Legal Secretary
No one at my Chicago Firm has been more concerned about my "condition" than the legal secretaries in the office. My back was really hurting by the end of last week. I mentioned it to two secretaries who had come into my office to say hello and they sprang into action. One got a bouncy ball she had sat on while she was pregnant- that helped quite a bit after all the unpacking and organizing I had been doing at the new apartment. Another went to Staples last night, found a back rest to put on my chair, sought approval to purchase it, and placed it on my desk chair as a surprise for me this morning. I am so grateful for their help and concern. I don't have a working relationship with a legal secretary yet (I'm pretty sure half the projects I do are ones normally handed out to the attorney's secretary), but I know mine will be an invaluable resource one day and I look forward to repaying him or her with the same kindness these secretaries have shown me.
A Brief Rant
I don't post about politics nearly as much as I think or talk about it- mostly because I find it difficult to express my fury and disgust with this administration in an eloquent manner. Every headline and news article I read just makes me more cynical about politicians in general and this administration in particular. I shudder to think of all the behind-the-scenes, unconstitutional crap that is going on (interesting how Cheney always seems to be involved where basic rights have been trampled on, yet he's never accountable and he's pretty much in control of Bush, yet he's always wrong). I was raised Christian and am still very much a believer in my religion, but it drives me crazy that religion has so captured the national government- things like science, constitutional rights/truths, and law should not be at the mercy of right wing evangelists. Which brings me to what prompted this post. In an article on cnn.com, the most recent surgeon general of the US (Dr. Carmona) talks about how the government actively interfered with his work. He wasn't allowed to publish a paper about global health challenges and his speeches were edited to remove any mention of sex education beyond purely advocating abstinence. The article talks about a SG under Raegan, Dr. Koop, who "is probably the most recognized former surgeon general. He talked about AIDS as a public health issue rather than a moral issue, which won him many admirers and some critics. He said President Reagan was pressed to fire him every day, but Reagan would not interfere." I think if the AIDS outbreak occurred during Bush's presidency, the SG would never have been able to talk about it as a health issue- and that is really sad (and scary).
JP's blog, The Rational Republican, has a lot of the ranting I would be doing if I had the energy. We're on different ends of the political spectrum, but the Bush presidency has done a lot to push us together since he's as disgusted as I am. Someday, if there's a good Republican president (i.e. one who believes in the Republican ideals we learned in high school government and not one bent on taking over the world, squashing civil liberties, pardoning his buddies, and being the nation's religious leader), we'll have a lot more debating going on at home- now there's just agreement and sad shaking of the head.
Tuesday, July 10, 2007
Looking Like Kielbasas
A little background: While on our cross-country road trip between Austin and Chicago, JP and I were determined to stop for a nice dinner. We needed a real break from the car and the firm was paying our travel expenses. Unfortunately there is nothing in the way of fine dining between Illinois and Texas- somehow on both of our car trips we ended up having dinner at the Perkins restaurant in Blytheville, Arkansas. Both times I had a satisfying meal of pancakes, and both times we marveled at the "Manly Breakfast Platter" complete with not one, not two, but FOUR types of sausage. One of those four varieties was the imposing "kielbasa sausage" and when I looked at my fingers this morning, those kielbasas were precisely what came to mind.
So I now have my first real nuisance of a third-trimester symptom: swelling. After wearing high heels and skirts during my 5-week internship in Texas, I'm now hiding my ever fattening ankles with pants and barely squeezing my feet into flip flops. So far no one at work has commented on my less than professional footwear and I'm really hoping they don't- I vastly prefer heels and don't want to buy wide, flat work shoes that I'll only wear for the next 4 weeks. I have some nice looking sandals and with the pants they're barely noticeable anyway. I tried to wear boots yesterday and even though I had on JP's large socks, they left a rather deep impressions in my ankles after only 20 minutes. I'd be alarmed except that I have no other signs of preeclampsia, my blood pressure is normal, and according to every pregnancy authority, swelling is to be expected this late in the game.
Just now I noticed that my toes are swelling and touching each other. I thought toes always touched, but they must not because I am suddenly very aware of their proximity. My ankles have no shape, they just bulge their way down to my foot. It's all very bizarre. Oh- and for the first time in my life, my thighs rub together when I walk. That has nothing to do with swelling and everything to do with my daily dessert eating, but I thought I'd throw it out there- it seems to fit with the "looking like kielbasas" theme of this post.
Sigh... only 4 weeks and 2 days to go until August 9th. I realize the due date is practically arbitrary as only about 10% of babies are born precisely on that day, but if I wake up on the 10th without a baby I'm going to be really upset. I keep reading that first babies are often late, but nothing will tell me how often and how late- any anecdotes? I figure a random sampling of blog readers is about as scientific as some of the official pregnancy articles out there on the internet.
Saturday, July 7, 2007
Random Acts of Kindness
I was irritated by the apparent lack of courtesy in the world when I wrote yesterday's post, but I was reminded today that there are innumerable random acts of kindness going on all around me. I was stuck in horrendous traffic on North Avenue this afternoon when I saw a middle-aged city employee sweeping up garbage that had collected in the gutters. For those who don't live here, today was an unusually hot day for Chicago- my car thermometer insisted it was 106, but it was probably in the mid-nineties. So this man was working hard when I saw a young guy, probably in his early-twenties, walk up and offer him a cold bottle of water he had just bought at a market on the corner. It was such a little thing, but I felt so happy and touched seeing it. I started wondering if I'd ever do that- notice someone working hard at a hot job and buy them a drink. I usually walk right by- I'm polite and try to smile or say hello, but I can't say I've taken the extra steps of kindness that the passerby did.
Seeing that little scene reminded me of the commercial where people see others doing small acts of kindness for a stranger and then passing it on. I'm now determined to pass on a few acts myself.
Friday, July 6, 2007
Common Courtesy
I've always appreciated it when a man offers his seat to me on a bus or train. I never expect it and I nearly always say that I'm fine standing, but I think it's nice of them to do. (I'm a staunch believer in equality of the sexes, but I believe there's room for chivalry and courtesy amongst equality.) Now that I'm nearly 9 months pregnant I pretty much expect someone to offer me their seat on the crowded and hot buses and trains I take to and from work every day. So far someone has immediately offered one to me and each time I've gratefully taken it. This morning, however, I stood amongst SIX sitting men in their 20's and 30's on a crowded El and not a single one offered me their seat. Two stops later people were tightly pressed up against me and I was really getting uncomfortable. Finally an older woman saw me and offered me her seat- of all the people on that end of the train, the only other person who should be sitting down, got up! I felt bad accepting, but my back was already hurting and I had several stops left to go.
I understand that I'm not actually entitled to a seat, but I think it's common courtesy to offer yours to a largely pregnant woman if you are capable of standing. It's not just about men giving up their seats to a woman- I've offered my seat to someone who is elderly, pregnant, or otherwise looks like they need to sit down more than I do. I got to work seriously irritated at those men for looking at me and then looking back out the window. One more thing to add to my list of "things I want to teach my son".
Wednesday, July 4, 2007
Mission Accomplished
We put in a full 10 hours of physical labor today and the apartment is finished. Not just unpacked, but organized, cleaned, and decorated- and it looks great! Everything ended up fitting pretty well and I think it's going to be a great place for us to live for the next year. JP even put together the crib and changing table in the nursery- we now have a place for our son to sleep! (Well, the crib is currently full of his other possessions while we wait to buy a set of shelves, but still it's there!). We also have our first bit of baby creep- I cleared out a shelf in the kitchen for the assorted baby feeding accessories we've received as shower gifts. So far all the baby stuff has been segregated in its own piles, so seeing bottles and baby spoons right next to our drinking glasses was strange (but a good/exciting kind of strange).
Now I'm just sitting here in our beautiful living room, reveling in the fact that there is nothing left for me to do except watch TV and cuddle with JP!
Tuesday, July 3, 2007
Overwhelming Chaos
I very rarely get overwhelmed. With the small exception of the entire second half of 1L year, I'm usually able to keep an upbeat attitude amidst to-do lists, deadlines, and general chaos. Returning home from Texas Sunday night to an unpacked apartment and non-existent nursery, with my family coming to visit this Friday, with a cracked car windshield, and starting a new job in 12 hours got me overwhelmed. I wanted to curl up in a ball, close my eyes, and make it all go away.
Monday didn't get much better. At some point during our cross-country drive (I think it might have been Missouri) a rock flew out from under a truck, directly at my face in the passenger seat, and cracked my windshield from top to bottom. Glass shards flew around the inside and outside of the car, but the middle layer of the windshield held strong (which is a really good thing since it was raining and we didn't want to have to find a car glass place in a really tiny midwest town). Once I recovered from the shock of seeing a rock fly at my face, I was pretty much just annoyed that now I had another item on my to-do list. At my first day of work yesterday I got a huge assignment with an urgent Thursday morning deadline- soooo not what I wanted to start with. I still managed to sneak out early with the intention of getting my car fixed. Unfortunately the el and buses were insanely slow and it took me nearly an hour to get home to my car, and then the traffic was terrible getting to the car place. I got there right when they were supposed to close and begged them (almost through tears) to take me anyway. They were awesome and did the job quickly, cheaply, and perfectly. If you ever need a a car glass place- Pilsen Auto Glass is your place. I then went to Target and Bed Bath & Beyond to spend a fortune on stuff to help organize our apartment. I got home at 8:30 totally exhausted and worked with JP to unpack until 11.
Today I got to the office really early to work through more of the awful assignment- it's on a confusing topic I know nothing about. I escaped for a doctor's appointment at 10 (everything looks great- blood pressure back to normal- kind of surprising giving the last few days). When I returned I found out the firm was "closing" at 3pm so everyone could start their holiday early. I had to stay until 5:30 anyway to get my assignment finished, but it is finished, and when I got home I decided the apartment wasn't so awful. We've definitely made progress and I now believe that someday I will come home from work, sit on the couch, and turn on the TV because there won't be a single thing for me to put away. I'm guessing I'll get a week of laziness, max, before our bouncing baby boy arrives to throw everything into chaos again.
Sunday, July 1, 2007
Unpacking Update
Six boxes are unpacked and the place looks a little more livable, but my back is absolutely killing me. Eight months pregnant and sitting, bending, lifting, reaching, and all the other motions that come with unpacking do not go together very well. I have never, ever needed Motrin and a glass (or bottle) of wine more.
We're back in Chicago. The drive was fine except for the 3 hours it took to go the last 50 miles into the city- very frustrating to be so close and move so slow.
I am staring at the complete disaster that is our apartment and feeling completely overwhelmed. I can't imagine what JP faced during those first few days- he did a lot of work and it's still barely livable. I just got a "Week 35" update email from one of the pregnancy websites I signed up with in the early days and it says I should have my hospital bag packed. Packed? I have to spend at least the next 2 weeks unpacking. Usually a daunting to-do list launches me into action, but right now I just want to curl up in a little ball on the couch and cry. Except I can't because the couch is covered with stuff. Perhaps I'll clear myself a spot on the floor. | http://lagliv.blogspot.com/2007_07_01_archive.html | robots: classic
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} | 6,667 | A few new Lucy updates
*Monday night = 2 pounds 10 & 3/4 ounces
*Tuesday night = 2 pounds 11& 1/4 ounces
*They've added 2 more calories/ounce to her milk.BM has 20 calories/ounce, and they were adding 4 extra calories per ounce, now she is at a total of 26/ounce. She is eating about 5 ounces a day still.I forgot to ask this morning how her residual has been. Monday night she still hasn't been having much.
*She had blood work Monday AM to check some things, and it all came back good.
*She is off of the Vapotherm machine, and just oxygen plugged into the wall and still in her nose. It's an even lower flow than the 2.0 flow she had on the machine.They are still able to adjust the % of oxygen if hers saturation starts to drop.
* Luke held her for the 2nd time today, but it was a short time. Her temp. was a little low today, and she was still getting use to the oxygen difference. She has to be sitting just right on us because she isn't strong enough when it comes to breathing and keeping the lungs open; her head and body have to be just the right way.
*Landon got to see her again today. As soon as we walked into the NICU doors, he started pulling his sleeves up (and grunting because he had 2 shirts on , and it was hard) and asking to wash his hands. This was only his 2nd time, so I have NO clue how he remembered that! He had a great short visit with her. She was starting to cry when we were in there ( we haven't heard that much at all) and he enjoyed telling her not to cry and that it was ok.
Blowing kisses
I did stop by my Dr. office for a minute today to get my BP checked, and it's much lower finally. It was 120 something over like 75. MUCH lower than 174/110. So, I'm down to 2 pills a day, back to the Dr. next monday, and then hopefully off of meds!
We went to Christmas Eve service at 11 PM, and left a little before it was over right at midnight. We were trying to make it down to the hospital since we were already practically downtown. Landon was still awake at that point, and we only had about 10 minutes once we got there ( they close from 12:30-1:30). So we decided to take him in, wearing his Christmas jammies, and introduce him to Lucy. All the nurses on the way back said "Hi" to him, and he told them all " Baby LuLu". His LuLu still sounds more like doo doo though =)He was SO excited! He kept telling her to WAKE UP WAKE UP WAKE UP, BABY! He wanted to get her paci and give it to her, we got him to blow her a lot of kisses, tell her that he loved her, and he kept saying she was cute. Of course then we still had a few things to do at home, and got to bed past 2 AM, and then I had to wake up at 7. I still physically feel like there is a newborn here because of the pumping--even though I get about 6 hours of sleep at night. Landon came home sleeping 4, but very shortly was at 6. It's draining. Plus the driving back and forth every day. We had to wake Landon and Elyssa up at 9 to open presents because we had to get ready and get where we needed to be the rest of the day. I think they would have slept much later.Landon would have probably slept till noon! After we opened presents, we had to rush to get to the hospital before they closed at 12:30. Of course we pulled in with only enough time for me to run milk in, and poor Landon cried "BABY" and tried to unbuckle his car seat because we had been telling him we were going to see Baby Lucy again. =( As it got closer to 1, I realized how dizzy I was getting & that my head was starting to hurt. Of course, it was time to take my 2nd blood pressure pill for the day, and I hadn't even taken it yet at all. This blood pressure thing is NOT my favorite. We met up with my sister to get my medicine, but the headache lingered the rest of the day. We had planned on getting back home from Luke's family's Christmas long before 5 so I could pump( once again, my life,yay!), Landon could get a good short nap in, and we could stop at the hospital and get just one family pic with Lucy out of her incubator wearing her Christmas outfit and bow. At that point my head was about to explode, Landon hadn't had a nap, and it was just 3 hours until his bedtime. aahhhh I hate when things get off schedule right now, not as we had them planned, and we don't get to fit things into the day that I want to. You think I'd learn by now, right?And my parents had already arrived at my house, we were still eating a Christmas dinner, and opening presents. But I just wanted to see my baby on Christmas and be able to hold her. Luke and I did eventually get back up there after 9ish, so Landon was asleep and didn't get to go with us. We weren't able to hold her that day either, but the pictures the nurses had taken did relax me, make me smile, and maybe shed a little tear.
The snow on Christmas Eve and Christmas Day was awesome, but Luke and I both realized how we didn't even enjoy it like we normally would have. Everything was so rushed and hectic and stressful. I was beyond exhausted. And the cycle continued as we got to bed after 1 AM, and up again to do it all over again and head to church today!
I did get a nap in today though, and I did get to rock with a little baby laying on my chest for about 20 minutes! I needed that. I've held her about 3 times now, and she will be 2 weeks old tomorrow. Daddy will get her next time because he's only held her 1 time. If we knew she was going to be able to stay out so long, we would have shared. It was a nice surprise, and it felt great! I can't wait to bring her home and have her fall asleep on me, on OUR couch. She is still doing about the same as far as health. She is up to 22 CCs at every feeding, and her weight is right around 2 pounds 10 ounces. Her jaundice is still looking good, so she has been off of the lights for over a week now. We'll continue to pray that she stays healthy,keeps gaining weight, and continues to do well bringing herself back up on her own when her breathing and/or heart dip.
We took this picture tonight to remember how tiny her head is at almost 2 weeks. It's difficult to not be with her all day like we would if she was full term and at home with us. But we are very thankful that the NICU nurses are so friendly, personable, and try to create little scrapbook items for us to remember this time by. It's still crazy to think that someone else is really raising our child for us right now, several different nurses and doctors actually. I wish that Luke, Landon, and I could be the only voices she hears and knows for comfort, and we know she won't remember any of this, but it's just part of this process that isn't so easy. I think we're all doing great emotionally. We have our small moments, but we know that we can't change any of this, and there is no reason to dwell on the things that have happened. We are where we are, and can't do anything but move forward and try to stay happy! We've had unbelievable surprises of gifts & letters from friends far away. And we are SO VERY thankful for those! We've been so blessed and feel so loved in the past 2 weeks, and every bit of it has helped us get through. Our family has been great too, especially helping with Landon.
The Juicy Details....
1st off, Lucy got moved to the next level up bed! She'll be there for the majority of the rest of her stay, until she goes to the regular hospital nursery crib( the wooden stand with the plastic bucket on top).But she has to be to the weight where she can regulate her body temperature, and that is a far ways off. She did weigh in at 2 pounds 7 ounces tonight! Almost back to her birth weight. 2nd, Luke held her for the first time tonight!He said it was wonderful. I did steal her for one minute at the end while she was being fed. Luke got her paci out to stick in her mouth while she was 'eating'. We're all about trying to get her into the sucking motion while her belly is getting filled up, and when Luke was holding her she was seriously rooting. It was a few minutes past when she usually eats. I know this little girl is going to be ready before the normal 34 weeks! And if they show interest in the paci and all that stuff, they will try the bottle as early as 32-33 weeks.She went to town on the paci while she was being fed, AND had the hiccups, AND her breathing didn't dip too much. She did good with it all.
We had a good LONG conversation with her nurse tonight about what all actually 'happened'. She had met Luke before last Tuesday night, but hadn't met me yet. But she had heard all about me and my liver from the other nurses and Doctors, and wanted to know the final story and what all went down. So we actually laughed about it tonight, and it's finally not making me feel like I'm going to pass out when I talk about it. I'm guessing it's easier to joke about it in person. But when we go to the NICU, the first set of locked doors we have to go through is the triage/L&D. When they saw me,those nurses even left from behind their desk to hug me and say how good it was to see me. So I'm that patient everyone has been talking about.
So Sunday afternoon my ankles and shins were numb from being so massively swollen. I sent Leslie a picture to see if that is how hers looked when she had Pre-eclampsia, and I said I was for sure calling my Dr in the AM., and she said to come get her BP cuff so I could check it. I woke up in the night with an awful constant stomach and back pain--so I thought maybe it was early labor. But Luke ran a bath for me, and it actually eased up.My ankles had actually gone down in the morning, but Luke says I was complaining of a headache. I ended up calling, got a few more tips and what else to looks for, laid in bed AS MUCH AS POSSIBLE with Landon here by myself and my feet propped up on pillows, and waited for Luke to get home (early from work)with the BP machine. By the time he got home, I was feeling miserable. My blood pressure was around 154/93 so I called the Dr right then.The nurse told me to rest for an hour on my left side, recheck my BP then call her back.Sometimes the at home machines are a little high. Luke gated off the hallway so Landon wouldn't bug me, and I just started feeling worse by the second, and could NOT get comfortable on the bed at all, and tried to take a bath to relax. I only lasted about 15 minutes, re-took the BP, and it was around 170/110. I couldn't even talk I was in so much pain, sent Luke a text, and told him to get Landon dressed we had to leave right then. So, finally we got to the hospital, FINALLY got someone to check us in, and as soon as we got to a room they basically told me it was c-section day. My Dr. was there ASAP ( Luke had called on the way, even though they closed early that day, he was on call!) waiting for someone to take my blood and get some results. They explained that they had to make sure my blood platelets were high enough for a spinal, but if not I'd be put to sleep. At that point I just kept saying I wanted to not feel the pain and I'd be fine. They kept assuring me that the only way to get rid of the pain was to take the baby. Luke didn't really comprehend that we WERE doing it because I kept asking him to call my family,and he kept waiting and waiting. My Dr was getting impatient & ordering for the results to get here, and find out where they were ASAP. My moaning and complaining was getting worse, and I remember apologizing to the nurses for having to listen to me, and that I was trying to not be a baby. Finally someone said it was going to be a spinal and we just had to wait 3o minutes because there were twins being delivered, and we couldn't bombard the NICU with 3 at once. About 5 minutes later, I got loud and told Luke he HAD to go get someone, and we HAD to do this now. Jokingly, but in pain, I said I was going to die if they didn't hurry. I couldn't even breathe it hurt so bad. He told me there was no one to go get, and they had JUST said 30 minutes. So I got louder =) And in ran a few nurses. They could hear me in the hallway, and were rechecking why we couldn't go. They were all mixed up as to why we were waiting, but someone eventually said that NICU could get over it. I opened my eyes, and we were basically running down the hall way with my bed with nurses slamming open doors. Neither Luke or I really knew the severity of anything, but the blood test also showed that my liver enzymes were as high as they can go. I don't know if it will just rupture or what, but whatever happens next, would have been BAD NEWS for me! They just told me that my liver was really irritated and inflamed, and to tell my baby not to kick it please. She was also curled up in a ball on top of it, that didn't help the pain.Not to mention my Dr kept laughing when I said over and over to give me the spinal to get rid of the pain, because " I'm afraid it's not going to help your liver pain at all, it's so irritated and inflamed". Great, I just wanted to pain to stop!ANYWAYS, we got the baby out, had a LONG delay on sewing me back up because of another oddity they found*my bruised uterus*, but I got a good long 35 minute conversation with my Dr and the plastic surgeon guy about how great modern medicine and technology is, how both my babies would have been still born not too many years ago, and how I'd not even made it through the night if I didn't come in. WHAT?!?! I was still happy go lucky at the moment. I'm pretty sure my body just had all the pain it could handle, and blocked everything out. Because when I got the spinal, it certainly did take away ALL pain. I even had pain up into my shoulders that was gone, but I could feel everything up top that you are suppose to feel. Thank God!
So, I was sent back into the L&D room to be monitored for 1 or 2 days to make sure I didn't " dance without the music" as my Dr referred to seizures. I was pumped with Magnesium , steroids, and more magnesium. My blood was taken seriously about every 2 hours. (AND since my IV had to be placed in my right elbow crease because I had no veins whatsoever to by found on my arms or hands because they were so massive, so my blood was drawn about 30 times from the same spot.The black bruises are ALMOST gone!)I made it to the next day before the seizure happened. My sister was in the room, and I remember trying to tell her to get help. After that, she says she tried to call a nurse, none of the buttons worked on the bed, so she stuffed some pillows around me, and ran into the hallway yelling. One nurse came in, and had to call the nurses desk with the phone to get more help, and Amanda went into the hallway to call Luke on his phone. The other funny thing that everyone seems to know about at the hospital is how much trouble Luke had getting into the room. There is the set of locked doors,and all the nurses were in my room. Once someone was finally there to open the doors, they couldn't see his "pass" the green bracelet to get in. So they said they couldn't let him in, and he started banging and trying to open the doors himself. haha He said some mean things, and finally got in when they understood what he was saying. He later went back to apologize, and they came and told me how much of a gentleman he was. They just left out all the bad words he said and that he tried to break down the doors =) To put it shortly, what Luke saw in the next few minutes ( that seemed like a lifetime to him) was me having a seizure, lots of blood from me biting my tongue, Doctors and nurses not being able to find a pulse on me, me being "bagged", and my doctor taking him into the hall letting him know that they most likely will have to do a scan to see what type of brain damage I have. Eventually they found a pulse, got the regular oxygen mask on me, and were relieved when I started pulling it off.I was surprisingly able to answer the questions of where I was, why I was there, what had just happened, and what my name was, so the scan was cancelled. I always tell Luke before he leaves to go or come home from work to be safe because I can't do this without him, but on Tuesday he thought he was going to have to do it from here on without me. Landon, a new 2 pound baby, witnessing that mess, and doing it alone was what he had to think about. And I'm thankful that he is so strong, and what I need him to be! I stayed in that room until Thursday ( not being able to eat until late late Wed. night), and got to see Lucy on the way to the post pardum room. We had a few issues with my blood pressure still, tried a diuretic, tried 2 BP medicines, took an ativan, almost passed out 2 times, felt like I was having an anxiety attack,had to use a bed pan ( haha I asked for it!)took some more blood, finally got a shower, got a good massage, and finally was sent home Saturday! It was a long mess of a trip because of pain in my right side. But now all the nurses know who I am, and can laugh with me at how crazy my week was at the hospital =) Now that I've written a book, it's time to go to bed!
A NICU Mommy
That's me! My life is DIFFERENT that I ever thought it'd be. Louisville played in the Beef O Brady's bowl game last night; never in my life have I really even missed watching a game. There I was in a lactation room in the NICU trying to catch the score on my phone =) We did hear the last 15 seconds on the way home on ESPN radio, and when I woke up randomly at 3 AM, the game was replaying on TV. Thanks, Coach Strong, for turning around the attitude of the program! That's where it starts, and it feels good again.
Lucy's ultrasounds both came back 'normal'. Her bowels are still good, and her brain shows no bleeding. They will do a 2nd check of the brain before she goes home. I've done good about not looking things up, and reading about what could be, or her higher chances of different disabilities. My child was automatically put on Disability insurance or social security or medicare or whatever it is because of her weight at birth, so I know they are much higher just from that. But it feels nice to know that so far she is still healthy! Her eye does have a little infection in it, but what baby doesn't have that annoying tear duct junk. GROSS. They started her with a little antibiotic in it today. She has also moved up to 19 cc's per feeding today(I think that is close to 5 ounces of milk a day) , and they are adding 4 extra calories into her milk at each feeding.She is also on a multivitamin and caffeine. The caffeine is to help with apnea. She doesn't have many spells, and her machine has never beeped when we are there, but it is supposed to help stimulate their body so they don't have as many. She is still on 3 liters of room air ( whatever that means) in her nasal tube. I believe she started on 7 liters when she was born. She has also been off of the lights since about Sunday. Since they took her bellybutton IV thing out--they used it for nutrients and also as a way to draw blood-- they haven't pricked her heal to test her blood again yet. As long as she looks good, they will try to do that as little as possible. The less blood they take, the less chance of having to have transfusions. We saw 2 of her Dr's today, and they said her color still looks great! They have also started freezing my milk because we are so far ahead. I enjoy knowing I can provide this for her at least at this time when we can't do much. Pumping all the time is nowhere near as stressful as I thought it would be. Luke has been really helpful with it too. He's ready to slap on the labels, rinse the parts, or pack up the containers and ice packs before we head up to the hospital. I'm getting into a great routine so when Landon gets back here, I'll be ready to go!
I also had a Dr appointment today to re-check my blood pressure. It is MUCH lower than when I left the hospital, but I still don't think it's awesome. So, I'm staying on my medicine 3 times a day for now. I'll go back next week to have the nurse check it, but I'll only take it 2 times the day before, and just once the morning I go. Hopefully it will still be ok, and show I can wean off of it.
I think these are all the updates right now. We might head back up later tonight for a little bit. We brought some blankets home today to wash, and have a few new ones to take back up. We had to buy something 'Christmasy' for Friday & Saturday. =) She'll have cute,comfy Christmas decorated blankets, and I'm hoping to make her a TINY TINY crocheted hat with a bow on it for her to wear. Hopefully we can get ONE family picture in when we go visit. We're hoping her big brother can meet her Christmas morning! ! ! We also had 2 presents today in her room.2 Former patient's parents left a present for each baby in the NICU. One present was a pack of receiving blankets, they are very girly cute ones! The other present was a Max Lucado Book Just in Case You Ever Wonder, from the great-grandmother of a little girl who was born last year 13 weeks early. So sweet!
Highs and lows
Who would think you could feel such highs and lows within such a short period of time? The day started as normal as it could, we straightened up a little, my cousin Katie and her husband Carl came to visit and bring food and Christmas presents, then I napped, and woke up in the lowest low. There were just SO many thoughts running through my mind. I have a lot of guilt running through me--for a few different reasons. The main thing I hate about this whole situation is that nothing is the baby's fault. She was healthy, and I wish I could put her back in me to finish growing. I just feel like I go to the NICU to look at a science project, and we are growing a baby in an incubator. It hurts to look at her sometimes. She doesn't have the girly physical features, or really any at this point. She is still growing them, and forming into what she will look like. I don't have the connection with her yet, I still find it hard to acknowledge that she is here, or that I have 2 kids. It's just a point that I haven't gotten to yet, and I will find a way.
Then I feel guilt that I am even upset over any of this because I have 2 children who are healthy at this point and are both alive right now. I know too many people who don't even get the opportunity to carry children, or lose them during the process, or have lost them recently. How dare I complain that it just isn't happening the way I'd prefer it to? I'm not sure what it is OK to feel. And I'm not sure how much of that I can even feel OK to share, and not feel like a brat.So that is the point I was stuck in today.
I read this poem today in the NICU book from Baptist:
You carried your baby as long as you could.
You cared as much as you could.
You loved as much as you could.
You cried more than you needed to.
Rest now, we will carry your baby for a while.
We will care as much as we can.
We will love as much as we can.
We will cry less than we need to.
Rest now, your baby has our gifts woven
with yours. We will give her our skills,
our touch, our heads, our hearts.
We will seek to cure and pray to heal.
Rest now, your baby is
small in the eyes of some,
large in the eyes of God,
loved in the eyes of us all.
-Mary Thayer
Lucy's health-- It has been a full week and a few hours since she came into this world! Really? A week old already? That makes her almost 31 weeks. I forget how they count her age now that she is here, and if she still goes by gestational age or what. After she lost her initial weight and stayed down for a little bit, she is back up to 2 pounds 6 ounces. She finally had a good poop today, so she stayed about at the same since last night even though her feedings went up. She is now at 17cc's of breast milk every 3 hours. She eats at 8,11,2, & 5 AM and PM. Yesterday she had some residual after she ate--food that stays in her stomach and doesn't digest. They put a syringe up to her feeding tube before they feed her again, and see what they can pull out. Quite a bit came out yesterday when we were there, but tonight her nurse said she had none! We stayed at the hospital from about 8pm-midnight. We took a little detour to see Kellye, Bill, and baby Chase too! =) We got a lot of conversation in with Lucy's nurse along with other nurses that had gotten to know Luke all last week while they were with her. They are all so positive and happy and say how great of a baby she is. She is just a little spastic at times.haha It's so weird how there are 7 or 8 pound babies in there that are really sick, and their monitors are beeping all the time. And here she is, not even 3 pounds, and is healthy. Praise the Lord! Once again, ah, I hate that my body failed her precious little body! She has 2 ultrasounds tomorrow morning scheduled. One of them, we knew she'd have no matter when she was born. Due to the 1 artery in her umbilical cord, they have to re-check her bowels. I'm staying positive that she is clear of anything due to the ultrasound at my 28 week appointment. The other ultrasound is preformed on all preemie babies to check for bleeding in the brain. Now we start talking scary thoughts. Preemies are just more susceptible to this, and need to be checked. But like her nurse said tonight, it has to be done, and doesn't mean anything is wrong with her, and it's just a bridge you wait to cross until you get to it. And then if it is something we have to deal with, there are many different stages, and different solutions.But we just wait now until we know. And here it is , 3AM, I meant to go to bed 2 hours ago. We will be heading back up tomorrow night to visit a few more hours. We'll use the day time to rest and nap, luke has an eye Dr. appointment in the evening, and then we'll head up to deliver milk and visit. I did get to hold her again tonight for about 15 minutes. It put me in a really good mood being at the NICU tonight, so the day eneded on a much better note that I'd been in the evening. Someone must have been throwing up some prayers tonight. THANK YOU! I'm hoping not to be on edge until we get the phone call from the DR tomorrow about the ultrasound results. So if you're reading this, maybe some payers for Lucy's good health to continue, good results, and peace until we hear!
Night 1 at home
What a roller coaster already!I've been able to sort through the WHATS and WHYS of physically what happened with my body, and know what caused which things, and what I was worried about for no reason. =)
It was much easier than I had thought to sleep in my own bed, even with a 2 year old who was crying and wanted to sleep with us. He NEVER sleeps with us, but last night was a first.And it was alright. He is gone for the rest of the week to visit family in KY. He is SO ready to go, and has been begging for his poppy for days! Who wouldn't be relieved to have their 2 year old gone for a few days on normal circumstances? I'm extra glad at this point we have gotten past the potty training stage, and he is good to go for a few days.
We will be spending the next few days together( Luke had vacation anyways) hoping to set up some type of routine.I am pumping for Lucy, so we will have milk to take to her every other day, if not every day. I'm trying to rest and heal as much as I can while we have the time to ourselves. I'm hoping that she will eventually get to breastfeeding only. I know this will be a challenge as we go, and some preemies don't get to the point, or even go home at just one BF a day and the rest bottles. But it is my goal as of now, and is keeping me motivated to pump every few hours.
The emotions did hit hard this morning. My eyelids are about 3x's their normal size. I have a newborn child, and it didn't happen the way anyone wants or plans.I won't be able to wear maternity clothes for another 2 months, and celebrate getting ready for a new life. I can't put her back inside of me now that I am healthy.That chapter was cut short, and we have to deal. I am so very grateful that she is healthy, and am so very grateful for technology and doctors that were able to bring her into this world, and keep her alive.I am grateful that they have test to know what was wrong with me, and to save my life as well. While I feel bratty about saying it, I also don't have a child with me. I won't have a child for at least 3-4 weeks, but I am still her mother. I can't wear a sign around my back to let everyone know that I have 2 kids, I just can't have one of them yet. I know there are many mothers, even close friends of mine, who have been through this. Whether they had their baby in the NICU for 3 days or 3 months, it's the same experience. And it might be something you can't understand unless you have been there, and have had to sort through the emotions.I know I have many people who I/we can talk to. I just think that it is a process that we will have to figure out. And I know that in 4 weeks, it will all be even more of a blur, and she'll be growing, healthy, hopefully breastfeeding, and then we'll just start to worry about Dr. bills =) I also know that even through the unusual circumstances, I am still blessed with 2 children. I never want to take away the joy and gratefulness of that. I know many people who go through trials and still are never able to conceive. We are just starting on this process of sorting through emotions and facts. We will keep learning more about how Lucy is growing, how much she is eating, when certain tubes come out, what milestones she has hit, and all the other confusing things I have already forgotten. I know there are certain factors and formulas that go along with each step she will face, but I will have to be reminded daily I'm sure. I will be keeping you updated!
Thank you again for thoughts and prayers =) If I haven't personally gotten back to you, please know I am thankful for every voicemail, text, e-mail, card, gift, flower, and message I have gotten. I'm still foggy on what happened Monday-Thursday/Friday. So I might have even sent you something, and just not remember it as well. I CAN tell you I have a solution to Starbucks bitter coffee! My mom got Luke a coffee, and it was an americano, because we all know they try to be lazy,and offer that to you, and it sucks! BUT if you want, bite the end of your tongue off, and everything tastes SO SWEET! I took a sip and said "THIS IS THE BEST THING I'VE EVER TASTED!" Yes, I did make the bed awfully bloody from biting my tongue during the seizure. Apparently Amanda and Luke thought it was going to be gone partly. But it is healing, and all in tact =) Hopefully the taste thing will return.
Lucy Emilia Howell
I will just start by copying and pasting an e-mail I sent out to the SS class. I might be able to go into details later, or maybe not. But I will be able to add more blogs as we continue on the journey and visit and help Lucy grow! Please keep the family in your prayers, it is greaty appreciated!
I'm trying to reply to everyone with this email, and wrap up the last 5 days! Thank you for you thoughts and prayers, it's been a tough time, and I feel we still have a long road ahead. Lucy Emilia Howell was born on Monday as you know from the e-mail. She was almost 30 weeks. There was not anything wrong with her that caused the delivery. I had pre-eclamtic symptoms, and blood test showed I had HELLP syndrome.The only answer is to deliver the baby, and the only time we had was for a repeat c-section. She was delivered, and was healthy and great. I was put on magnesium to try to help me. I don't really know what happened what day after that. I remember moments and feelings before I had my seizure, but that is all. After I had the seizure, I was considered full blown eclamptic. HELLP has to do with elevated liver enzymes and low platelet counts. I was told an average liver count is around 35, and mine was about 600 when I checked in--I'm under the impression it doesn't go any higher than that. Normal platelet count is around over 100,000, and mine was around 25,000 which is considered severe. My blood was taken over and over to monitor my counts, and they did continue to raise/lower the correct way. I was kept in the same room until the Dr.s were comftorable with the direction the levels were going. I saw some visitors and felt GREAT, and was ready to eat and move rooms. I think I moved to a regular recovery room Thursday. Then everything hit me at once, and I couldn't relax my mind. I got to feeling dizzy, about to pass out, anxiety, and needed help by several nurses to move and get up and down. They then put me on another blood pressure medicine, and also a medicine to get water in and out of me that I was holding. Thursday and Friday were very tough mentally--I had to learn to not associate certain physical feelings with anything that had just happened to me. Today was hard to undertand I'd be OK at home, and not overwhelemed. I got to actually hold Lucy today--and wasn't expecting to for at least a week. For me, I haven't been worried about her at all, my main worries were acutally my life itself. I guess all of this is to say what I'd like prayer for! At this point, I need mental peace most of all. Physically I feel good, except for a small headahce and side effects of BP still up.Peace of mind that I am OK, and for my mind not to wander and worry, is the biggest issue I am facing as of now. I know somewhere soon it will hit me that I am at home, and have a 2 pound baby at the hospital. But she is doing so much better that I'd ever thought, and progressing SO WELL. Her food is increasing ( by feeding tube), her jaundice levels are lowering, her IV fluids are way down. She tolerated 20 minutes out of her isolet today, and did great. We will continue to visit and take her milk to her often. Landon will be going to KY for a few days with my family to give us a few days to get things in a routine as well as we can. I will try to keep up with our blog, and will put most of this on there. Thanks for listening. I'm not writing this for any type of sympathy, just so you know what direction you can pray! It is appreciated, and I hope this isn't jumbled and makes sense.I'll try to add a picutre =) | http://lucasandemilyhowell.blogspot.com/2010/12/ | robots: classic
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} | 6,348 | Wednesday, July 30, 2014
Things are looking up
As you probably recognized from yesterday's post, things were bad yesterday. I even ended up calling my OB nurse because I felt like my health was also suffering after we got the news. My BP was very high and I was dealing with serious, serious anxiety. They put me back on the BP meds I was on during pregnancy which also helps with anxiety and also prescribed me Zoloft. I'm already feeling a little more in control today just from the BP meds alone but glad I have the Zoloft if I need it.
Yesterday morning, I tried to make an appointment with the specific geneticist we were referred to, but I found out the earliest that he could see us was October. I just about lost my mind. I felt like I was in no mans land - just enough information to scare the life out of us but no one could help us get answers. I ended up calling the pediatrician's office and asked if they could get ahold of the geneticist and make something happen sooner.
As we waited for the call back, we took our precious little Sammy girl into the children's hospital to have her blood drawn. I was running on no sleep, and watching them pin her down, tourniquet her tiny little arms until they were white and poke her while she shrieked, was a little piece of hell for me. I know parents watch their kids go through far, far worse things and that this is nothing. But to me, I was just sickened and it was awful.
Our sweet, little Sammy sleeping at home after the blood draws earlier in the day.
When we got back, the pediatrician called. He said he couldn't get us in sooner, but that he had talked to the geneticist about the situation. The geneticist didn't think our situation was even remotely an emergency! And in fact had said, and I quote, that "95% of these state mandated screens come back as false positives"! I knew that there was a chance this could be a false positive but knowing an expert in this field was saying this gave me a huge, huge rush of relief. I still worry about being in the 5% but those odds are incredibly promising. I could sense in the pedi's voice that his urgency had declined after talking to the geneticist.
We also got some answers as far as timelines and tests go. Sammy had a urine collection done on Monday and her blood draw yesterday. The geneticist recommended a third test, which would require a blood draw to check for some enzyme or something (I think?) Because we had just returned from the lab, we will have to go back on Friday to have poor Sammy poked again for more blood. But that should be the end of it, I hope.
We should have the urine and first blood test back within 10 days or so and those results should be pretty telling about where we stand with this disorder being legitimate or a false positive. And the final blood test will take a month but will seal the deal either way. I pray that these initial tests are so blaringly clear that we won't have to worry for that last test and it's just final confirmation that this truly is nothing.
Anyway, there's my update on her health and I am so, so grateful for the kind words, prayers, and encouragement from my blog readers. I know that this is what being a parent is all about - being worried because you love your baby so very much. But I had no idea we'd be going from the typical new-parent kind of worrying about things like colic, weight gain, sleeping etc to being thrust into knowing which signs to watch for in the event of a seizure, or that we must take her to a particular children's ER in the event of an emergency from the VLCAP situation.
And on the breastfeeding front, I hired a lactation consultant to come over last night. Ever since the news of the genetic test results, Sammy hasn't been latching. I figured she could sense my stress. She roots really well, hops on, but then gives up after a few seconds after attempting to latch. We've been frustrated and have been supplementing with formula while I pump. Despite that, my supply has been growing and the LC was pleased with where I was at with it. And as far as the newly developed latch issue, it turns out that we just have to entice her with a little milk on me first before she latches and she will get going on it! The LC said that once we introduced bottles, she got used to immediate reward with the milk coming out. On the breast, she has to work for it and has gotten impatient so gives up when nothing comes out in a suck or two. Why work for something when it comes out so easily from the bottle? T his baby girl is just too smart for her own good. :) I had no idea how intelligent such a tiny little baby could be, but I'm learning every day!
We weighed her and she's finally gaining weight and her jaundice has all but disappeared. We also have clear guidelines on how much she should be eating every day - something we've been clueless about. We've also rented the LC's very sensitive scale that can tell how much she's consuming. I feel in control of breastfeeding again and it's a really wonderful feeling. I have no problem supplementing or using formula if we need to go there, and still need to top her off from time to time, but I am so glad we are back on track with it.
I'm well rested today, on my BP meds and feeling better, and I hope to finally tackle her newborn pictures to share with you all.
Again, thank you for all of the support and prayers, and please continue to pray that we aren't in the 5% of these screens that are not false positive after all. I still do worry.
Tuesday, July 29, 2014
Why does God keep testing us? WHY?
I write this as I sob uncontrollably after a horrible, horrible night.
Yesterday started like any other day. We had our first pediatrician well check, and all that was on our minds was Sammy's mild jaundice and moderate weight loss. I've also struggled with breastfeeding, I feel clueless.
We left, came home, went about the day when the phone rang. It was the pediatrician. He told us that one of Sammy's state genetic screens had come back "out of range" and needed us to come into the office right away. Nothing in my life has been so terrifying. He didn't answer many of my questions over the phone.
The genetic problem is called VLCAD. I guess it's a problem where babies can't process fats properly, something about lacking an enzyme. But if they go without eating for long periods of time (beyond 3 hours or so) they could go into metabolic distress and need hospitalization, or could even die. It's something that is treatable but terrifying because without strict management could cause serious, serious issues.
No mom wants to get news like this. No dad wants news like this. I hung up the phone and cried and cried.
We rushed Sammy into the pedi and I felt like we left with more questions than answers. We were referred to a geneticist at the local Dell Children's hospital here in Austin. They collected urine and will be getting blood this morning. I'm just sick of the thought of these tests alone, let alone the outcome. Like I said, having left the pedi with more questions than answers, I've been left to look it up online. I guess another confirmation test is to do a skin biopsy on her leg.
Do you all realize how tiny this little girl is? The idea of them doing these tests sickens me. She looks up at me and smiles with her big cheeks, she doesn't understand. I don't understand why this is happening.
With my stress levels high, I've been unable to breastfeed. She's not latching. I'm waking up every 2 hours to feed her formula and then follow with pumping. Even if this screening turns out to be nothing, we probably won't know for a very long time - months even. I have no idea since I still have so many questions lingering. My blood pressure was sky high yesterday after returning from the peditrician. I already felt like I had a level of post-partum anxiety due to how much I feared something hapening to our little girl, then I get news like this. I don't have words to describe how sick I am over it. I'm terrified for our future. I'm horrified by the thought of watching her go down this testing path. I just wanted to spend these first few weeks like a normal family, with our beautiful baby girl.
Why does God keep testing us?
Please pray that this screening turns out to be a false positive. Please pray we get the results quickly. Please pray for our mental health in the meantime. We are not doing okay.
Saturday, July 26, 2014
We're home! And some pictures...
I'll also be making this post short, as I'm sure you'll all understand because there's a little girl who will undoubtedly be calling my name any minute. A quick update - yesterday, we went home with our beautiful snowflake girl and I cried like a baby as I looked at her in the backseat of our car. I just can't believe our "take home baby" is home with us now. I kept thinking "is this really real? IS THIS REALLY HAPPENING?" I can't begin to tell you how there were many days I never ever thought this day would come. But it did. Oh boy, I'm crying again just typing that.
We made it through our first night. Kevin and I are taking shifts the best we can while I pretty much nurse her around the clock. I have some minor issues with breastfeeding but am pushing through them with the support and help of friends and taking naps every opportunity I can.
I'll try to type up a birth story in the next few days while our little angel sleeps (wish us luck) with lots and lots of pictures.
And like many of you said, I couldn't be prepared for the amount of love I'd feel for this little girl - you were right and then some. I love her so much my heart just aches, in a good way. Like it's going to explode all over the place. I can't wait to get to know her and love her and see her grow. I don't want anything to happen to her and would do anything for her. Kevin feels the same way.
Here are a few pictures to share in the meantime until I can write more. I also hope to do a newborn photo session with her tomorrow and capture her in all her sleepy sweetness while I can. Lots more pictures will come your way, I assure you all!
Kevin having a heart-to-heart with his brand new little girl
Hi, world! Here's a picture of Sammy as she officially turned one day old. :) I could eat those cheeks up!
Cracking a smile for daddy. (Or probably gas, but we can always pretend because she's too cute not to share!)
More smiles (gas lol)
One of the happiest moments of our lives. Strapping this beautiful girl into her carseat and heading home with her. She's ours!
Tuesday, July 22, 2014
She's here!
I'm posting from my phone because my other arm is holding the most incredible bundle of love we've ever laid eyes upon.
Meet Sammy, our much prayed for snowflake.
She arrived at 7:39am CST weighing in at 7lb1oz.
Despite having a planned c section, my water broke one hour before we were leaving for the hospital anyway!
Goes to show this was meant to be her birthday all along.
All of the tears, years, and heartache - it was all worth it.
It was all for this little girl, meant to be ours all along.
Monday, July 21, 2014
Tomorrow is the day
She's coming tomorrow.
I just got a call from the OB nurse and I'm scheduled for the c-section at 7am CST.
I'm beside myself with emotion right now. I'm in disbelief that we finally get to meet this long awaited baby girl. All of the years, the tears, we're finally looking at the finish line. This will be the moment it was all leading up to. I can't even think straight. I can't even type straight. It's hard to type with the tears in my eyes.
Please say a special prayer for us tomorrow for a safe arrival and smooth recovery. My next post should be from the hospital with pictures.
July 22, 2014: Our snowflake's birthday.
We're just hours away.
<3 <3 <3
Sunday, July 20, 2014
I did end up at the hospital. But...
I did end up at the hospital yesterday, but they discharged me after spending five hours in L&D. Sammy is still an inside baby and I'm resting at home. Whew.
I had been fighting a horrific headache since Friday around 5pm. I had a BP reading around that time of 152/88 which wasn't quite at the threshold my MFM had set, but was flirting with it. So I just laid down and kept an eye on it every 30 minutes or so. It stayed in the 130s/80s. But throughout the night the left side of my head and face started to hurt really bad - my eyebrow, my scalp, my cheekbone. And it didn't just hurt internally, it hurt to the touch! The weirdest part was the roof of my mouth on the left side hurt really bad and was swollen.
I "woke up" Saturday morning (which isn't really true seeing how I barely slept because of the pain) and spent a while laying on the couch. I sucked on some ice chips to try to help the swelling go down in my mouth because I had hoped it was just related to hot food I ate on Friday afternoon.
But finally around 2pm, my BP was at 138/90 laying down which was the threshold my OB gave me for calling them. And the clincher was when I thought I saw sparkly confetti falling down in front of me. When it happened, it didn't even register that this confetti wasn't real, and I even waved my arms around to try to get it away from me. It freaked me out. But then I realized that it might be visual light disturbances from pre-e and decided it was time to call my on-call nurse. I hated the thought that I'd be in hospital bed rest but knew it was what had to happen.
Sure enough, the nurse sent me to into L&D. They were so, so busy yesterday. Their triage rooms were full so I was put in the pre-op room which ended up being full as well.
They monitored Sammy who looked great the whole time. And of course, while I was there, my BP was nice and normal, although my pulse was crazy high! Having normal BP at the hospital irritated me so bad because I felt like I was looked at for crying wolf and felt embarrassed. They didn't make me feel that way, it was just my own crazy, sleepless insecurity. But my headache, facial and mouth pain persisted. Because of that, they wouldn't let me eat or drink in the event that I would need to actually deliver Sammy on the spot. They started an IV in preparation and ran some blood work to make the determination.
Well, sure enough, a few hours later the blood work all came back normal. That was the biggest relief of the day. They were still concerned about the monster headache and facial pain so they asked if I would be willing to take a Norco as a test. If the headache responded, then they believed it wasn't related to pre-e. But if it didn't, they were planning to admit me for observation and hospital rest.
I took the Norco, and thankfully it did help the headache, even though the facial pain persisted. What a relief! The L&D OB felt like the headache was maybe a virus or something which was also causing my mouth swelling and facial pain. I guess most pre-e headaches are in the temples and are on both sides. My pain was all on my left side only.
I went home, had a good night sleep for the first time in a long, long time, and woke up this morning with even more mouth swelling and that same persistent headache, but I feel reassured knowing my blood work looked good. I'm happy to be home in my own bed and knowing Sammy will still be coming this week regardless. I'm really anxious to see what my OB wants to do when tomorrow rolls around. I'm still guessing they will make the decision that Tuesday will be the big day! I'll keep everyone posted!
Oh and last thing to mention...
While waiting the many hours in triage I overheard many conversations from other patients. I happened to overhear an angry man asking the nurse if his pregnant wife/girlfriend could go outside and have a smoke. He was arguing with the nurse about it! And I heard the nurse say "We think that her smoking is what caused her first loss."
I just shake my head.
Saturday, July 19, 2014
The suspense
Yesterday I had my growth scan and BPP appointment with my MFM. Sammy weighs approximately 6lb 12 oz and measured at exactly 37w1d, which was how far along I was. Just perfect. She passed the BPP with flying colors, and I couldn't be more proud of her.
In talking to the MFM, he said that due to the pre-eclampsia, Sammy must be delivered this week. He even said to cancel my next appointment with him that was scheduled for next Friday because this little girl should be an outside baby by then.
So both of my doctors have said it. This little girl will be born no later than next Friday. That's just crazy to wrap my head around! I don't think it's quite registered yet.
So with my MFM being even more insistent than my OB, I called my OB yesterday to see when he wanted to schedule it for. Unfortunately, he wasn't in, nor were the schedulers who could schedule the actual c-section. But I do know that my OB considers Tuesday his surgery day. If I had to make an educated guess, I would guess the c-section will be Tuesday for that reason. But it's the weekend now and we won't know until Monday. The suspense! Right? I could find out on Monday that Sammy is coming on Tuesday morning!
I'm still desperately trying to keep my blood pressure down, yet it's still going up. My MFM said if my BP goes over 160/100 at any point (sitting, standing, laying, whatever) it's time to go to the hospital. And if I do, they just might deliver same day. I know my OB wants me to to try to make it through the weekend so I'm not sure if being admitted would mean hospital bedrest until Monday/Tuesday or a weekend delivery, but I've got a close eye on it. My BP landed at 154/92 yesterday evening so I'm definitely flirting with the possibility of being admitted this weekend. I'm hoping and praying I can wait it out at home.
I haven't been sleeping well at all. I don't know if it's physiological from the pre-eclampsia itself or because there is so much running through my mind. But I feel really run down physically and I'm sure lack of sleep has to do with it.
Also, since yesterday I've been dealing with a headache on the left side of my head only. And the top left side of the roof of my mouth is swollen and tender. But I'm pretty sure I burned my mouth yesterday with some hot food which likely explains that. But still being smart, I'm keeping an eye on it and if it doesn't get better, I'll be calling and heading in. Again, I think there's a decent chance of hospital time this weekend.
I'll leave you with a picture of my hospital bag(s) (okay, its more of a pile right now.) I think I only have four last-minute items to add to it as we actually go out the door. I've had some anxiety about leaving for the hospital bedrest in not feeling prepared so having these bags done has helped me feel better about it.
I have my camera bag with professional camera and lenses because I want to be able to get some really good shots of Sammy and Kevin during our first few days together. I know I may or not be with it mentally and physically but I think I'll be able to get a few good shots to share. I've got a duffel bag full of essentials like comfy clothes, nursing stuff, toiletries, etc. I'm bringing my brest friend, laptop (so I can update my blog, of couse!) and Sammy's diaper bag with her going home outfit and other baby essentials.
Please continue to pray that everything turns out okay and that this preeclampsia stays at bay until next week when my OB can deliver! Or if she has to come this weekend, that we are safe and sound. Thanks for all of your support!
Thursday, July 17, 2014
Crap just got real.
First off, the happy news....
I'm 37 weeks today! THIRTY SEVEN WEEKS which is..... *drum roll* full term! Yes, it's early full term but still full freakin' term! I figured that if I were ever so lucky to sustain a pregnancy, I'd definitely not make it to full term. But yet here I am staring full term right in the face, shaking it's hand and introducing myself. I have a full term baby named Sammy, ladies and gentlemen. It's just unreal.
Now onto the bad news.
We confirmed I have pre-eclampsia. Ugh. It's really mild right now but I am spilling protein into my urine and my BP is continuing to rise.
What does this mean? It means we are going to wait it out carefully over the weekend and it's highly, highly likely Sammy will be coming next week instead of the following as planned. Yes, you read that correctly. Next week we will likely have this little girl in our arms.
I'm excited and scared crapless all at the same time.
I'm supposed to take it easy from here on out and call the after-hours number if my BP goes over 140/90 while laying down. If that happens, they will probably admit me to the hospital for bed rest and deliver early next week. I have tried to be a 'go with the flow' type person about all this, but if there is one request I could make to the universe it is that my OB himself gets to deliver Sammy and not just some random OB on-call. He's such a caring person, an amazing doctor, and it would mean a lot to me that it's him and no one else. He's optimistic we can ride this out and nothing major will happen between now and next week, but if you could offer your prayers up that I can continue to stay stable until at least next week for all of the obvious reasons, but also that my OB will be the delivery man, I'd appreciate it. I have an appointment with the MFM tomorrow for what sounds like will be my final growth scan and BPP.
And today we have hired a team of house cleaners to come by and clean every square inch of this house. It's in desperate need of it. It's my version of nesting....from the couch as I watch. :)
Stay tuned, things just got really real.
Monday, July 14, 2014
Yup, I'm benched. But it's okay.
As mentioned in my previous post, my SI joint dysfunction pain has increased so much that I can't walk even from the parking lot at work to my desk. BUT the good news is that although I was skeptical that I'd be able to work out a telecommuting arrangement with my work, on Friday, I did! YAY! I'm officially telecommuting from here on out instead of going on early disability. This means I will likely work until Sammy arrives and will get to spend more time with her on the tail end!
Also on Friday, I mentioned my blood pressure readings to my OB nurse because my BP had passed the threshold I was given (above 140.) She put me on bed rest over the weekend, which I did. And luckily, my BP stayed nice and low while I was laying around. I'm also not spilling any protein which is another sign of pre-e. I just might avoid it after all, we shall see. Over the weekend, Kevin and I watched movies and lots of TV and laying around significantly helped my SI pain as well. I think even minimal walking is what has been exacerbating it. It's much more bearable at home after long stretches on the couch.
Laying around has me daydreaming a lot about the moment I will finally meet this beloved baby girl. I picture the room we will be in, the doctor and what he will say, the sounds, and the moment I finally get to lay my eyes on our Samantha for the very first time. I imagine her hair, her eyes, and her lips. I picture seeing Kevin hold her for the first time. I imagine her first cries. I've done all of this kind of day dreaming before but it's become so much more real and I can't describe the overwhelming feeling I feel when I think of it now. I wonder if because of infertility and loss, there was still a part of me that wondered if this was all just a dream and was afraid to really let myself believe this little girl's arrival was going to become a reality. And I think finally now it's starting to hit me that it is. This really IS happening. I'm sure the feeling I imagine about her grand entrance is going to be pale in comparison to the real thing. I can't wait.
So that's my happy update for today. I get to telecommute and work until delivery AND my BP and SI pain seems to improve as long as I'm not moving around. I'm seriously on the home stretch and will be considered full term on Thursday. Three short days!
14 days, 22 hours, 52 min, and 20 seconds until our little snowflake arrives.
Or less.... ;-)
Friday, July 11, 2014
I think I'm about to be benched
I'm 36w1d and I can tell my body is starting to give me big signs that it's time to slow way, way down.
I'm thinking I'm going to end up on disability early. In fact, I would bet money it will be as early as next week. Or I could even deliver before July 29 to potential pre-eclampsia creeping in. But guess what? Sammy is doing WONDERFULLY, and to me that's the most important thing. She passed yesterday's biophysical profile with flying colors in four minutes. She's an overachiever!
Please don't read the next few paragraphs and think I'm complaining. I'm not. I'm just reporting what is going on with my body because it's part of how pregnancy works. I could not be more grateful that I've made it this far and can even write about these inevitable ailments that come with third trimester pregnancy.
Despite physical therapy, my SI joint pain has become so intense I can't even do the most basic things anymore like cook dinner, clean the house, or get ready for work without being in excruciating pain with every single step. Kevin is doing everything around the house, and I am so, so grateful. Because even the walk from the couch to the restroom is putting me in tears. It feels like a knife going into my back/hip when weight is put on my leg, and then again when the weight is removed. The only relief is to lay down on my side. At first, the SI pain was only on the left side and was mild. But as my belly has grown and my joints continue to give out, the pain level is much more intense and it is also on my right side. I can no longer favor one side and limp around. I just plain can't walk anymore.
Even though I work a desk job, walking from the car to the office or from my desk to the bathroom is beyond-comprehension painful. I'm hoping to figure out a telecommuting arrangement with work between now and delivery (which I'm skeptical will happen due to our new company policies) or I'll be forced on disability earlier than planned. Leaving for LOA early will mean returning to work early. I don't like that, so I'm really trying to tough it out as long as I can. I obviously want to spend the LOA time off with Sammy, not alone on the couch debilitated before her arrival. But I'm at the point where I think I don't have a choice anymore. I see it coming soon and I'm bracing myself for that reality. It's okay. I'll deal with it.
And as for pre-e, my blood pressure is slowly but surely going up over the past couple of days. Until now, I've been shocked that my BP has been relatively low/normal during my entire pregnancy. And so has my MFM! I have pretty much every risk factor out there for pre-eclampsia and using donor embryos is one of them. So I suppose it is inevitable. It's not super high yet, but since it's steadily going up up up, we think that it is just a matter of time until it's high enough to be a problem. My MFM says that if I show even signs of mild pre-e after 37 weeks, that's an indication to deliver. I'm keeping a close eye on it but I'm happy I'm so close to being full term that it shouldn't even be a big deal if it happens.
Infertility has taught me a lot. But probably one of the most profound lessons is to just roll with the punches. If I try to plan and work around MY plans, that's when disappointment and heartache enters. I'm going to just follow doctor's orders, try to tough out this SI pain until it's clear I'm forced to throw in the towel, and then leave it up to God and the universe as to what will happen next. The most important thing is that Sammy makes it here safe and sound. And she's dancing around in my belly as I type this so I have a smile on my face no matter what else is going on with my body.
Anyway, I'll leave you with my 36w bump picture!
Sporting my new, shorter mommy haircut!
Sunday, July 6, 2014
It's always fun when...
It's always fun when I meet someone in real life who has had experience with embryo adoption. It rarely happens since it's such a rare and unknown thing to most people.
Yesterday I was at the nail salon getting a pedicure with a dear friend of mine who had spent the last week house hunting in Oklahoma. (She's moving away, wahhhh.....) We spent the time in our pedicure chairs catching up and inevitably we started talking about Sammy and my pregnancy. I was telling her about the 3d ultrasound we had just had earlier in the day (which I'll get to in a moment) and somehow ended up on the topic about how I had read a frustrating, ignorant anti-embryo adoption article a couple days prior. As I mentioned the article to my friend, a nice woman sitting next to my friend spoke up and said "don't let anyone tell you anything negative about your baby!" She went on to explain her very close friend had struggled with infertility and found success with embryo adoption. Her friends friend had remaining embryos which she didn't want destroyed and gave them to her friend. She adopted them and had beautiful miracle twin boys. She even showed me a photo of her friend's miracle boys!
I could tell that while although this stranger at the nail salon perhaps had not endured the pain of infertility herself, she had been touched by the struggle of her close friend and had become an advocate for embryo adoption herself. It was such an exciting thing to talk to someone who knew of it, thought fondly of it, and lived right in the same town as me. I gave her my information and hope she and her friend contact me. Our embryo adoption community continues to grow!
Even without having someone overhear me talk about embryo adoption, I have my elevator speech about embryo adoption ready whenever I feel it's appropriate to share. Usually, someone will ask me a question about my pregnancy or due date. And quickly as the conversation progresses (provided we have enough time) I'll slip in something like "We waited a very long time for her. She was actually adopted as an embryo!" Usually that peaks curiosity and I'm able to answer questions about it for whoever I am talking to. Everyone has seemed interested to hear more and I love talking about our journey. I hope that they keep it in the back of their minds to share, and perhaps someone who has remaining embryos to donate will consider donation, or a couple struggling might consider pursuing this path just because I got the word out. I really hope I'm making a difference, even for one person as cliche as that sounds.
Last, I'll share with you our ultrasound from yesterday. Sammy hasn't cooperated too well for the 3d ultrasounds so far so they sent us back for one final try. We figured if she didn't cooperate yesterday, we'd just give up and wait for her arrival in just a few short weeks.
While it was hard to get a really clear shot at her due to her face being so close to the uterine wall, we were able to get this picture which gave us a glimpse at her gigantic lips! I don't care what she looks like, but it's so much fun to get these puzzle pieces for what she will be like and imagine them all together.
These lips are for lots of kisses!
That's it for today. I'm 35w3d and my MFM says that if she were to come now, he wouldn't be worried at all. In fact, she probably wouldn't even need NICU time. I still can't believe I'm a mama to this beautiful girl. I can't believe a real life human being is growing in my tummy, from a snowflake that was frozen for so long. It's just amazing.
Thursday, July 3, 2014
A snowflake's baby shower
Saturday was out much anticipated baby shower. And of course, it was snowflake themed. Would you expect anything else? :)
My friend, Candace, flew in last Wednesday and we had a great time planning and prepping for the big day. I'm surprised we were able to find so much snowflake themed stuff in late June, but we did. And the stuff we couldn't find was made by friends and family. They really went all out to make it nice. I can't thank Candace enough. On top of tending to her 7 week old baby, cooking and prepping, she also took the beautiful photos above. Super woman, right?
It was so perfect and amazing and much more than I could have ever dreamed. I honestly never thought I'd have a baby shower. After the years of infertility, I figured I'd never even be a mom. But even if I did, who would even care enough to go celebrate a shower or throw one for us? My mom had passed away amidst it all and I had distanced myself from many of my friends who "didn't understand." Infertility is a cruel beast and as many of you know, can rob us of more than just a chance at parenthood. But my true friends stuck it out and my dream of a baby shower came true. It was a celebration I'll never forget. Lots of happy tears were shed. I still can't believe we are celebrating a baby that is growing inside of me. It's surreal. There really are no words to describe how happy I feel.
And to my very special blog-reader-turned-friend who made the long drive down to celebrate with us, thank you. Having you join us was one of the best parts. You know who you are. :)
We got so many beautiful and thoughtful gifts. Everyone at the shower knew of our struggle and of the incredible way that this baby came to be. I still think about it and cry.
Everything is now put away and I am realizing it was the last major milestone on the countdown to Sammy's arrival. There's nothing left but to wait. CPR classes? check. Nursery finished? check. Hospital tour? check. Baby shower - check! I just can't believe that in 25 days, or less, this little girl will be an outside baby and in our arms. I'm 35 weeks today and in just two short weeks, I'll be full term. Un-freakin'-real. If this is a dream, I don't want to ever wake up.
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} | 5,988 | Tuesday, December 22, 2015
Liddy Rose...Her Story
She's HERE! I have to apologize for the delay, but it's been a heck of a week and a half.
But...my little girl arrived on December 11th at 8:07 pm. She weighed 7 pounds 9 ounces and was 21 inches long (I question that length being accurate as she was about 19 inches a few days later). I was 36 weeks and 4 days.
My water broke (at work of all places) on Thursday, December 10th around 3:45 pm. After a tiny bit of mayhem, I made it to L&D only to find out I wasn't dilated. They wanted to see if I would start on my own, but nope! Around midnight I was put on Pitocin. An hour or so later, they administered the epidural.
Now, I always assumed I'd get the drugs for labor and delivery of a baby. And many people on that day said, "don't be a hero, get the drugs". I will tell you right now that is my biggest regret. The epidural made me the most miserable of any other part of my labor. For this reason. I got "wet tapped". Google it. But it basically means that they went to far. They punctured my dura. This meant that they had to give me the meds for the epidural very slowly because of the intense effect it would have. My lower body was complete dead weight. I couldn't feel them at all and even worse, for about 8-10 hours my legs felt asleep. Like the pins and needles asleep feeling. It pretty much drove me insane. To the point that I finally told them to turn the epidural meds way down so I could have feeling back.
By around 5 pm, on Friday, December 11th, I was finally dilated to a 10. We pushed for over 2 hours but she wouldn't budged past my pelvic bone. The doctor didn't think she was going to be able to get past it. She said I could push for another hour, but she just didn't see it working. So c-section it was.
At 8:07, my beautiful Liddy Rose arrived into this world as perfect as she could be. I will never ever forget those moments. The moment in which we became a perfect family of five. When my family was officially complete.
The next day, my cup runneth over when my boys "strolled" into the room. It was in that moment that I broke down in tears. One, I'd been away from them for 2 full days. Two, I had all my children together, in one place for the first time.
I wish I could say that things were super easy and smooth sailing from there. They weren't exactly. We were discharged on Monday, December 14th. But on Tuesday, Liddy was looking a wee too yellow and we had her bilirubin checked. It was 19. WAY too high. She was immediately admitted into the NICU and put under lights. That same day, my headaches from the last 2 days intensified. This was something I was told to watch out for from the anesthesiologist. I was told to go to triage (2 floors down from the NICU) and it was confirmed that I was having spinal headaches from the wet tap. So in between feeding Liddy in the NICU, I had to have a blood patch to try and fix the wet tap. Luckily it worked and the headaches went away immediately. But having a second epidural knowing that the same thing could happen again...was NOT fun.
The next two nights. I stayed at the hospital. Walking the halls at night (less than a week after my c-section) every few hours to feed my little girl. Luckily my milk had come in around the same day she was admitted. I like to think that I helped in a small way with getting her out of there and home quickly. On Thursday, December 17th, we finally went home for good.
It was so hard being away from the boys for so long and especially hard knowing I couldn't pick them up. The restrictions from the c-section AND the blood patch were pretty clear on that. It sucked. I won't lie.
The past 5 days have been a bit of a blur. We have 3 babies age 5 months and under. Pretty freaking amazing, but pretty exhausting too. Especially while recovering. But I'm doing great...and so is she. And so are my boys! We're finding a decent little rhythm and luckily have had family in town to help us.
My husband was my hero through all of this. Everything he's done and continues to do makes me realize how lucky I truly am to have him. I look at him and these beautiful children and trust me, I know how blessed we are this very special Christmas.
Tuesday, November 24, 2015
Good news
Yesterday was a big day. We had our ultrasound with our MFM to look at a particular part of my placenta to see if it was or was not placenta accreta.
It was not.
My placenta looks great. Go figure. After all these years of calling my uterus "crap", I feel a little guilty. It's doing it's thing. What more could I ask?
Her bowels also did not look echogenic at this appointment. Which is awesome. Further reassurance that it was just another fluke that backs up all the tests that we've gone through to rule out any abnormalities.
What they DID find was that this little gal is a whopping 6 pounds and 1 ounce at 34 weeks. I'm still trying to wrap my head around this. I'm a 112 pound girl (pre-pregnancy) and was only 6 pounds and change when I was born at 39 weeks. Granted, Trevor was a 9 pound baby and if you've seen pictures of our twins, there is no shortage of cheeks, chins and fat rolls at our house. So apparently, she's taking after them and will be a little chunk. Her head was 98th percentile (WTF people) and her tummy is 87th percentile with her femur measuring around 85th percentile.
My doctor seems pretty against inducing early, which is seriously stressing me out. She's also very low. They had trouble getting her head measurements because she's so far down in my pelvis. However, after a little reading, that doesn't really mean much about going into labor early.
Speaking of...I spent Saturday night in the hospital. I have been having Braxton Hicks contractions since week 28. On Saturday, they were coming about every 7 minutes for several hours and by the time I was hooked up to monitors at triage, they were every 5 minutes. She was doing great, so I received a Terbutaline Injection which stopped the contractions and I got to go home. They weren't painful and my cervix was not affected.
I have a lot of back pain, pelvic pain, carpel tunnel issues (my hands go numb at night), acid reflux and most recently, my hands and feet are swelling. And, I would take all of these things and much much more to get to be these little ones mom. It's 6 more weeks. I've got this.
Wednesday, November 18, 2015
4 Month Update
My precious little loves are 4 months old. While I won't have a true statistic update until next week, I can't help but post about how simply amazing they are. They both have such sweet and very distinct personalties. They've also started sleeping about 8.5 hours per night. Their very pregnant mama REALLY appreciates this little gift.
Meet Casey, aka Twin A
Casey was and still is a chill little dude. Even in utero. He spent much of his 9 months in the lower corner or Kelly's uterus curled up and super content. He has stayed true to those first glimpses of his personality. He's perfectly content being put down anywhere, but also absolutely loves to literally melt into your chest when you hold him. He has a lip quiver that will literally turn you into a puddle. If he keeps that little quirk, I'm pretty sure he could get away with anything. He's my sweet, sensitive soul. He's more reserved with his smiles, but when he does give you one, it lights up the room. I'm completely wrapped around his chubby little finger. He loves his bottle. Just check out those cheeks and you'll see that is no joke. He definitely is a bit rounder than his brother, but has typically been about 1/2 pound less than Britton. Curious to see if that is still the case come next Wednesday at their 4 month wellness appointment.
Meet Britton, aka Twin B
Britton was all over the place in utero, keeping Kelly up at all hours and giving nurses fits at the hospital just to keep monitors on him. He's sassy and full of spunk. He wants to be held. A lot. And not just held, but walked around. It's like an instant soother. He also has some of the most awesome facial expressions I've ever seen. No doubt this is my funny guy. He adores being talked to. One of his favorite things is sitting on his daddy's lap and this weird little "thing" they do. I can't even explain it, other than to say, it's hilarious and he loves it. He also loves baths with his mama. He likes to eat, but he's not necessarily a "finish every single drop, every single time" like his brother is. He's got chins for days (I've included a special picture just to show you how many), but he seems a little more dispersed than Casey with his weight.
Both little guys are getting stronger and stronger with their neck and back strength. I'm so so proud at how far they've come since their days as wee little things in the NICU!
It's still difficult to wrap my head around how blessed we are. I can't imagine these two not in my life. I can't imagine not coming home to them or waking up to their sweet, smiling faces. I wouldn't trade these moments in their life for anything in the world. I only wish I could keep them little forever. But then, I also look forward to all the stages of their lives.
Here's how much they love each other...most of the time. ;)
Tuesday, November 10, 2015
"Your baby looks wonderful"
Those are some pretty strong words for someone coming from the infertility depths in which I've been. But that's what she said after my first NST (nonstress test) this morning. "Your baby looks wonderful".
I feel like everyone is waiting for a complication. A blip in this otherwise seemingly great pregnancy. Other than aches and pains, which I would gladly suffer through for as long as it takes, this pregnancy really has been, well, normal. Other than the constant monitoring, but that's more because the risk is there.
But she...she is great. It's all up to my body to just hang in there a little longer. As of yesterday, I was 32 weeks. In 6 more days I'll be at the same point in which my boys were born. I certainly would rather she didn't come early...but if she did, my little guys are proof that all will be fine. I take comfort in that.
I'll be doing weekly NST's for the remainder of the pregnancy. This little gal is in the 81st percentile and measuring 3 weeks ahead. I can't believe I'm actually looking at having a BIG baby. How that's possible, I have no idea. My husband arrived in this world weighing around 9 pounds. So guess she's taking after him! My doctor seems to be against inducing early, regardless of her size. This should be interesting. Guess we'll find out at the MFM appointment when we find out about the placenta accreta in two weeks if it even matters.
My boys are amazing. Like I can't get enough of them. I miss them like crazy when I'm at work and think of them nonstop. The second I get home, I don't know who's happier, them or me. Probably me. I sometimes want to pinch myself because none of this seems like it should be real. How is it fair? There are women I still think of often and pray get their miracle. They deserve it so much. How is it possible that regardless of what I've gone through, here I am about to have my third child in less than 6 months? The realization and guilt does overwhelm me at times.
But I couldn't, wouldn't change a thing. Not the years of infertility. Not using an egg donor. Not using a surrogate. Even if I knew then, what I know now...it wouldn't matter. Those boys light up my world. They are my first born and will for the rest of my life, be the little loves of my life.
My sweet, sweet Britton & Casey
3.5 months
Monday, October 26, 2015
My little girl - Finally an update on her
I haven't posted a ton about my pregnancy. I guess life has been so focused on the boys at this point, that most everything revolves around them. I take care of myself and I'm enjoying the pregnancy as much as I can, but they are here smiling at me every single day, so it's hard not to talk about them, them and well, more of them.
So...here's a bit of an update on HER. Her name is Liddy Rose. We didn't keep it secret as we did the boys. It's a name we always liked and decided on it as soon as we knew this was a little girl. We wanted something that was an updated version of my mother's name but not the same. Her name was Linda.
I've been monitored very, VERY closely this entire pregnancy. I am or have been at a high risk for placenta issues; placenta previa (don't have), placenta accreta (or percreta), preterm labor and incompetent cervix (don't have). So this entire pregnancy I've had cervical checks, monthly ultrasounds and multiple visits to the MFM. Not that I mind the extra monitoring, I don't, for even a second with all we went through to have this little miracle right here in front of us, and only a few months away from being able to hold her in our arms.
The issues that have come up are marginal cord insertion, which they aren't concerned about, especially since it can cause growth restrictions, but for her, it has not in the least. So it's just something they watch.
Echogenic bowel. So if you remember, the boys BOTH had this as well from 20 weeks on. This is supposed to be rare. It also can be a soft marker for downs syndrome, cystic fibrosis or a virus such as Toxoplasmosis or CMV. We've gone through multiple screens for down syndrome and we're at very low risk. Trevor was genetically tested at CCRM and is not a carrier for CF, so again, an extremely low risk there. I was tested for the above mentioned viruses and I was negative. So just like Kelly and the boys we have this fluke that we just watch that it seems will be nothing, just like it was nothing with the boys. I certainly am less freaked out about it after going through this before and knowing it really can mean nothing at all. But so strange that all three of my children have this odd little fluke in utero.
I also failed my 1-hour glucose test. I was pretty nervous going into the 3-hour but I got word yesterday that I passed! To add that complication to the mix would have been pretty stressful. But because Liddy is measuring at about 75th percentile, I was thinking it really was a good possibility that I would fail.
I also have regular Braxton Hicks, sometimes every few minutes. However, I was monitored in L&D one night and they aren't effecting my cervix at all. I just need to try and take it easy when I can. Hard to do that with all I have going on, but, I'm doing my best. Luckily, sitting or lying down tends to make them stop.
Lastly, placenta accreta. They've been monitoring me for this since week 20. I've seen the MFM twice and their is an area of concern, but they aren't ready to call it accreta yet. However, at 34 weeks I'll be seeing him again and they'll be looking for a more concrete decision on that area and how to proceed. If it is an accreta or potential accreta, I'll be having a c-section and most likely a hysterectomy. IF they do the hysterectomy, I've requested that they remove my ovaries as well. My biggest concern obviously, for all of this is the recovery. Not only will I have a newborn, but I'll also have 5 month old twins. To think about how long I'll be down and not able to truly care for them hurts my heart. But, I also want Liddy to be delivered as safely as possible for her and me. I've asked that my ovaries be removed in that instance because of my family history. My mother's ovarian cancer was very aggressive and resistant to chemotherapy. I've also found links to endometriosis and that specific cell type of cancer. If they are in there removing parts, I'd rather go through a bit of menopause vs. risking the chance of my babies having to lose their mother and my husband losing his wife. My mother died only 14 years older than I am right now. This is something I was planning on doing in about 5 years regardless. I've put a lot of thought into this and while I know that it's a big decision, we've been beyond blessed in ways that can not be measured this year. I could not feel more complete with our little family.
So I'm going into this with no birth plan. I've waited too long and worked too hard to stress over how she comes into the world. The fact that she does in fact come into the world safely is my plan.
My due date is January 4th. We kinda hope she's born in December just so we can say all our babies were born in 2015. How crazy. But whenever she arrives, we will be over the moon. It's a happiness that I wish for anyone and everyone that wants so badly to hold their child in their arms. We are in a far different place than we were just one year ago.
How far along: The above picture was taken today - 30 weeks
Total weight gain? This is a point of stress for me. I've gained 37 pounds this pregnancy. Seems like an awful lot for a singleton. My doctor doesn't seem to concerned, but with 10 weeks left, I'm a bit nervous!
Maternity clothes? Yes. I can wear my pre-pregnancy leggings, but everything else is maternity.
Stretch marks? Still none... just biding my time though.
Sleep: Ha. This is a funny one. Between 3 month old twins, going pee every hour and being overall uncomfortable, I'm pretty sure sleep is just a thing of my past. And that's okay!
Best moment this week: Passing my 3-hour glucose test after failing my 1-hour. Whew!!
Miss anything? Sushi and red wine. But giving it up has been absolutely worth it a million times over.
Movement: Lots and lots of this! And it's really kicked into high gear these past few weeks. I love every little kick!
Food cravings: Pasta, french fries, apples and ice cream. Probably why I'm up 37 pounds.
Anything make you queasy or sick? Haven't felt queasy since the first trimester, thank goodness.
Gender: A little miss.
Labor Signs: Braxton Hicks seem to be a regular thing for me. Mostly when I'm up walking around a lot or cleaning, etc. When I sit or lie down, they stop.
Symptoms: Just back pain and pelvic bone pain. I'm seeing a chiropractor and massage therapist to help. I'm sure it's because not only am I carrying this baby inside me, but also carrying two on the outside, so this is no surprise. Also have a bit of heartburn and I'm stuffy a lot at night.
Belly button in or out? It's WAY out. I always had a borderline outtie...so it's been out since about 20 weeks.
Wedding rings on or off? Still on
Looking forward to: My 34 week ultrasound with the MFM to really have an indication of what kind of labor this will be.
Her sweet profile
It appears our baby girl will hold her own against her brothers. Check out her biceps!
I think she looks like Casey.
Luckily, we got the majority of her nursery done before we left for Texas. Only had a few finishing touches when we got home. Funny. We use her nursery a lot right now when we are both changing or rocking the boys. It comes in pretty handy having two! (Liddy's room is Stella the cat's favorite place to be)
The 4 photos make up the Wizard of Oz Quote:
"Somewhere Over the Rainbow
Skies are Blue
And Dreams that you Dare to Dream
Really do Come True"
Thursday, October 22, 2015
Casey + Britton
When the boys were born in July, my posts were short and quick. I feel like it's finally time to share the whole story of when they came into this world. My world.
Our plan had been to head down to Texas on July 25th. That would have been between 34-35 weeks pregnant. The average time that twins come is 35 weeks. I figured we were doing good. Especially since Kelly usually went past her due date.
I had one last business trip scheduled for the week of July 13th. I was heading to Portland for a conference. Was excited that I even had a girls night planned with two awesome gals that have supported me through my diminished ovarian reserve and surrogacy. But...a nagging feeling that what if something happened while I was on the other side of the country was there weeks before the trip. It nagged me enough that on that Monday morning, July 13th, when I left the house with my bag packed for Portland, our dining room was completely packed with everything that we would take to Texas. Every. Single. Thing was ready.
Around 10 am I sat in my office (my flight wasn't until later that afternoon) I received a message from Kelly. She was at her regularly scheduled OB appointment and her blood pressure was elevated and she had protein in her urine. The OB wanted her admitted to the hospital and thought we should come to Texas. He said best case scenario the babies would probably come within a week. Worst case, around 3 days. (Did I ever mention this was Kelly's birthday!?) So I went into my super planning mode and within an hour had my flight changed from Portland to Corpus Christi and Trevor was headed home to pack up the car to drive to Texas. (This would be where my proactive planning/packing was REALLY helpful)
I was at the hospital with Kelly by dinner time and stayed on a little cot next to her bed the next few days. My husband's brother was kind enough to fly into an airport on Trevor's journey south so he didn't drive alone. They arrived the following evening.
While Kelly's blood pressure actually stabilized over the next few days, her 24 hour urine collection was extremely high. Like in the 5000's. So we knew that this was definitely pre-eclampsia. We were faced with decisions like do we go home and monitor? Do we transfer to one of the larger hospitals that has a NICU? Do we stay at the hospital with our OB that we adore, that knows us and our situation? We ultimately made the decision that on Wednesday evening we would go home with the plan to go into the MFM's office first thing Thursday for him to make the call as to whether or not she be admitted to his hospital to be monitored for the remainder of the pregnancy, or not. However, as we're packing up to go home, her blood pressure spiked again. The OB decided it would be best to keep her hospitalized and have her transferred. Unfortunately, the other hospital would take her because they were out of beds. So we were kept at the small hospital overnight to be monitored and hopefully would be transferred on Thursday. Trevor had came to visit that day and early evening when knew Kelly and I would be staying another night, he left. An hour or so later, Kelly started to have visual changes. Bright spots, if you will. Our OB had told me that if that happened, he wanted me to text him right away. I did and he came back to our room. He said his concern was that the eclampsia was getting more severe as visual changes typically meant it was getting to her brain. The best option was to deliver the babies.
He explained that while they didn't have a NICU and we were literally hours away from being 33 weeks, and she couldn't be transferred, that he would call in the Children's Hospital and have NICU teams sent for each baby. They would be delivered, stabilized and then transferred. I trusted this doctor completely. There was a reason we chose him and it was the right decision.
Right about that time, Trevor text me a picture of the beer he just ordered, you know, after his very long drive and finally getting settled for the night...my response was "you need to come back". HA!
The doctor did another ultrasound to determine position of the babies. We had still hoped that just maybe she could have them vaginally, but both were transverse and it wasn't an option. They started her on magnesium and began to prep for a c-section. We were only waiting on Trevor and Kelly's husband.
The great thing about this doctor and this small hometown hospital, was that they truly cared about this unique situation and experience. The allowed Kelly's husband, myself and Trevor all to be in the operating room for the birth. No other hospital in Corpus Christi had said they would allow that. I didn't realize how anxious I was until Casey was born and let out that beautiful cry followed by Britton who did the same. They were tiny...but perfect.
They were born at 12:14 am and 12:16 am on Thursday, July 16th. We had made it to 33 weeks by only minutes. Even better, the boys share a birthday with the amazing doctor that delivered them.
The boys were both stabilized and I requested that they be wheeled into Kelly's room where she was recovering before they be transferred. I knew it would be a while before Kelly would be able to see them again. I hope it meant as much to her those moments as it did to me. She was absolutely amazing. So strong, brave and quite literally my hero. Her recovery was hard. She had complications and had to have multiple blood transfusions over the next few days. I'm in awe that I was lucky enough to have THIS woman care for my babies in the most beautiful way possible.
And care for them she did. Because while small at 3 lbs 12 oz and 3lbs 15 oz, they were mighty. Their entire stay at the NICU was one of growth and progress. Not one setback the entire 23 and 26 days of our stay there. Those boys are healthy and happy because of her.
It makes me sad that I don't know if Kelly can be a surrogate again. I know CCRM would disqualify her because of the severe eclampsia. I know that even if there was an RE somewhere that did allow her to be a carrier, she shouldn't carry twins again. I will always feel guilty for this. Whether or not she hoped to do another surrogate journey or not, I would hate that we took that decision away from her. Because truly, she's amazing. Her whole family is amazing. And I'm so blessed to have her and them in my life always.
Nervous but excited!!!
In the OR...and super anxious
Britton's first moment
Kelly meeting one of the twins as he's about to be transferred
My handsome little chunkers
Monday, October 12, 2015
Sometimes things go horribly wrong
Last week in a few of my surrogacy Facebook groups I learned that a gestational carrier had a placenta abruption the day before her scheduled c-section and died. I don't know for certain the outcome with the twins she carried, but I know from a few posts, that things looked dire for them as well. This has been on my mind constantly since I heard the news.
As an infertility blogger, I've come across many women who like myself, have had to go to extremes to make our family. Donor eggs and surrogacy, while something that may not roll off the average person's tongue in day to day conversation, is a huge reality for me. And here I think about the two women that so selflessly put themselves at risk for our family and it hits me deep in my heart.
What if that had been us? What if something had happened to Kelly? How would I have lived with that? Death during childbirth isn't something you hear of often, but it does happen. And to think it happened to someone that wanted so badly to help another family that she paid the ultimate sacrifice.
I stare at my boys daily in wonder and awe. They are my light and they have my whole heart. It's never mattered to me that they don't share my DNA or that I didn't carry them. They are mine and I couldn't love another human more than I love those two little guys. So this tragic story makes me that much more grateful and thankful for what Kelly did for me. For us. She has a heart of gold. In more ways that you possibly imagine. My life is better because of her and her family...and not just in the sense of the boys that hold my heart in their tiny little hands. Because true honest and good people like that are hard to find, and the good in their souls reaches out and grabs you. Makes you want to always be that good.
I also read on some of the threads a few people talking about how you shouldn't be able to have a surrogate unless it's absolutely medically necessary. This also has sat with me. It was medically necessary for me. My doctors, not just at CCRM, but locally as well, all told me...you need a carrier. But here I am, 28 weeks pregnant. And I feel guilty. Guilty because I wouldn't change a thing. Because knowing what I know now, I would still choose these boys. They are part of my world and were meant to be mine. I hope that Kelly never, ever feels like my pregnancy diminishes her and what she has done for me.
My infertile mind still struggles daily that this pregnancy is real. That the little girl is really growing inside of me. I'm along way from holding her in my arms, so I'll remain a wee bit cautious if it's all the same. But her dad, brothers and I are so very, very hopeful.
So yes, to sum up this post...I'm thankful on so many levels that Kelly was able to safely deliver our boys. While there were complications that I'll be posting about later this week, I can say that her and our boys are all healthy and happy. I wouldn't, couldn't have it any other way.
Monday, October 5, 2015
The Hardest Goodbye
After almost 12 weeks of spending every minute with my little guys, today was my first day back at work. I'll admit, the anticipation of today over the past week, was probably harder than this morning actually was. Every time I thought about leaving, I cried. This morning, I made it out of the door with just watery eyes and my lip poking out. I'm almost through the day and counting down the minutes to head home.
Our little guys are doing amazing. Growing like crazy, seriously, these guys are some major chubba wubs. See for yourself. We have arm rolls, chubby cheeks and chins for days. I sometimes can't believe they are the same 3 plus pounders we first met in July.
I hope that one day they understand the reasons I had to return to work vs. staying home with them...which I would prefer. Right now I just have a bit of guilt and jealousy. Guilt because I wonder if they are confused by my absence. Jealousy because someone else gets to see their cute smiles and little daily progress of developmental changes. I want that to be me. But for them and for my family, I work. Luckily, my job has agreed to allow me to work from home on Friday's. Once our little girl arrives, I will work from home two days a week. This does help. (a little)
I realized recently that something I haven't blogged about was their birth story. I'm sorry for that. I think it's important that you all here about it. Not just because it's part of our story, but for others that read about the generosity of Kelly. I want everyone to know what she went through to give us these most precious little boys. So stay tuned for that. Expect my blog updates to be a bit more frequent now that I'm officially back on a computer 5 days a week. Forgive me for putting that aside for so long while I enjoyed my time at home with my Casey & Britton. :)
Tuesday, September 15, 2015
Nursery and Newborn Pics
Here I am...finally, almost another whole month has passed. Seriously, when I go back to work next month and I'm sitting in front of a computer all day, you'll get SO many more updates from me! Pinky swear promise.
What I do have for you is to share our newborn photos and FINALLY nursery photos. We are so so happy with how everything turned out and we're even almost done with our baby girls room. (more to share on her on another post)
Now...the boys...they are AMAZING! Growing like crazy and are simply a delight. They light up my world in so many ways that there are just no words. And they are great babies! I keep waiting for the day that all changes. But they cry (not super loud) when they are hungry, getting changed or just want some snuggles. Any or all of those three things, fix all that is wrong in their world. Being pregnant with newborns certainly has a few challenges and I think these guys are just taking it easy on me for that reason. I'm dreading the day I go back to work and have to leave them. It will probably break my heart into a million pieces.
Finally...our nursery is finished and I'm ready to share!! It meant so much to me that Trevor made the states for the walls. His friend had some reclaimed wood that we cut them out of. I'm so happy how they turned out. I want these guys to always know the journey that brought them home to us.
And here are our newborn pics. These were shot 3 weeks ago. So when I post their two month photo soon, you'll see the big difference between then and now!
And this last photo...was our official Facebook announcement. As of yesterday, we were 24 weeks. Viability! | http://www.ourjourneytoababybump.com/2015/ | isPartOf: CC-MAIN-2019-26
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Miracle: A Birth Story
I didn't plan to put this off until today. But sitting here thinking about my sweet Scotlin on his 4th birthday while putting the story of his little brother and sister's birth into words seems like a sweet sentiment. A perfect way to remember his life: writing about a happy conclusion to our child-bearing experience that started 4 years ago today. So before I start, I just have to say how grateful I am to be the mother of 4 beautiful children and that Mira and Cole have 2 angels to watch over them.
It was Friday, Oct 18th. I was at my 34 week appointment and had been having more intense contractions than usual, so I asked to be checked. I was a "generous 3cm" dilated and we discussed how dilated I would be when they would no longer stop my labor if it started again. She said that if I came in with stronger contractions and was a 4 or greater, then they would let me deliver. The next day was difficult, because I kept having short bouts of contractions (we're talking 2 or 3 hours at a time) where my contractions would be very painful. We thought about going in, but right about then, the contractions would stop, so we stayed home.
Sunday, Oct 20th, we stayed home from church because my contractions picked up again. Ev checked me (benefit of having a med-student husband) and thought that I was at least a 4, if not more. We decided to go get checked, just in case. It was about 3:30 in the afternoon when we got there. The nurse checked me and said "Yeah, you're having these babies today." I was 5 cm and my bag of waters was bulging. Doctors were called, ultrasound came and checked babies' position, and I was transferred to L&D. Everything happened so fast, I didn't really have any time to prepare. Ev just kept saying, "We're going to have babies today!"
Pretty sure I'd just had my epidural placed
An hour later, at 4:30, I was dilated to a 7 and the doctor came in to chat. Both babies were head down, so we were going to try for a vaginal delivery. For safety purposes, though, they deliver twins in the OR just incase something happens and they need to do a c-section. I had my epidural placed (yay!) and the Dr. came back and broke my water. Over the next hour and a half, my epidural fluctuated between being wonderful and then not numbing my right side, so they put me completely on my right side and it finally resolved! About 7:30, I hadn't progressed past an 8 and my contractions were really weak, so they started pitocin to get things moving again. It worked: in about 10 minutes I felt a lot of pressure and spurting of fluid. I told the nurse I felt weird, so she checked me. As soon as she did, she said, "okay, DON'T PUSH!" The Dr. had just left because he figured I'd be a little while longer, but I was complete and Cole's head was really low. The nurse got on the phone and told someone, "She's ready!" Ev changed into his awesome outfit:
I was wisked to the OR where about 20 people rushed around me getting things ready. Someone said, "It's going to feel pretty chaotic, but it's organized chaos. Everyone has a job and it will go really smoothly."
Within minutes, I was told to push. As I was pushing, the Dr. was counting and when she got to 6, she said, "stop, stop, stop". Apparently his head was coming too fast and she didn't want me to tear. After two more pushes, Cole popped out and I heard the most beautiful sound I'd ever heard! He started crying and so did I. I was trying to see him, but they took him straight to the warmer on the other side of the room. Ev went with him and I could see him smiling-a huge grin from ear to ear!
Meanwhile, the ultrasound tech was having a hard time finding Mira's heartbeat. Mira suddenly had so much extra room, she decided to flip sideways. A lot of things could've happened next, but I'm really happy about the way things went down. When Mira flipped, the doctor reached her hand up into my uterus (yes, her WHOLE arm was in there...up to her elbow!), grabbed Mira's feet, and pulled her out. Her head got stuck for about 5 pushes. Just before she came out, they were about to use the forceps. BUT...we got her out without them. I watched as she flopped into the doctor's arms, 4 minutes after her brother, and was subsequently passed onto a NICU nurse who rushed her to the warmer. She didn't cry and that made me cry even harder. But Ev was with her and he was smiling, so I new she was okay. It took a bit of help to get her breathing, but after a few minutes, she had pinked up and was crying! I was sobbing, Evan was sobbing, both babies were warm and breathing. I never imagined this moment would be as happy as it was!! And I didn't even need a c-section! :)
I got to hold Mira for a few minutes but her apgar scores were 4 and 8, so they wanted to take her to the nursery to check her out. Cole got to come with me back to my room. (His apgars were 8 and 9). Ev stayed with Mira so Cole and I got 10 minutes of cuddle time. I noticed that he was grunting a lot and nasal-flaring, so I opened his covers and he was retracting really bad (all indications that he's having a hard time breathing). I told the nurse and she put him under the warmer and put some O2 on him. Unfortunately, cole had fluid in his lungs and had to go to the NICU. That was the hardest part of my whole experience: sitting in my room having just delivered 2 babies and not only did I not get to have them with me, but I was numb from the waist down, so I couldn't go to them either. I'll post about their NICU experience later, but their birth was the most beautiful, happy moment of my life. We got one picture all together not knowing that it would be almost 2 weeks before we'd all be in the same room again.
So often, Mira and Cole look up at me with such light in their eyes, yet I know they're not looking at me. The vail is thin for babies and I KNOW that they can see angels. It helps that they have Scotlin and Kayden to be with them. I know that these kids love each other and that as Mira and Cole grow up, we'll tell them all about their brothers and how one day we will be a family together forever!
Oct 3, 2013
Another Hospital Visit
This last week, I went into active labor again. I was exactly 32 weeks. I got to the hospital expecting that these babies would be delivered, but instead they stopped my labor. I know our desire to have these babies here now is a bit controversial. Some friends agree with us (usually other baby-loss parents) that the doctors should just let me deliver. Other friends (usually the ones who haven't experienced loss) remind me-as if I didn't know- that the longer they're inside me, the better. On one hand, if they're born now they have the probability of complications that will keep them in the NICU longer and the potential for long-lasting effects of prematurity.
On the other hand...they would be alive. They would be breathing, even if it was with a little help. They would have heartbeats, and they would cry. I would get to see their eyes open and hold a warm baby without the help of warm blankets. I could cry tears of joy and thanks rather than tears of grief, sorrow and pain. My husband could hug me because we did an extraordinary thing bringing two lives into the world, rather that to hug be because I'm falling apart inside.
Few people outside my close friends and family have witnessed the stress and anxiety that has accompanied this pregnancy. Not just for Evan and me, but for our family as well. Every time I call my mom, she answers, "Whitney, is everything okay?" I appreciate the concern, but it makes it difficult to call anyone. My sisters are the same way, and even though others haven't mentioned it, I'm sure they have the same heart palpitations when they see my name on the caller ID. Moreover, baby boy is my little mover. He's head-down so he's constantly kicking me in the ribs. But baby girl is in an awkward, transverse (sideways), oblique (diagonal) position with her feet tucked against her chest and positioned neatly under her placenta so I don't feel her kicks very often. It's a good thing I'm at home all day with the opportunity to doppler her heartbeat anytime I go an hour without feeling her move. (Yes, I'm that paranoid).
The nurses say that as long as I have two episodes a day of at least 10 kicks in an hour then everything is fine. But it's not fine. I was told by previous doctors that whatever caused Scotlin and Kayden to die took minutes, 10 tops. They didn't die slowly, it was fast. So even if I feel kicks in the morning, I worry all day long if I'm not hearing a heartbeat or feeling them move. And when I say worry, I don't mean a little nervousness. It's heart-wrenching. It's an overwhelming fear that if I put the doppler to my belly I won't hear anything or be able to find a heartbeat. Today, for example, I hadn't felt baby girl move yet, so I had to wait until Evan called on his lunch break to doppler her so that just in case I didn't hear anything I wouldn't be alone.
We feel beyond blessed to be parents of two angels. Now we're ready to be parents of two more living angels. Beyond anything else, we appreciate the prayers and support from everyone offering them up for us. We feel strengthened and hopeful, even with the bouts of anxiety and uncertainty. Please, please keep these babies in your prayers for us, and know that we are so appreciative!
Much Love
Sep 30, 2013
Virtual Baby Shower (updated)
I get asked on a daily basis where we're registered, which, we have an open registry at Along with that, my sister is putting on a "virtual baby shower" to help get donations for us to get a stroller. She wrote a post about it here and I've also attached a paypal button below if you'd like to contribute. Any donations would be immensely appreciated. Any amount totaling more than the cost of the stroller will be used for the babies (probably diapers!)
P.S. if you do donate, please include your email or mailing address so I can send you a huge THANK YOU!!!
Sara Davis*
Becky Martin*
Brittney and Seth Warburton*
Staci Dearden*
Leanne Loscher*
Elizabeth Vandenberghe*
June Fulkerson*
Amanda Parker
Kenna Hendricks*
Karen Payne
Alicia Herterich
Kendra Gates
Brandy Elegante*
Melynda Epperson
Laura Grinder*
Jesse and Sara Steinback
Kristi Bruner
(*= please email or text me your address so we can send you a personal thank you!, 209-914-8104)
Sep 12, 2013
Staying Pregnant is Hard
I've been posting on FB this week about our eventful hospital visit, but I'm gonna re-cap here for my benefit.
Last Thursday, Sept 5th, I was in the office for an appointment. It was my 28 week visit and we were starting weekly non-stress tests. It just so happened that they hooked me up and I was contracting every 1 1/2 to 2 minutes. They were pretty painful, and I was given the option of going to the hospital or going home. The babies were doing fine and not being affected by the contractions. I was in an uncomfortable position and I felt that if I could go home and lie down, the contractions would stop. The Dr. agreed and it worked. It took a few hours, but the contractions settled down. They told me to head to the hospital if they started back up again.
I contracted on/off through the weekend and Evan kept trying to get me to go in, but I resisted. (We had gone in the week before because I was bleeding and I didn't have a good experience so I was trying to avoid it). At that visit, my cervix had been basically closed.
On Sunday, we were sitting in sacrament meeting and the contractions started up again. I was squeezing Evan's hand and trying to breathe through them. He whispered that he was taking me to the hospital, but I resisted again. With 5 minutes left, he insisted, but I told him I'd only go if I had 2 more before the end of the meeting. Well, that took about 2 minutes, so we headed to the hospital. We called on the way and they tried to tell us to just go home, lie down, and drink lots of fluids. Evan told them no and that he was bringing me in.
Of course, once they got me hooked up, I was contracting like crazy. They checked me and said my cervix was between 1-2 cm. They were going to be very aggressive stopping the contractions, so they put me on mag sulfate. The only side effect I could feel was the hot flashes. I was on it for about an hour while they admitted me to L&D. Once there, Evan was on the phone and I suddenly felt like I had an elephant on my chest. The nurse just happened to walk in right then and I told her I couldn't breathe. I remember saying it a few times, but the next thing I remember was Evan sternal rubbing my chest, people saying my name over and over, an oxygen mask on my face, and about 8 people around my bed. Apparently my eyes had rolled to the back of my head, I turned white as a sheet and had passed out. They had called a rapid response team even though I had been out for less than a minute. It was just a reaction the the medicine. It's a vasodilator so the doc said I had a vasovagal reaction. Needless to say, they stopped the medication right away. That's the most interesting thing that happened, which I'm grateful for.
The next day I was transferred to the antepartum unit where they watched the babies and me closely. I didn't have cell service in my room, so once or twice a day, my phone would catch a bar and I'd get 10 texts and missed calls all at once. The babies continued to look good, but my contractions continued. They gave me indomethacin for my contractions every 6 hours, but it only kept them at bay for 3-4 hours, so I was dealing with the pain as well as I could. It was hard being without Evan, but my dear friend Shanna came and stayed every day to keep me company. (It's nice having a substitute-husband).
On Wednesday, they did a test called a fetal fibronectin. It is supposed to indicate whether a person will go into labor within the next 2 weeks. Mine came back negative (Hallelulah!!). Also, the nurse checked my cervix and said it was dilated to a 3. But 2 minutes later the Dr. came in and decided that they were checking in the wrong place and that the internal part of my cervix was only a 1. SO...after 4 days, I got to come home on bedrest. This is so hard! I'm grateful that the babies are okay, but doing nothing is going to be a challenge. Any suggestions to keep the crazy away would be appreciated!
Thank you thank you for all the prayers and support. I know I say it all the time, but Evan and I can feel the love and peace that has resulted from them!
Much Love
Sep 6, 2013
A blog post in pictures
I don't really have anything new to say that the pictures don't say better:
Baby girl at 27 weeks 2 days. I was having some bleeding problems so I got to spend a few hours at the hospital in OB triage. I finally got to have a doctor look at my cervix rather than a nurse, so we got some answers about what was causing it (finally)It was nothing serious and we're all fine and dandy, but they said it will continue through the rest of my pregnancy. yay! :(
Baby girl is starting to get some chub. It's getting harder to get 3D pictures of them because there's almost always something in front of their faces. The next picture shows her taking a drink of amniotic fluid. Yum!
Baby Girl at 28 weeks 2 days. She's on my left side and has never been head down. They say she's in the "penthouse" because she has a lot more room than baby boy so she flips around a lot. I think she just makes the room as I'll show you in the next picture.
So, this is Baby Boy at 28w 2 d as well. He's always head-down like a good little baby. We couldn't get a 3D of him because *something* was in his face. If you look closely, you can see his membrane along his nose and mouth. So what's the blob on the left side? That would be baby girl's foot. While we watched, she repeatedly kicked him in the face. That's how she gets all her extra room...she kicks him into submission until she has lots of space and he's cowering in the corner :)
The blanket I crocheted for baby girl. It's quite uneven on the edges, so I'm debating taking out the white and yellow and re-doing it.
Baby Boy's blanket. It looks black/white, but it's actually Aggie Blue/White. GO AGGIES! I might even stitch Utah State University into it...we'll see how ambitious I feel.
Not the most flattering picture, but this is what 28 weeks looks like. I've gained 25 lbs and my hips are really sore. I wish I could skip that part because I'm most likely going to have a c-section and won't be needing my pelvis to open to let them out, but I'll take it. I'm so glad the little ones are growing like they should and my doctors are finally on the same page so I don't have such a hard time at each visit.
Thanks for all the continued prayers and support. I know that this pregnancy is going so well because of the prayers from so many people. After an unpleasant non-stress test yesterday, we're hoping to make it to at least 32 weeks. In the meantime, I'm taking it easy at home and tackling my next project: crocheting blessing day blankets. I'll post pictures when I get them done, but here's a sneak-peek:
Add caption
Jul 17, 2013
Babies Update
So, I've been bad at blogging this pregnancy, but it's been a crazy couple weeks, so I thought I'd do an update.
First, the good stuff. I've always gained exactly the amount of weight I'm supposed to during my pregnancies. This time around, however, I was really sick so I lost a bunch in the first trimester and have had trouble gaining it back. Finally, at 21 weeks, I'm proud to be putting on weight at kind of an insane pace and officially weigh the most I've ever weighed in my life. Here are the pictures to prove it:
I know it's hard to tell, but these pictures represent a 7 lb weight gain and the difference of about 1 1/2 inches around my belly. Also, babies Lytle are finally moving consistently, easing my anxiety and reassuring me that they're there. :)
Now, the non-good part. While I was in Utah this last week I had some problems with bleeding and cramping that landed me on the OB unit at Utah Valley Regional in Provo for a few hours. They didn't do a whole lot except check babies heartbeats and check my cervix. Babies looked good, but my cervix was open a fingertip. Also, I had some bacteria in my urine, so they gave me a single dose of antibiotics and sent me home to take it easy and to follow up with my doc in AZ. Only thing is: my doc couldn't see me for two weeks.
Utah Valley Regional- I sent this pic to Ev to reassure him that I was fine, hence the "Love You"
When I got home on Saturday, I was having menstrual-like cramping again along with more bleeding. So, I landed in an OB triage unit here in Chandler for another check-up. This time, they did a cervical length that showed my cervix had shortened almost 1 cm in the last 4 weeks. That wasn't a big deal, because it's still long like it should be. But they did decide that I definitely had a UTI that was causing all my problems, so now I'm doing a whole week of antibiotics. I'm feeling a lot better and I'm so glad our little ones are doing well.
Chandler Regional Medical
Jun 6, 2013
"Can you count?..."
We found out we were pregnant again on March 17th. Later that week, my 48hr bHCG (blood test for pregnancy hormone levels) QUADRUPLED (It's supposed to at least double)! We were absolutely thrilled and terrified at the same time. I worried every time I went to the bathroom that I would be bleeding and everything would end.
So, I have a lot of people asking what we're doing differently this time to make sure these babies get here with a heartbeat (maybe not in those exact words, but it's implied...) The day I got a + pregnancy test, I started heparin injections. This was something that, after three losses, was one of those, "Well, it won't hurt you, it'll only help you" scenarios. Basically, if I was losing babies due to an undetectable clotting problem, the heparin would probably help.
That first week was hell. I mean really REALLY bad. It started with fevers. Then the body aches and chills. I missed a couple days of work because I couldn't get off the couch and my fevers were getting higher and higher. By the next Sunday, my fever was 103.5, so we went to the ER. My platelets had dropped 60,000, and my liver enzymes were up (probably because of the fever and tylenol use). It has a name: HIT- Heparin-induced thrombocytopenia. The heparin was making me sick!!! Talk about frustrating...the thing that had given me hope that I could have a normal pregnancy was out the window. It didn't take long for me to get better once I stopped taking it, and now I'm on a regiment of aspirin, a butt-load of folic acid, vitamin D, and fish oil. We have high hopes (and a lot of faith) that these babies are going to be just fine!
So the title of this post, "Can you Count?" those are the famous words spoken by Dr. Speak at my 6 week appointment. We saw on the screen the following picture:
Yes, I can count, and I knew it was twins. We had an unsettling next couple of weeks as we went between appointments with my OB here in K-ville and the perinatologist in Columbia; every time they put the probe on my belly, wondering if there was still going to be two babies.
This picture was labled wrong in CoMo, so I tried to label over it.
By 10 weeks they were starting to look like babies instead of blobs. Baby B usually gets the shaft because almost every time I went in before 10 weeks (s)he wasn't in a good position.
Having had just one and now two babies at a time, I can definitely say that twins is...much more difficult. Everything happens so much faster, and stretches more painfully. Somedays I just sit all day because my round ligaments hurt too bad to walk. Don't think I'm complaining, though- just comparing. And I'm THRILLED and SO HAPPY to be stretching and hurting because it means these kiddos are growing!
12 weeks 6days.
This is the perfect example of how baby B is in a bad position for a photo-op.
14W 5D
These babies are fraternal twins which is a lot less risk. (I don't think I could handle any more risk) At 15 weeks, we're feeling grateful for all the pictures we have of our sweet little ones and that we've had so many opportunities to watch them move and kick each other in head. We're in love with our little #3 and #4 children and hope to have an idea of what their genders are next week. I have 3 more scans before I leave Kville, so hopefully we'll know for sure before we leave.
I really need to say thank you for all the support and love we've felt from friends and family; for your prayers, fasts, and words or comfort and love. Random strangers tell us that they'll pray for us, which absolutely fills my heart with love for them.
Sometimes when I pray I tell Heavenly Father that we've already buried 2 babies and we can't do a 3rd or a 4th. These babies are perfect and we haven't had any complications and hope that it stays that way. In the next few weeks, Evan will be taking his boards and we'll be packing up and moving to Chandler, AZ for 2 years so Ev can complete years 3 and 4 of med school. We're excited and I promise I'll be better at keeping up the blog with updates for the friends far away and the friends we're leaving in Kirksville (*tear).
Much Love! | http://littlebitoflytle.blogspot.com/ | robots: classic
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} | 2,327 | Sunday, October 10, 2010
Beautiful Gifts
In case you find yourself wondering what the title means, it's the arrival story of my beautiful boys. I wanted to jot down everything I can remember for something not only to share but something I can look back on a remember as vividly as I can.
My last doctors appointment was thursday, October 7th. I didn't talk to my doctor directly, I was scheduled for a full ultrasound scan to evaluate the weight/anatomy & positioning of the boys. This was followed by my weekly non stress test. Now, for a non stress test, this is just them finding the heartbeats of the little ones and placing a heart rate monitor as well as a contraction monitor over my stomach. It measures and counts the movements of them in the womb as well as measures how well they react to my contractions. Fairly simple. It usually last about an hour. This week I noticed it was a bit longer because I had a few big contractions. The boys reacted fine however. The nurse said i was ok to go and also said she would see me next week...if those big contractions didn't take over first :D This gave me the indication that the boys were probably coming soon. How soon, I was NOT expecting...
Friday was a typical day with a few exceptions. A few days before I was nauseas and feeling not myself. I felt normal thursday but woke up friday in the same kind of funk. No nausea however, but I did feel yucky. Food didn't sound good to me but I made it a point to eat anyways. I found myself wanting to nest and clean the floors but I was also extremely tired. More than usual. Every so often I noticed myself getting an occasional side cramp kind of feeling on my left side that would hang there for a few minutes then disappear. Not the typical contraction I was ever used to so I ignored it. It only happened 3 times if that all day and not really close together. No biggie. I had a hard time remembering a true sign of labor anyways since my water never broke by itself and I haven't gone into labor since...well kayleigh back in 2005. Abigail was different since I was induced so it was hard knowing signs of what to look out for besides the obvious.
My husband has a job that has a lunch break everyday from 230-4:30pm then he heads back to work until about 930-945. Unpleasant shifts but someone has to work. He was heading out to work about 4:10 and I was planning on taking the girls to blockbuster to grab a few rentals to enjoy on a friday night. Especially since on fridays, he works until 1030 so we needed something fun to make time pass. He left, I got everything ready to go, we headed out the door when suddenly i was hit with the worst strong,sharp pain in my left side next to my belly. It scared me because I couldn't walk, breathe,talk,lay down without it going away. I thought it felt like an intense version of a walking cramp + sciatica mixed in one. I also thought it would go away so, I ran by the bank drive through before it closed thinking it would be gone in a sec and the boys just shifted wrong. I got to the drive through and the pain intensified. Something wasn't right. You can automatically tell when something isn't right either when it's your own body...the thing that sucked the most is by the time I received that feeling, I was stuck in the line with someone behind me and someone in front of me. I had to wait 15 minutes to get out of there and head home. Driving was intense so I brought myself right home and kept telling my husband to come get us.
He had a hell of a time trying to get off work so I called family and tried to see what the possibilities were of someone grabbing the girls and i and dropping us off at the hospital. Meanwhile doing this I was lying down on my couch HOPING the pain would go away if i swifter weight. I had to be brave in front of kayleigh because she was worried about me and any sign of me in any pain, she would flip. I couldn't have that because then it's just 3 females freaking out. I couldn't do that to them. I managed to get jared to get his butt home and come get us. About halfway to the hospital my pain shifted and radiated from my side to my uterus...shit, I was having contractions and they were about 6-8 minutes apart. Well, this just might be it.
We go in, they monitor me like a non stress test for about an hour and see that they were indeed contractions. My parents came and got the girls,took them home with them overnight and the nurse was off calling my doctor. He wasn't a fan of me delivering just yet since I was only 34 weeks and 3 days. He wanted me to hold off for two weeks at most so they gave me a muscle relaxer called pericardia (spelling?) so relax my uterus and stop contractions. They also decided to give me a steroid shot in my thigh (worst shot ever, it burned so bad) to speed up the babies lung development should I go back into labor the next week. I stayed on the monitor for about an hour and a half and the contractions started not being as frequent but intense when they were around. We all figured it was doing it's job until about 30-40 more minutes later my contractions were practically starting to be back to back and pretty knarly. Mind you, I haven't had any pain meeds from the whole time it initially started till about 9pm at this time. here's a picture of my contractions...the bottom green mountains are them and you can see exactly how intense they were:
The nurse looked a bit concerned and said she was going to call the doctor again to see where it was going to go from there. He came in, did a mini ultrasound to see where the boys were so I could choose what labor I wanted to go with if that were the case. My baby A, typically the lowest one,was and had been head down for 2-3 weeks; decided he was going to not engage in my pelvis anymore but let his breech brother instead. SO, after thinking for weeks I had a choice in either a vaginal delivery or a came down to one thing only. Baby B was the lowest one and he was feet first so a csection it was. I was a bit scared since that's the one thing i was trying NOT to get...The plan? hold out on my contractions until I absolutely needed any meds. That was the sign that i was having those babies after all and that they would hook me up and wheel me in.
Sure enough 930 rolled around and it was completely unbearable. 5 1/2 hours of contractions and NO medications takes its toll on people. Especially nerves. I felt like screaming at the nurses to give me some "fucking drugs" I was going nuts. Which was amusing to my husband because I've NEVER been like that during any labor. He doesn't realize at that moment that I couldve easily strangled every nurse and given myself a shot of morphine...anything to stop it lol. They told the doctor I demanded drugs and couldn't tolerate contractions any longer without (which were about 1-3minutes apart by then and never died down, just went into the next contraction) The brought in my lovely stylish cap, had me take out all my facial/body jewelry and told jared it was time for a csection and to change. He did just that super quick. within 10 minutes I was wheeled into the O.R. and jared had to wait outside till I was given a spinal tap. Man that stuff is amazing by the way. Instantly i was numb from the chest down and felt like heaven. They strapped my arms out and hooked me up to monitors and made me a nice little "tent" to cover me and hubby from seeing anything. Then it all started.The only thing that will never go away in my head is the smell of my own cooking flesh. Not pleasant. It only lasted a second until they made an incision then all i could feel was light tugging. Then I heard Max (mr.feet first) Max decided to mark his territory and pee all over the doctor as he came out apparently. That's my boy. haha. They dried him off and started performing an apgar etc on him like normal. Then came Micah who was also pissed and didn't want to come out yet.
Out of all things I felt i couldn't handle in life, the worst feeling is hearing your babies cry and not being able to hold them,see them or touch them. Jared got to participate while i laid there like chopped liver. It was hell. Ive waiting months to see them and dreamt endlessly of holding them and here I was...strapped down and not able to do either. It was hell. I was a wreck at that point and couldn't stop crying. They let jared carry Max to the NICU and they wheeled Micah back as well as I was left in the room being fixed up. I didn't see anyone for about an hour and a half, then jared came back. I had to spend about an hour and a half in this enclosed room while the nurses filled out paperwork and checked on my numbness. Finally on the way out i begged to get them to push me by the NICU so i could see my boys. I saw them but couldn't touch them since they were hooked to breathing monitors called CPAP. which is forceful oxygen to get them to breathe better. Max, who weighed the smallest at 5 pounds 3 ounces was having trouble breathing on his own while his brother was doing better but still needed it. Micah was 5 pounds 13 ounces and a bit healthier. Both were ok though. I lost it on the otherhand. They pushed me back into my room where I still was crying because I wanted to fix them and make them all better. I felt guilty for not holding them in longer...
I wasn't able to see them again until 10 am the next day. I got to hold them and man I was instantly in love all over again. They are both so precious and doing much better with the oxygen. It doesn't need to be forced into their lungs anymore they are working on doing the breathing themselves. The nurses said they are pleased but that it can always change so I should expect them to be in NICU for at least a few weeks. Such a hard thing to grasp knowing that you can go home in 3 days and you cant bring your babies. So I'm bummed about that. I know they are getting the best care though and as selfish as I am for wanting them home to myself-i have plenty of time to do that after they get healthy themselves. That's most important.
So that's my long birth story and where I am standing at as of right now. I will be leaving by monday and my boys cant come with. Now, I have to schedule me coming down and snuggling them a well as bringing them breastmilk for them to get them started on feeding. This will be a bit tough but in the end i am so thankful that they came out safely. I already love them more than the world and am ready to start this new chapter and including these little sweet peas in our everyday family life.
I'll keep you updated if that's what you'd like. If not, i'll still keep myself updated so I can always look back at their progress. Now, I should probably sleep. It's almost 130 am and I have not been so good at that part.
Lia, Jared,Kayleigh,Abigail
Max and MIcah!
1. Congratulations on your precious boys, Lia!! And I love the names. I'm glad to know that they're breathing on their own (relatively) and that you're doing great as well. Get some rest, because you know as soon as you feel up to it, YouTubes gonna wanna see those little angels.
2. They're here!!! And they're just perfect. Well done on being so strong for them and for your girls. Micah and Max will be home before you know it!
Take care xx
3. It's such a beautiful story.
Scary and worrysome but the miracle of birth is just phenomenal. You made not one more life, but 2. And that's amazing. I can't even wrap my head around it. I'm so happy for you!!!
4. Congrats on your little boys! They're precious. I'll be praying for all of you. For a quick recovery. Honestly, they are just the most precious babies! I'm excited to meet my little girl too. She's actually over due!
5. Congratulations Lia & Jared, your beautiful sons are so gorgeous. I'm so happy they had a safe arrival and are doing well. They'll be home before you know it, even though I know that going home without them will be hard. My sister's little boy had a really rough 1st week but is now a very happy and healthy 7 mth old. I can't wait to follow their brand new lives as a part of your wonderful family. Welcome to the world Max & Micah xx Gilly xx | http://twinsmakefour-aladynevertells.blogspot.com/2010/10/beautiful-gifts.html | robots: classic
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} | 1,540 | Saturday, May 31, 2014
Welcome to Maine
Well, we finally have internet in the apartment. Thank goodness for data plans and smart phones that allow you to take care of the essentials until your internet gets hooked up.
We're in Maine! I think it has rained everyday so far. My dear Watson went through his first week of orientation and now the real thing starts up on Monday. Apparently this summer semester is the very hardest. The advice previous students gave spouses was to pay attention and make sure their spouse takes a break from studying every now and then. Apparently there is enough stuff to learn that you could study 24/7 and still not be fully prepared for the test.
My mom left today. She was amazing. She unpacked my ENTIRE house. It would have taken me months to do it. I was in charge of unpacking my bedroom and by Thursday mom finally came in and did it because I was making no progress :). But hey, I feed my baby a bagillion times a day and change his diapers too, so....I do stuff.
We've already met some great people - neighbors, ward members, class mates etc. I think we'll like it here. We are both trying to figure out how we are going to do everything. How do we take care of ourselves, our family, and all the day-to-day essentials? I'm not really sure yet, but I guess we'll give it a go and find out soon. If you remember, please keep us in your prayers. The truth is, we're going to need all the help we can get. I think we're scared to death.
I'm feeling great physically. Still a little rocky emotionally though. Hormones. New baby. Big move. I'm not sure what to blame it on, but I'm a little sensitive. Our biggest scare right now is that we're not sure what to do for medical coverage for Redd and me. We will apply for Medicaid but it could take up to 6 weeks for them just to review the, not sure what to do in the meantime. Hopefully we get that figured out.
Redd is adorable. According to my scale, he weighs 8 lbs. He's a little gassy so that means fussy at times, but really he isn't bad. He eats and then sleeps or sometimes he likes to be awake looking around, but I don't have to always hold him in order for him to be happy. He doesn't like to be cold, so baths, lotion, diaper changes and clothes changes are all really frustrating to him. He does that cry where he doesn't breath for a few seconds almost every time he gets his diaper changed. I don't like that very much.
We made it through all this crazy stuff and now we just have to endure the challenges ahead. It seems like everything has worked out so far, so we should expect things to work out from now on as well. Before we know it, this will all just be routine.
The kitchen. We bought that pantry because there isn't enough cupboard space.
View from the front room.
Our purple couch. I'm not complaining, it's my favorite color.
Sleeping with daddy.
Lighthouse selfie!
Tuesday, May 20, 2014
Ihadababyitsaboy - The Birth Story
Remember those commercials? They were for 10-10-2-20 or something like that. Anyway, here's the story.
Tuesday, May 6th I had a Dr. appointment and he tells me there's no chance of being induced before a week late. Not that I really wanted to be induced, but given our tight time frame, I wanted to be induced.. So that was disappointing (although I know the Dr. has that rule to help prevent C-section and other complications).
Wednesday morning I notice some spotting. I called the Dr. and they said just watch it - if it's a lot of blood, that's bad, otherwise it's normal.
Thursday I was still bleeding so I called again and this time they sent me to Labor& Delivery for an assessment. All seemed to be fine and they expected I would go into labor soon.
So we came home and went on a hike, did squats, etc.
Friday I was real frustrated. I wasn't feeling great and all I wanted to do was focus on getting the baby here. So I stayed home from work and we loaded up our stuff from the Watson's and took it to my moms. Then we walked around the aquarium, then later we walked/ran/squatted around the track.
I still wasn't feeling any progress. So that night I made a treat. Then around 8:00 pm I started noticing a stronger contraction coming about every 5-10 minutes. I kept expecting them to get closer together, but they stayed that far apart, but did get stronger. At about 12:30 I called my mom and asked her when I should go in. She said to go and then call her after they check me out. The contractions were strong enough now that I had to stop whatever I was doing when one came on.
We got in the car and my dear Watson sped to the hospital like the baby was about to pop out. I told him he probably didn't need to go so fast, but he said it was the only time he could speed and not feel, whatever.
We got to the hospital and I was dilated 1 cm more than when I was at Labor & Delivery the day that was disappointing. They kept me there for an hour to see if I made any progress. After an hour I was dilated a tiny bit more, but effaced now at 100%. So they called it labor and I called mom and decided I would get the epidural. I was nervous about it, but it was no big deal. It made labor so easy. I took a nap and before I knew it I was at a 6.5. Somewhere around that time the nurse thought baby's heart rate was way too slow....that was a scary moment. So they broke my water and put a lead on the baby's head. His heart rate was fine. She was picking up my heart rate mixed with his on the external fetal heart rate monitor. The lead on his head was much more accurate.
By 8:30 am the doctor was here and I was complete (at a 10). We were ready to start pushing. They didn't think it would take much because the baby was already down pretty far.
Two long hours later he finally came out.
Everyone who came in and out kept saying "oh, that was so close" "it's like he pops out and then pops back in" "keep going" "harder" "push down".
I was so tired of everyone - I just wanted that baby out. Pushing was nothing like I expected and was by far the worst part for me. By this time I had very little epidural in my left side so I was feeling concentrated pain on that side of my body. I was getting a charlie horse type cramp on the left side of my rear end, and they made me wear an oxygen mask because baby's heart rate dropped when I held my breath and pushed for 10 seconds. Imagine that. The blood pressure cuff kept going off right during pushing and I wanted to rip it off my arm.
Finally the Dr. said he was going to do a small episiotomy and he felt that would be the trick to get the baby out. I think it was the next push, maybe two pushes later that he came out. Alien head and pointy nose, and pretty much perfect. I got to hold him right away (thanks to my great nurse who made sure that happened). I wasn't feeling very good at this point, so they took him away and did their stuff.
The Dr. stayed down there forever....I heard him talking to the resident who was there about lacerations and it seemed like he was stitching me up. I didn't think it should be taking that long. Then I learned I had torn pretty bad and he was doing a complicated stitching-up job. He pretty much said it looked like a bomb went off down there. After he was finished he ordered a little more epidural and boy was I glad. I started to really feel the burn. I also almost passed out and then got the shakes. So they took my dear Watson and the baby to the nursery without me and I rested in Labor & Delivery.
And so Redd entered the world. 6 lbs 9 oz, 19 inches long, May 10th at 10:34 am. You can tell from the pictures, he is a clone of his daddy. I still don't see any of me in him.
He was small for his gestational age so they had to check his blood sugar every 6 hours for the first 24 hours. He passed all those tests just fine. I was really feeling good after the first day so we decided to go home. They wheeled me down and waited for my dear Watson to go get the car. They watched us load the baby up and then let two 25 year olds ,who had no idea what they were doing, drive off with a newborn baby and no instruction manual. I still can't believe it.
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I've hesitated in writing this for a number of reasons. It's a little bittersweet to me as it will most likely be my last telling and it occurs to me now in this stage that not everyone cares, or is comfortable with these sorts of things. On top of that up until this point writing again has been done in passing, for myself, not to be shared among people I know, in real life.
But here it is, it demands to be recorded, I have all the others written, in blog or email form. The ultimate story of waiting, coming to fruition, the birth story. How this sweet, patient, even tempered babe came to know this world and begin to capture hearts right away, beginning with his Mama.
Birth stories are each one so different, for each child born into a family, but widely so for each Mama all over the earth, some begin with a phone call or water breaking, some involve heart breaking and hours of trauma or sweet blissful silence. Mine have all been within text book normal range but each has been as vastly different as each of my children's personalities.
After weeks of false labor and one intense bout of back labor the Wednesday after Thanksgiving, I went to my scheduled appointment the next day after embarrassingly being sent home from the hospital the night before. My body hadn't progressed much in preparing itself for labor, so we made an appointment for an induction the next week two days after my due date.
Monday, December 5 came around, still pregnant, and it was my due date. I went to the ob's office tired, passed my nonstress test, exam, and sonogram (still not any progress to speak of) and they sent me on my way with a warning about my slightly elevated amniotic fluid levels. This was basically a warning that if my water broke, I would definitely be aware of it. There are other risks with elevated fluid levels but everything appeared normal. And so we began "try all the old wives tales at once" to make the baby come out. We plotted the rest of our day accordingly. We ate lunch and I ordered all spicy things, we went to walk at our local indoor track and I bounced and swayed for 45 embarrassing minutes on an exercise ball. Still nothing, so we went home, had dinner with the kids and settled into an episode of Downton Abbey (I still had not finished the series).
Now don't get me wrong, when I say nothing, I don't mean absolutely nothing. I mean nothing different than what I had been told to ignore the last few weeks. I had been having contractions regularly in the evenings for weeks, sometimes painful, sometimes rhythmic and close together for hours, sometimes both. But none of them progressed far and I'd been told to basically wait for my water to break to head to the hospital.
Eventually I had Adam stop the episode of Downton so I could take a bath and relax before bed. The contractions continued but did not progress anywhere so I relaxed, had a snack and climbed into bed. I started to fall asleep but the contractions kept me awake, once I remember drifting off and then one particular one woke me up. I got out of bed and rocked in the trusty rocking chair while reading a magazine (and having another snack).
Finally frustrated with nothing being painful enough to "count" I laid back down after drinking a whole glass of water (maybe I was dehydrated?) and then next three contractions I remember vividly two were painful and the third I had to get up on my hands and knees and sway to make it through. After a few more I was shaking and couldn't walk during the contractions and had to focus and breathe and realized that this was for real.
It was time to go to the hospital, I had ruptured some membranes and was bleeding, so there was no turning back now. I woke up Adam who was so confused in his sleepiness but finally understood the situation enough to help me by getting our bags to the car and letting his mom know (she was staying with us and so watched the big kids). We pulled out of the alley at 2:03 am. On the way I called the doctor's line and my mama and sent a few texts to people who "needed" to know.
We arrived at the hospital at 2:32am and got wheeled up to L&D, checked in, settled, all the while more shaking and contractions, but when an exam was done, I was actually only half way progressed but definitely in active labor. I elected to have an epidural fearing a little that it might stall labor, but fearing a 9.5lb baby a little more. The epidural didn't work with Penny, so I knew I was risking this again. It was working mostly, and was enough to take the edge off but still allow me to feel in control of myself (as much control as you can have while in labor).
At about 5 am I had progressed all the way to7-8 cm and our favorite Dr L was called to come on into the hospital to break my water. He arrived around 5:20am and had forgotten his warning to me from earlier, he was underprepared for breaking my water they gushed everywhere causing him to have to change his clothes and even poured into the nurse's shoes.
The nurse I had that night was amazing. Rachel. She thought Adam and I were funny and was just a quirky as us. She was so excited to have someone in "hot" labor and enjoyed the excitement of a quick paced event. The most important thing though is that she believed me. She believed everything I told her and took me seriously. I've had the opposite happen during labor so this was quite a relief for me and I'm sure helped overall in such a smooth delivery.
Historically my babies come quickly once my water is broken, so we waited only a little bit and then I was ready to push. I remember Dr L saying he wasn't going far and there being two possibly newish residents as well. When I decided pushing would happen soon Rachel was quick to gather the doctors. She was efficient and encouraging. The residents were taking their sweet time gowning up and Rachel understanding that my babies do not wait, was telling them to hurry up and finally I snapped, "Hey! The baby is coming... NOW!" and they jumped to right away.
I pushed less than 5 times. I remember thinking there was no stopping this and that I was so tired that I couldn't push anymore all in the same second. I'd been up all night apparently laboring more than I thought at home. now it was 6 am and all I wanted to do was have this babe safe and sound and take a nap.
The babe was here at 6:12 am and as they clamped the umbilical cord, I remember just repeating over and over, "Is it a boy? What is it?" It seemed an eternity, but really was less than 2 seconds because Adam got to tell me, "A boy!" and they placed him on my chest even before the cord was cut. Adam cut the cord but I don't even think I was really watching, I was impatiently trying to see my baby boy's face. It struck me immediately that he looked like his brother and sister. He was (and still is) definitely a Kipp baby.
After his initial protest of being outside the nice warm womb he was silent and serene and sleepy. I nursed him a little bit and Adam and I just stared and talked to him for well over an hour until they were ready to move us out of that room.
They had to take him to the nursery to test him and bathe him because I'm a strep b carrier and didn't have enough antibiotics before his arrival. As we were transferring and so many nurses were in and out we kept asking opinions on a name. we had a firm girl name but in the 24 hours before this babe was born had decided against our chosen boy's name. Even while expecting Penny we knew our next boy would have the middle name Fox, but didn't have a solid first name choice.
In the end we went back to a name we had discussed all along. Felix.: happy or favored one. And that is exactly what he has been. A happy happy baby. He is even tempered and sweet and calm. He is relaxed and intent on watching the crazy world of our house around him. He cries when he is hungry or tired or needs to be changed and hardly even then. He is basically everything I prayed for throughout this pregnancy. A patient and flexible baby who flows with our hectic family schedule. | http://caraekipp.blogspot.com/2017/01/ | robots: classic
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I've hesitated in writing this for a number of reasons. It's a little bittersweet to me as it will most likely be my last telling and it occurs to me now in this stage that not everyone cares, or is comfortable with these sorts of things. On top of that up until this point writing again has been done in passing, for myself, not to be shared among people I know, in real life.
But here it is, it demands to be recorded, I have all the others written, in blog or email form. The ultimate story of waiting, coming to fruition, the birth story. How this sweet, patient, even tempered babe came to know this world and begin to capture hearts right away, beginning with his Mama.
Birth stories are each one so different, for each child born into a family, but widely so for each Mama all over the earth, some begin with a phone call or water breaking, some involve heart breaking and hours of trauma or sweet blissful silence. Mine have all been within text book normal range but each has been as vastly different as each of my children's personalities.
After weeks of false labor and one intense bout of back labor the Wednesday after Thanksgiving, I went to my scheduled appointment the next day after embarrassingly being sent home from the hospital the night before. My body hadn't progressed much in preparing itself for labor, so we made an appointment for an induction the next week two days after my due date.
Monday, December 5 came around, still pregnant, and it was my due date. I went to the ob's office tired, passed my nonstress test, exam, and sonogram (still not any progress to speak of) and they sent me on my way with a warning about my slightly elevated amniotic fluid levels. This was basically a warning that if my water broke, I would definitely be aware of it. There are other risks with elevated fluid levels but everything appeared normal. And so we began "try all the old wives tales at once" to make the baby come out. We plotted the rest of our day accordingly. We ate lunch and I ordered all spicy things, we went to walk at our local indoor track and I bounced and swayed for 45 embarrassing minutes on an exercise ball. Still nothing, so we went home, had dinner with the kids and settled into an episode of Downton Abbey (I still had not finished the series).
Now don't get me wrong, when I say nothing, I don't mean absolutely nothing. I mean nothing different than what I had been told to ignore the last few weeks. I had been having contractions regularly in the evenings for weeks, sometimes painful, sometimes rhythmic and close together for hours, sometimes both. But none of them progressed far and I'd been told to basically wait for my water to break to head to the hospital.
Eventually I had Adam stop the episode of Downton so I could take a bath and relax before bed. The contractions continued but did not progress anywhere so I relaxed, had a snack and climbed into bed. I started to fall asleep but the contractions kept me awake, once I remember drifting off and then one particular one woke me up. I got out of bed and rocked in the trusty rocking chair while reading a magazine (and having another snack).
Finally frustrated with nothing being painful enough to "count" I laid back down after drinking a whole glass of water (maybe I was dehydrated?) and then next three contractions I remember vividly two were painful and the third I had to get up on my hands and knees and sway to make it through. After a few more I was shaking and couldn't walk during the contractions and had to focus and breathe and realized that this was for real.
It was time to go to the hospital, I had ruptured some membranes and was bleeding, so there was no turning back now. I woke up Adam who was so confused in his sleepiness but finally understood the situation enough to help me by getting our bags to the car and letting his mom know (she was staying with us and so watched the big kids). We pulled out of the alley at 2:03 am. On the way I called the doctor's line and my mama and sent a few texts to people who "needed" to know.
We arrived at the hospital at 2:32am and got wheeled up to L&D, checked in, settled, all the while more shaking and contractions, but when an exam was done, I was actually only half way progressed but definitely in active labor. I elected to have an epidural fearing a little that it might stall labor, but fearing a 9.5lb baby a little more. The epidural didn't work with Penny, so I knew I was risking this again. It was working mostly, and was enough to take the edge off but still allow me to feel in control of myself (as much control as you can have while in labor).
At about 5 am I had progressed all the way to7-8 cm and our favorite Dr L was called to come on into the hospital to break my water. He arrived around 5:20am and had forgotten his warning to me from earlier, he was underprepared for breaking my water they gushed everywhere causing him to have to change his clothes and even poured into the nurse's shoes.
The nurse I had that night was amazing. Rachel. She thought Adam and I were funny and was just a quirky as us. She was so excited to have someone in "hot" labor and enjoyed the excitement of a quick paced event. The most important thing though is that she believed me. She believed everything I told her and took me seriously. I've had the opposite happen during labor so this was quite a relief for me and I'm sure helped overall in such a smooth delivery.
Historically my babies come quickly once my water is broken, so we waited only a little bit and then I was ready to push. I remember Dr L saying he wasn't going far and there being two possibly newish residents as well. When I decided pushing would happen soon Rachel was quick to gather the doctors. She was efficient and encouraging. The residents were taking their sweet time gowning up and Rachel understanding that my babies do not wait, was telling them to hurry up and finally I snapped, "Hey! The baby is coming... NOW!" and they jumped to right away.
I pushed less than 5 times. I remember thinking there was no stopping this and that I was so tired that I couldn't push anymore all in the same second. I'd been up all night apparently laboring more than I thought at home. now it was 6 am and all I wanted to do was have this babe safe and sound and take a nap.
The babe was here at 6:12 am and as they clamped the umbilical cord, I remember just repeating over and over, "Is it a boy? What is it?" It seemed an eternity, but really was less than 2 seconds because Adam got to tell me, "A boy!" and they placed him on my chest even before the cord was cut. Adam cut the cord but I don't even think I was really watching, I was impatiently trying to see my baby boy's face. It struck me immediately that he looked like his brother and sister. He was (and still is) definitely a Kipp baby.
After his initial protest of being outside the nice warm womb he was silent and serene and sleepy. I nursed him a little bit and Adam and I just stared and talked to him for well over an hour until they were ready to move us out of that room.
They had to take him to the nursery to test him and bathe him because I'm a strep b carrier and didn't have enough antibiotics before his arrival. As we were transferring and so many nurses were in and out we kept asking opinions on a name. we had a firm girl name but in the 24 hours before this babe was born had decided against our chosen boy's name. Even while expecting Penny we knew our next boy would have the middle name Fox, but didn't have a solid first name choice.
In the end we went back to a name we had discussed all along. Felix.: happy or favored one. And that is exactly what he has been. A happy happy baby. He is even tempered and sweet and calm. He is relaxed and intent on watching the crazy world of our house around him. He cries when he is hungry or tired or needs to be changed and hardly even then. He is basically everything I prayed for throughout this pregnancy. A patient and flexible baby who flows with our hectic family schedule. | http://caraekipp.blogspot.com/2017/01/ | robots: classic
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Birth Story of Milo
I've had a difficult time wanting to write this story - or knowing HOW to write it. I don't even know WHEN the "birth" story started. I felt like I'd been in labor for at least a week before Milo was born, and by the time I knew for certain that it was the "real deal," it felt like a bad joke. That said, everything went well once things really began to happen, and I shouldn't have any complaints. I had a list of things that I wanted in my birth:
a healthy baby
a natural birth (no IV or drugs)
my doctor
to make it to the hospital in good time (not too early or too late)
I got all of those things!
I've gone back and forth about what to include in this birth story, and I've decided to error on the side of telling too much, rather than to pick and choose what to include. So this will be long (it's already long!),but it felt long at the time, so maybe it's appropriate. Today I'm going to post the preliminary stuff, and then later, I'll post the actual BIRTH story. :) Feel free to skip all of it if you want to. :)
With this being my 5th baby, I felt a lot of braxton hicks contractions - starting back in November, and getting progressively worse until in March I was going a little nuts. After 36 weeks, the contractions got a lot stronger, more often, and more regular. On Friday, April 3rd, the contractions were strong and 3 minutes apart. I felt awful - nauseous, light headed, sick . . . after agonizing about what to do, John and I decided to go to the hospital to find out what was going on. It didn't seem too likely that I was in active labor, but with contractions that close together, we didn't want to risk having the baby in the car or something.
Greg came up to stay with our kids,and we arrived at the hospital around 11:30 pm. Once I was in bed and hooked up to the monitors, the contractions slowed down in both frequency and intensity. After an hours' observation, the nurse said we could go home, or walk around, shower, etc. to try to get things to pick up again. We were tired, so we went home, fully expecting to be back soon. (My cervix hadn't dilated during that hour, but it had gotten much softer, so our nurse was optimistic that we'd be back in the next day or two at most. Although I know these things are unpredictable,I held onto the hope that she was right.)
She wasn't. I continued to have fairly regular and strong contractions (up to my due date), but they didn't progress.
The next Wednesday (April 8th) was my due date, and I had my 40 week appointment that morning. My doctor was leaving for spring break with her family early in the morning on the 10th, so I knew I had less than 48 hours to have my baby if I wanted her there. And I did. I'm generally opposed to induction, and I really like to just let things happen, but the previous weeks' fake-outs/practice and the desire to have the baby before my doctor left won out, so I asked her to strip my membranes. The theory is that if your body is ready,stripping the membranes can help start labor - that's what happened with Ruby, so I was hopeful that it would once again get things moving. If my body was not ready to have the baby, stripping the membranes wouldn't do anything.It seemed like a safe move.
I came home from my appointment and took Ruby and Jonah on a nice long walk. During our walk, the contractions were really intense, and 5 minutes apart. We came home for a break, and the contractions slowed down and got weaker. We walked to the school to get Maxwell. Once again, the contractions kicked in. And once again, after we got home,they slowed way down.
After lunch, Ruby and I went out to walk, AGAIN. This time the contractions were quite painful,and at least 5 minutes apart - many coming closer together. The wind was blowing, it was cold, and I was tired, so we came home - only to have things slow down again!
That afternoon, I helped the kids practice piano and do their reading. We walked to piano lessons and back a couple of times (with strong contractions each time). We made popcorn balls. I sewed four burp cloths and made dinner. Finally,around 6 pm, my contractions seemed to stay strong when I was not walking, but by this point, it seemed like a cruel joke.
After dinner, I sat down and read a book while John put the kids to bed, I took a shower, and then watched a movie with John. The entire time I was wondering if I should be paying attention to the contractions, or if it was another false alarm. At 10 pm, we started to get ready for bed, and debated whether or not to call Greg. Eventually, I gave him a call. I explained that I wasn't too optimistic, but there was a chance that labor would get serious that night and we'd need him to watch the kids. I asked if he'd rather spend the night, or just come up in the unlikely chance that John and I decided to go to the hospital. Greg said he'd just come up and spend the night. Shortly after I got off the phone with Greg, my contractions became more painful, and I started to feel sick. By the time Greg arrived, I'd decided that we'd better go to the hospital. I gathered my things together, and we'd set out - just like we had almost a week earlier.
When we got to the hospital (at about 11:30 pm), they quickly got us into a room (my reputation for quick births preceded us because a nurse we'd had before was working). Our doctor was called, and she told them to do a 20 minute test strip, to let me move around after that, and that she would be over soon. When she arrived, she had the nurse set the room up so they'd be ready when I was. Ruby, Jonah, and Maxwell were all born less than 2 hours after we arrived at the hospital, and my doctor seemed confident that this labor would follow the pattern set by my last two births. On the other hand, I was worried that we'd spend the night with everyone waiting and waiting for me to have the baby, and that he wouldn't be born for HOURS.
At about 12:45, I asked to be checked because the contractions were very strong. I'm always hesitant to be checked because the news can either be encouraging, or very depressing. Luckily, I had progressed to a 7, so I was encouraged, although still not confident that things would move quickly. My doctor and a nursing student stayed in the room with John and I after that. It was nice to have people to visit with between contractions, although it was kind of strange to have everyone quiet down while I was having a contraction. A little while later, I began to feel pressure (not quite an urge to push, but close to it) during contractions. After a few contractions like that, I asked to be checked again, and was found to be complete. The urge to push was still not overwhelming, and I was worn out emotionally, if not physically, so I asked my doctor to break my bag of waters to speed things up a little. After a few more contractions, she broke my water, and said I could push whenever I felt like it. I pushed on the next contraction, but it was so weak no one could tell I'd done it! Argh!
I pushed harder on the next contraction, and the next,and the next, and I started to wonder what was going on! The last 3 babies had all been born in just a couple of pushes, and I couldn't figure out what was taking so long.It turns out that Milo wasn't in the right position,so as I pushed, he was rotating into position before he could be born. (I wonder if breaking the bag of water made him drop down before he rotated all the way. If so, it was my own fault that I had to push so much longer.) The pushing was really hard and really scary. I always forget how painful and scary pushing is for me.
It's so strange to be the one in labor. No one else can feel what you're feeling, and even though John and my doctor are there, I feel pretty alone.Birthing my baby is something I have to do - no one can do it for me, and besides the baby, everyone else is mostly spectating. This time, the difference between the experience that the others had was markedly different from what I was experiencing. I managed to not scream out loud, so the nurses, my doctor, and even John thought that I was doing really well. I LOOKED calm, in control, and focused as I pushed. What I remember is totally different. I was scared silly, in a ton of pain, and felt like I was freaking out. It just hurt too badly to open my mouth to yell or scream or cry or even to open my eyes to see the birth (I always plan to watch the birth, and I've never been able to keep my eyes open). I remember thinking of how much it hurt, and how long it was taking, and just wanting it to be over and for him to be OUT. It felt more like chaos than calm to me.
Eventually, my pushing and his rotating did their job,and Milo was born! John helped to catch, and I managed to open my eyes to see my baby (and to ask for my camera so I could get a picture of John holding our newborn).
Once the cord stopped pulsing, John cut it, and I got a chance to hold our baby. He was hungry! Milo was basically born rooting. :) He was quickly cleaned up and weighed
(we were all a little shocked at his size - my biggest baby), and then I got to hold and feed him while the doctor finished taking care of me.
Milo hardly cried at all, which worried me, but his color was good and no one else was concerned. He was born at 1:17 am. Great timing. Just as my doctor finished with me, she headed over to another hospital to deliver another baby. :)
To read Jenny's blog and see beautiful pictures of Milo click HERE.
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Thursday, November 15, 2007
Zoe's Birth Story
Green Style Mom is having a birth carnival.
Go add your birth story, too!
Zoe Mikhala
June 1, 2001
3:43 a.m.
18 inches long
I had a prenatal appointment scheduled for June 1 at our new house, where all the midwives would practice getting here, and we would go over our last minute plans of how we wanted the birth to go. On the morning of May 31, Michael said upon leaving the house, "Today would be a good day, it's Thursday, you know." We'd been joking for a few weeks that she needed to be accommodating and be born on a Thursday (he has Fridays off) so that he could take the entire following week and not have to go back to work until the next week. I laughed and said, "No way, she has to wait until June now, today is my sister's birthday, I don't want her to have to share!"
Instead of sleeping in, I decided to get up and get started on the things on "the list" that needed to be done around the house. Admittedly, it's an ever-shortening list, which is a relief, but after breakfast I started not feeling so well, having to run to the bathroom every half an hour or so. After about the third time, it suddenly occurred to me that this was probably a good sign that labor was going to begin at some point, maybe not today, but soon. Either that, or the thai food we'd eaten the night before hadn't agreed with me!
I hung around the house, kind of anxiously anticipating something, almost as if I could feel it in the air. Sure enough, contractions started that afternoon. Nothing major, a little bigger and more intense than the Braxton-Hicks I'd been experiencing, in fact they were so far apart and weren't so bad that I wasn't sure they were "real" contractions at all. The hardest part was not knowing for sure!
I picked the kids up in the afternoon from school, and noticed that I was having a hard time concentrating on what they were saying if I was having a contraction. Hmm... that was a good sign. Maybe these were "real" then! I tidied up when I got home, got a few last minute things together for the birth (just in case I'm really in labor, I told myself!) and started preparing dinner. Contractions weren't really close together, anywhere from five minutes, to eight minutes, and sometimes fifteen minutes apart. No real pattern.
Michael called at five, and I told him, "Well, you may be a daddy today." Even though I told him not to, he canceled his last client and came right home. I was afraid that it wasn't really labor, and I didn't want to disappoint him if it wasn't really it! I had contractions through dinner, through clean-up, through kids' baths and bedtimes, but again, they were anywhere from five to eight minutes apart, and while they were uncomfortable, I still doubted if I was really in labor.
Finally, I called the midwife around 8:30 p.m., just to give them a heads up. I didn't want to have to wake anyone up in the middle of the night if I didn't have to. I gave her all the information, and she told me that she would call all of the other midwives, and told me to sleep if I could, and if they got worse or changed, to call her back.
Michael and I decided that distraction was a good idea, because both of us were too excited and anxious to sleep, so we played Yahtzee until 11:30 p.m. or so. We went to bed, and I curled up with Michael and the contractions started spacing themselves out. Ten minutes apart. Then fifteen. I was sleeping between them, but then I'd have a contraction and it would wake me up and I would grab Michael's hand, which would wake him up, and he'd breathe through the contraction with me until it was over and I fell asleep again. It was a good system, and I think the sleep did me good. It did us both good.
At 12:30 a.m., interestingly just as it was becoming June, my contractions started picking up. They became stronger, and started waking me up every five minutes. In fact, I wasn't so much sleeping between them as I was zoning out. At 1:00 a.m., Michael gently suggested we call the midwives. I hesitated. I was still doubting that this was "it"! Maybe they would space out again between, like they had before, how did I know?
At 1:15 a.m., Michael was suggesting it more strongly, and after my next contraction, when I sat up and had to arch my back to keep the pressure off my lower back through it, I decided that it might be a good idea. He called them while I was in the bathroom, and I when I came out he said they were on their way. As soon as I knew that, I was somehow able to relax some more, which made the contractions seem a little more bearable. Of course, that made me think that maybe this wasn't really "it" and they would slow down or stop when they showed up! My fear was of being the little boy who cried wolf (or the woman who cried labor) but in the next forty-five minutes before they arrived, the contractions were coming regularly and were fairly intense, and I became pretty sure (finally!) that this baby was going to be born on June 1.
The midwives arrived at about 2:15 a.m, and of course wanted to check my progress, but I didn't want to move. Things were starting to pick up and it was becoming uncomfortable. I did anyway, of course, and she checked me both before a contraction (about 4 cm) and during a contraction (which hurt beyond belief, but I was 5-6 cm during) and after that, contractions seemed even closer together and were getting to an intensity I could barely remember from my other two births. Michael was having a hard time getting me to focus, and both of the midwives were giving pretty good directions (keep my voice low, relax my forehead, breathe, etc) and I tried hard to listen and follow their instructions, but things were getting fuzzy.
I have no idea how much time passed, but the pain went from "Wow, this really hurts" to "Oh my god, I'm going to die" so quickly that I didn't even have a chance to breathe. The midwives were still telling me to breathe through them, Michael was having me focus on his face, look into his eyes and breathe with him, and while everyone around me was saying how good I was doing, I felt like I was falling apart. Not only was I in pain, but suddenly I was really afraid. They had checked me at what felt like minutes ago, and I was only at 4, so these contractions couldn't possibly be as intense as they felt like they were, and I must just be acting like a baby. My fear (and of course I was doing the labor math in my head: this kind of intensity at 4 cm, times 1 cm per hour, that means at least 6 more hours like this?!) was that I couldn't possibly handle this much longer.
Then my water broke. I'd never felt that before. With both of my other births, my membranes had been artificially ruptured. I remembered the feeling, but this was different. This was pressure that broke the bag, and I said, "You guys, I think my water just broke" and oh my god, I remember contractions getting more intense after that in my previous births, but this was beyond anything I'd ever experienced. It felt as if the baby was coming, and not just coming, but coming right now!
I saw the midwives' faces, and the first question out of my mouth was, "Is there meconium?" She said, "Yes," and my heart sank. "A lot?" I asked. "A good amount," she said. They were setting up suction equipment, and I thought, well this is the thing, then. This is the thing that had to go wrong. Then, I couldn't think anything anymore. It all happened too fast. She decided to see how far along I was then, and she said, "Oh, you're a stretchy 7." Close to transition, then. I felt like I was dying.
The baby's head was now so low in my pelvis, I was starting to have the urge to push, but knew if I said anything they would tell me to breathe through it. I was afraid I couldn't do it anymore. Then they couldn't find heart tones. They were using the Doppler, but no matter where they put it, they couldn't find her. Finally, they heard something faintly, and thought that maybe the uterus was tipped too far back, so they wanted me on my hands and knees so that the uterus would tip forward and they could check it from underneath.
I was saying, "No, no" when she suggested it, but she was firm, and Michael helped flip me over I was amazed how good it felt to be on my hands and knees. The baby was low, really really low, but I was in so much pain that all I could do was grunt and moan. I had two contractions like that, while they were frantically checking for heart tones from underneath, and could feel myself starting to push through them, unable to stop.
The midwife had me flip back over and that's when I gasped and said, "The baby is right there!" She said, "Ok, I believe you," reaching for a glove, and suddenly I felt the familiar stretch and burn of the baby crowning. She was shocked and said, "There's a head!" Both Michael and I reached down to feel her head, wet and full of hair. They checked for a cord, and suctioned her there on the perineum because of the meconium.
As soon as her head was out, I was lucid again. One more little push and she was up on my belly. They suctioned her again, making sure to get any meconium out of her lungs. She was pale at first, but began to cry and pink up. She was born at 3:43 a.m.
I was shocked at how tiny she was! She was the smallest baby I'd ever seen, aside from a preemie. After the initial worry about her breathing (which was fine and clear from that point on), we slowly got to know her as I kept her warm on my belly and the midwives did what they needed to do, checking her, checking me, having me push to deliver the placenta (within about fifteen minutes after she was born). Blake, whose room is right across the hall, woke up when she began to cry. He came into our room, and I told him to go get Autumn. I was sorry they missed it, but we all nearly missed it, it went so quickly at the end! They were thrilled to see the baby, and crowded around to say hello to her.
She's a perfect little peanut, and looks just like Michael when he was a baby. I cleaned up while Michael held her, and then we settled back into bed and napped and snuggled for a half an hour or so while the midwives cleaned up and made some calls. They wanted her checked out by a doctor as soon as possible (which was standard practice for them anyway, but because of the meconium and because of her size, they were insistent that it be right away) so they made an appointment for us, and one of the midwives said she'd go with us.
Blake had gone back to bed, and Autumn was out helping the midwives prepare things. She was the biggest help to them, and is an even bigger help to me now. After the doctor checked her out and gave her a clean bill of health, I think we all relaxed a little bit. She weighed in at all of 5 pounds 3 ounces, which is slightly smaller than the minimum average (which is about 5 and a half pounds) and was 18 and a half inches long. Her head circumference was 12 and 3/4, which is on the small side and is probably why I had no second stage of labor. I didn't have to push her out, she just kind of slid right down the birth canal and into the world!
Her size is a mystery. The doctor said it could have been my blood pressure, which was borderline at the end, that may have effected placental function, and she may have been meant to be a small baby regardless. The good news is that she's healthy, and is nursing like a pro and hasn't left my arms (or someone's who loves her) since she was born.
I shudder to think what may have happened if we had delivered in a hospital. The meconium alone would have had her in the nursery for "observation" for 12 hours or so. Her size would have probably had her in the NICU, just as a precaution. It certainly could have been warranted. There are a lot of babies who are small who have a hard time holding their temperatures, who have hard times breathing. I was so grateful to be at home, with people who knew what to look for, who were willing to watch her and wait. She passed every test, and handled it all on her own, and they were satisfied with that and so was I. It was a relief and a blessing.
I can't tell you what a healing experience it was to have a baby in my own bed. In spite of the pain (which was much more intense, not only than I remember, but than I'd experienced before) and my fears of falling apart, which I would have had in or out of a hospital I imagine, I was able to have a positive birth experience, when I'm nearly 100% sure that it would have been a snowball of interventions in a medical setting that probably would have traumatized me, the baby, and my husband. I felt confident that although there were things we had to take seriously and pay attention to, the midwives would respect the normal process, and trust in my body and the baby's, and they did. It was a gift, a blessing, and a truly amazing experience for all of us.
Tiffany said...
My daughter Mikayla was born at 37 1/2 weeks and she weighed in at 5 pounds 3 oz too. She was born in the hospital and she did have trouble keeping her temperature up. But since it is a small hospital there was no NICU to go to. She was the only baby in the hospital so she got lots of attention. She only went to the nursey when I tried to get some much needed sleep but they still brough her in every couple hours for me to nurse her.
Penny said...
So interesting! Thanks for sharing!
GreenStyleMom said...
What a beautiful birth! Thanks for participating in the carnival! | http://countrydawn.blogspot.com/2007/11/zoes-birth-story.html | robots: classic
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A brand new birth
The third time around contractions started on their own with no efforts on the part of my husband and I to get labor started! In fact, labor started two weeks earlier than we had been hoping. But true to form, my third child was born in a different month than the due date indicated.
Baby Elizabeth was born on Tuesday March 27 at 7:43 am after two days of early labor and about 8 hours of active labor.
I woke up with contractions 15 minutes apart on Sunday. I knew based on the week before that I wasn't going to make it all the way through church but that the walk there and back would at least be good. All through the first hour, I felt contractions but they were very mild. After the meeting, I went home and decided that I would take a longer walk to see if I could get contractions going that way. When I couldn't get a hold of the friend I really wanted to talk to, I posted a shout-out on facebook for someone to call and talk to me while I walked.
I was disappointed that walking seemed to cause the contractions to space out more. I think all I accomplished was getting my hips sore. I did get a hold of the friend I had wanted to talk to (my best friend from fourth grade) and was able to talk to two others (both of whom are doulas). Upon getting home, I took a nap while dinner was being made and then went to bed after dinner. Throughout the day, I saw that I had lost a little bit of mucous plug and the contractions became slightly stronger. It was not a great night sleep, not because of the contractions but because my throat was getting increasingly sore and dry. It was difficult to breathe because it was so raw. Finally, I fell asleep and got about 7 hours.
The contractions were interesting because they were short and mild. They seemed very easy to deal with. By Monday afternoon, I was starting to believe that I was going to be in early labor for a few more days. Since I had had a good night sleep, I knew I could keep it up, if need be. Monday morning I took the children to their gymnastics classes and visited the chiropractor. I got an adjustment and the doctor said that it should do something to the contractions, though she wasn't sure if either they would stop or progress. I went home to just see what would happen.
That day I was supposed to have a midwife appointment but I just did not feel up to it knowing that I also would be going to other appointments. I called and said I wouldn't make it. My visit that day was supposed to be with a group of pregnant women, based on the Centering Pregnancy model. I just wasn't feeling social enough to be contracting every 8-15 minutes through that meeting. However, I still was able to get a prenatal visit in that day because my midwife's partner lived near enough to me that she came and did a home visit. Based on her assessment of what she was observing from me, she too thought that I could continue in labor for a couple of days.
It was at that point I started wondering what the heck was going on. Why were the contractions so easy? Why weren't they going away? Why weren't they progressing? I got really tempted to check my cervix to see if anything had been happening. I even posted to my local birth group my frustration and asked for opinions on whether or not it was worthwhile to check. A funny thing from that conversation was that the henna artist I had scheduled for the following week to come and do a henna belly for me volunteered to reschedule my appointment to the next day, in hopes that I could get the belly done before the baby was going to be born. We made the appointment and waited to see what would happen.
I also got a call that day from a good friend who had been planning to lead a blessingway ceremony for me the following weekend. She called because she kept feeling like she needed to talk to me about it. She was glad she did when she found out that I was experiencing early labor. She quickly volunteered to call me that night and do a little ceremony by phone. I spent the rest of the day waiting for 8 pm to roll around and just settled in for whatever was in store.
That night, she called and spoke to me about the history of LDS women giving blessings to pregnant women and calling on that tradition, she prayed for me. I will post her prayer on my spirituality blog if you are interested in reading through it. After she closed her prayer, she suggested that I get the older children in bed and then get as much sleep as I could, and get to sleep as soon as I could. As it turned out, contractions changed in intensity and became slightly longer and stronger as I was cuddling children to sleep. My son was quite sure that the baby would be born that night and he excitedly told everyone just that. It sounded almost exactly like what he said on Christmas Eve when he announced that Santa was coming.
At 1 am, I gave up trying to sleep and called my midwife's partner. I still wasn't convinced that I was in active labor but I asked her to come over and see what she thought before I sent her home or called the midwife. The partner came, she checked my cervix and found that I was 5 cm. She settled in to sleep but before she was even able to sleep, the contractions shifted again and became stronger.
Check out that hippie having a homebirth!
At 2:00 am, we called the midwife who then headed to my house. At 2:30, I headed downstairs to the bathtub. My mom was so sweet making preparations as I took over her living space. She gathered candles and laid them out in the room. She plugged in my aromatherapy diffuser and got my favorite fuzzy robe into the dryer. She arranged the towels, gathered seating for midwives and my husband and stayed to hang out with me and chat between contractions. She had never seen a homebirth before and didn't have great births with my brother and I (I was a induction turned c-section for undetected breech and my brother was stillborn). While my mother made her preparations, my husband got my ipod set up and turned on my birthing playlist.
I did not want to be alone during my labor at all, so when the midwives got there, I invited the assistant in and asked her to talk with me. After all the birth supply preparation was taken care of, everyone joined me and we listened to music, laughed and talked.
At one point, my mom asked me if I was hungry and I wanted anything to eat. I didn't really have an answer for her at that point but it came to me awhile later when during a contractions, blackberries occurred to me. I opened my eyes, looked at her and said, "Blackberries." That confused everyone in the room except my husband who was the first to suggest that someone go upstairs and get me a bowl of frozen blackberries. Those were excellent to munch on between contractions. A little later, the midwife made me a fruit and yogurt smoothie and some red raspberry leaf tea.
The midwife really loved the music I had playing. Since it was on shuffle, we got some interesting juxtaposition between songs. For example, Give Said the Little Stream was followed by Bohemian Rhapsody. A little later, Laurie Berkner's Song in My Tummy came on which caused everyone to laugh. My midwife requested that I share the playlist with her because she really enjoyed the mix of music on it.
They were also surprised that for the most part I was able to continue talking and laughing through contractions. All of us kind of believed that not much was going on. We knew that the baby was moving down because the place where we detected her heart rate became lower and lower on my abdomen. Each time heart tones were recorded we used the fetoscope to listen, just as I requested.
Listening to heart tones with the fetoscope
At one point, we couldn't hear the baby's heart beat. We could find mine and the placenta but not the baby. For the most part, we were listening through the placenta to hear it anyway and at this point, it was difficult enough to hear. We tried a couple of different times but not having success, I did consent to try with the doppler just until we found it and heard it. Once I found it, the doppler went off and we knew the baby was just fine.
Around the time I started pushing, one of my favorite gospel anthems came on called Arise and Shine Forth. As I listened, something that my friend prayed for earlier happened. She had asked that I feel encircle about with the love of my heavenly parents and with angels and the spirits of my loved ones. I I felt just that and started to cry. The midwives were also concerned about me, thinking that I was upset and they began to reassure me that everything was okay. A contraction came on and I knew I couldn't explain to them what was actually going on so I managed to say "Its a happy cry, don't worry. I'm okay." I don't think they've heard the explanation for that yet, actually.
Pushing this third time around was the hardest yet. The baby was descending slowly and I knew for quite a long time that her head was still high. The midwife asked if she could go a vaginal exam to see how high the baby was but I was able to tell her just based on what I was feeling. It was around that time I tried to will myself to get out of the bathtub and head either to the toilet (which can help a baby descend) or to the stairs (since she was probably acynclitic). Each time I would try to raise my hips out of the water, the contractions became so intense that I would immediately change my mind.
Getting out of the tub seemed like a good idea, but I couldn't bring myself to do it.
After quite a while of pushing, I told my husband that it would be a good time to wake up the older siblings to come and witness the birth of our new baby. My husband took one look at me and said he didn't think that was a good idea. I realized that the reason he said that was because of how hard pushing had been for me and he was concerned that it would be too intense for the children to see me working so hard. Through each contraction, I was yelling quite loudly with effort. So they stayed sleeping and we let them sleep until they woke up on their own.
At one point, the midwife asked me how long I had pushed with my previous births. The longest had been with my first, a whole 45 minutes. At that point, I had been pushing for longer than 45 minutes. I finally started feeling like the baby had moved down and that I might be able to feel where the baby was if I reached for her head. I couldn't feel her head but I did feel a intact and bulging bag of water. Just then a contraction started and I felt the bag of water break over my hand. Looking at the water of the bathtub, you couldn't tell at all which is always a good sign.
With the bag of water out of the way, her head descended quickly. It was just a couple of more contractions before she was crowning and I was at the crazy point of feeling my body push involuntarily and trying to stop pushing because I felt my tissues stretching and stinging. It took a few moments to integrate and coordinate the movements and with the next contraction, her head was part way out. I could feel her ear off to the side of her head and her soft thick hair floating in the water around her head. The next contraction, her whole body came out and she floated up in the water to my hands.
I picked her up and realized that the cord was quite short. I held her against my stomach as we waited for her to breathe. Right before her body came out, I felt her feet kick inside me so I knew she was awake and alert, but when she got to my arms, she was still. Her face looked at rest like she had decided it was time to sleep. I think that's when I told her rather forcefully that it wasn't time to sleep, that I knew she was awake and it was time for her to breathe. She started making some respiratory effort but it wasn't enough. Everyone who could reach her started stimulating her body tactically. That's when the first assistant noticed the cord was rather tightly wrapped around the baby's back and neck. My second baby completely tangled in her cord! We got her unwrapped and the primary midwife reached for her and gave her a rescue breath mouth to mouth and that's finally when the baby seemed to come into her body. She did not like being breathed into and she yelled and then started breathing.
Into Mama's arms and telling her to breathe
Throughout the resuscitation, the midwives had been talking about her as he. When she was back in my arms I asked if it really was a boy because I hadn't seen yet. My husband and I looked together and saw that our first surprise baby was our second daughter!
I cuddled her to my chest and she with much enthusiasm launched herself at my nipple. She surprised me with how she even knew that there was something she desperately wanted behind that bathing suit top. We got her access to the nipple and she attempted to latch on immediately. Since she's my third baby, I knew immediately that something was really wrong with her latch. In spite of her enthusiasm, we knew that getting her latched on would take some work and that it was best that I get out of the tub at that point and settled into bed. On the way out, I birthed the placenta (which by the way, the midwife said was the most perfect, healthy placenta she had ever seen).
Cuddling with my baby for the first time
Once in bed, her temperature was below the outer limits of normal (97.4) so we got very busy trying to get her temperature up--using a heating pad, blankets, skin to skin and a hat. Because her latch was so wrong and wasn't getting better, I couldn't give try to get her some colostrum to help regulate her temperature. The midwives then recommended that she be given a dropper-full of glucose water (made with blackstrap molasses instead of processed sugar). Once her temperature got up to 97.6, that was stopped. We were all surprised by how long that took to happen.
I then spent the next 24 hours hand expressing colostrum and feeding her with a pipette while I waited to get a Lactation Consultant to the house. When she was less than 3 hours old, I had already called around to get someone over. One LC that I spoke to by phone suggested giving a craniosacral therapist a call (especially after I described her birth) and when she was 4 hours old, she had already seen her first therapist. The next day, we saw the Lactation Consultant and she was diagnosed with tongue tie. I'll post all about that experience in a separate post.
Elizabeth was born at 7:43 that morning, with our children still sleeping upstairs. They didn't wake up until 10:30 or so when they came downstairs and met their baby sister. I was right, they even got to unwrap her just like the a Christmas present since she was so bundled up.
Later that night, we had a little birthday party for her. My husband went out and got a cake and then brought it to us singing Happy Birthday. We all then tried to get the best night sleep we could.
In total, her birth was longer and more exhausting than I thought it would be. I had hoped that hers would be longer than her sister's birth, which I got, but I never even considered that her birth might be longer than her brother's! If I count all the early labor, her labor was 49 hours long, with a 1 hour pushing stage. It was however, a very easy 49 hour labor with only about 2 hours that I would consider intense enough that I had to really get serious.
All together
Brooke said...
You are an AMAZING woman. Such strength to do natural birth:) Congrats on the beautiful baby girl!
Rixa said...
Wow, congrats! I was thinking you had a while more to go, so I was totally surprised at this announcement. Interesting to hear that the tongue-tied latch immediately felt different...
TopHat said...
Congrats! And Woohoo! And I think it's great that you got tongue tie diagnosed as early as possible. The earlier the better!
Lani said...
Congratulations, Jenne! Love this: "She had asked that I feel encircle about with the love of my heavenly parents and with angels and the spirits of my loved ones. I I felt just that and started to cry." :-)
EmilyCC said...
What a story! Thanks for sharing it, Jenne!
Lena said...
Congratulations on your baby girl! Sorry you've missed my home birth, but I am so glad I found your blog! | http://descentintomotherhood.blogspot.com/2012/04/brand-new-birth.html | robots: classic
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Welcome Baby Z! (A Birth Story)
May 17, 2012
I’m not sure exactly where this birth story is supposed to start, but I don’t feel I can tell Z’s story without mentioning certain significant pre-birth events. At 36w1d, my midwife Lisa unexpectedly passed away as the result of a “sudden cardiac event.” Lisa had delivered LM and I was totally devastated by suddenly losing her and her calming presence. I hadn’t realized how much Lisa was a fixture in my vision of Z’s birth; it was as much an assumption that she would be there as that DH would be there! But now Lisa was gone, and since home birth midwives don’t exactly work in group practices, I had very little time to make some big decisions about my birth plan. I really didn’t want to go to the hospital or birth center, and there was only one other home birth midwife practicing (that I was aware of) in my town, so I contacted her immediately, and left a (really idiotic and frantic sounding) message on her voicemail. Fortunately, Amy responded to my message, we met and she was willing to take me on as a client, even so close to my due date. After our initial meeting, the next appointment was the home visit to make sure that all the supplies I had collected for the birth were the same for Amy as for Lisa (since every midwife has a different list), and then it was in to the typical waiting game: weekly prenatal visits, occasional texts or calls to discuss braxton-hicks contractions, natural methods of encouraging labor, etc.
At 39w6d, I officially started to get antsy. L had been born one day before her due date, and weren’t second babies supposed to come earlier? My mom had come to town to help during the last few weeks and during the birth, and here I was seeing no real progress. At 40w2d, we went to my weekly prenatal visit and I was still only about 1+ cm dilated and 50% effaced. I started trying some of the labor encouragement methods, without any encouraging results. A week passed in which two friends of mine had babies, who had been due only one and two days before me. I was very very happy for their new arrivals, but starting to get nervous for myself; home birth midwives can only attend up to 42 weeks; a Non-Stress Test (NST) was discussed, which may have the effect of buying more time, if the “official” results could be interpreted that I was less far along in gestation then previously thought. At 41w2d, it was time for the weekly prenatal again, and I was very hopeful since I’d had sporadic but noticeable contractions on and off since around my due date. I was still declared barely-2 cm dilated, and maybe 60% effaced. We talked about the NST some more and talked about Tuesday or maybe even Wednesday as being the better day for it than Monday. I was very discouraged but Amy was hopeful that labor would start naturally before that. Fortunately, she was right.
On Monday, April 30, around noon, my mom and I were walking around the yarn section of Michael’s when I noticed that I’d had three contractions in a row that actually caught my attention. Mom stared timing them at 12:35, and they varied from six to ten minutes apart for a couple hours, so I decided to start letting people know. I texted Amy the midwife and let her know that I was getting regular contractions, and that I was going to try to lay down for a nap while LM had her nap. I let DH and my brother both know that I thought it would finally be the day, and I would keep them posted. As soon as I laid down and tried to catch a nap, the contractions immediately got much closer together, 3.5 to 4 minutes apart instead of 7 to 8. They were slightly more intense but still not painful in any way, so I just laid in the bed and wrote down the times every time one started, for about 35 minutes until LM woke up and came in to find me. I got up and started walking around and the contractions did not space out farther again, so I called DH and told him to head home (since it was 4:00 at that point, it wasn’t a big deal for him to leave work) and texted Amy, asking her to come by and check me before she headed to a 24 hour visit she had planned, for a baby she had delivered just the day before. I also called my brother to start heading over, since he lives about half an hour away, my sister to come over and start her food prep, as well as the photographer who was coming to the birth.
DH got home and agreed that it was the real thing. My sister arrived shortly after 5:00 pm and jumped right into her food prep duties; it was absolutely delightful to have my birth catered! Sis made mini turkey meatballs in brown gravy, fried rice, and bean dip for tortilla chips, and they were very much appreciated. Amy arrived around 5:15 and we started talking about how my contractions were feeling and whether I felt comfortable with her going to do that 24 hour visit on her other client, who lives about an hour away; I didn’t really, but I wanted her to check my progress before we made any more decisions. Meanwhile, my friend Jenna the photographer arrived and began documenting the event. My brother had wandered away from his phone at work, and missed a few calls for him to come get LM, then my sister hijacked him to go to the grocery store on his way over, so he didn’t arrive until about 6:15–and there was no way that Amy would be able to do a cervical exam without LM having a fit (she is VERY strange about people touching me, even DH). So once my brother arrived, said his hellos and we said our goodbyes to LM for her first night away from both parents, Amy was able to give me a thorough exam. She took my blood pressure, monitored the babies heartbeat, then we went into the bedroom for the first (and only) cervical check I would get.
At 6:55 pm, I was 5 cm dilated and 90% effaced, which Amy declared as active labor and she wasn’t going to leave to go to that other clients house an hour away. I was really relieved since I know how fast LM’s birth went, but I looking back I think Amy was resigned to a long night of labor. After it was all over, Tom and I were amused that no one had really seriously believed how fast we KNEW this labor was going to go, but we did–although I’ll even admit I underestimated how fast it went at the end!
DH and my mother prepared the bed room by clearing off our big dresser for Amy’s supplies, and making the bed up with a clean pair of nice sheets, covered with a heavy plastic sheet and then that covered by a clean pair of cheap sheets for the birth. I put on my birthing gown and the beautiful necklace of beads given to me at my blessingway–each bead from a different person, with a story and words of encouragement for me to focus on while I labored. I love this necklace!
Now that all was prepared, it was just the waiting game, which is recorded in my own memory as basically a cocktail party with contractions. We ate my sisters wonderful hors d’oeuvres, checked Facebook and text messages, and sat around talking about birth stories and Jenna’s photography. My contractions were still coming about 3 minutes apart and were more intense, causing me to stop and concentrate on them, and they lasted about 45-50 seconds. But there was enough respite between them that I could relax and follow what was going on.
At about 7:30, Amy gave me a dose of cotton root bark suspended in water, explaining that it would prevent my labor from stalling and even help move things along. I can’t really say if it worked or not, since my labor seemed to be progressing on it’s own, but it couldn’t do any harm. The cocktail party continued until just after 8:00 when Amy suggested I take another dose of the cotton root bark. As soon as she handed me the glass and I smelled it, I immediately got nauseous and experienced a sensation that I have read about in other birth stories, of “throwing down.” It immediately made sense to me (having never experienced it before) because it felt like my body was using the same muscles to bear down as it would use to throw up. I didn’t think (or I really hoped…) I would throw up but I told DH to get a bucket anyway, just in case. I sat still, in my own little world, while I had two or three really intense contractions and fought the nausea so I could swallow the second does of cotton root bark. The cocktail party went on around me, and Amy told me later that she sent a text to her assistant around 8:15 telling her to be ready to come over but that there was no hurry.
I got up from my chair around 8:20 and took deep breaths while I walked around, and had two more contractions while leaning on the dining room table, which felt a lot better than sitting; all the nerves in my core and pelvic region must have been lit up because the pressure of sitting had become uncomfortable and when DH came up behind me at the table and tried to rub my lower back and hips, I had to tell him to stop. I appreciated him wanting to help, but I didn’t want ANYTHING to touch me, it was too overwhelming. I managed to control the nausea enough to drink the second dose of cotton root bark at 8:26, and felt like I really wanted to go to the bathroom. I remembered this from LM’s birth and knew that I was probably in transition, but I think Amy still didn’t suspect it, until I was in the bathroom and had a contraction sitting on the toilet (didn’t actually have to go, another sign of transition) that made me moan and cry out something that I don’t remember. I really wanted to lay down all of a sudden.
I came out of the bathroom at 8:32 and apparently Amy recognized the moaning for what it was and decided to get her birthing bag out of the car; she had been telling us earlier that “getting the bag” is the signal to her assistants that a birth is imminent. Again, Amy told us later that that is the point when she sent the follow up text to her assistant saying COME NOW. While Amy was getting the bag, I was moving from the bathroom to my bed, and laid down on my side. I had another really painful contraction and told Amy as she came in that I felt like I wanted to push. She was unpacking her supplies on to the dresser top; she told me to drink something and someone brought me a cup of apple juice that I sipped from. My mom said I looked really pale so Amy suggested I take some oxygen and she got the tank and put the mask on me. After a few minutes in the mask and another contraction, I was really off in ‘labor land’ and had no idea what all the people in my house were doing. Amy wanted to try to check what was going on, but I told her another contraction was starting and she told me to lift my leg. I did, and as the contraction peaked, my body started to push on it’s own and my water broke with a huge gush at 8:40. The urge to push became overwhelming and I yelled something vaguely like “make it come out!”
Amy was standing a few feet away at the end of the bed and said something like, “uh, you look complete from here. You can probably reach down and feel your baby’s head” which I tried to do but I wasn’t really able to differentiate between baby head and my own body at that point. She asked me to roll on my back so she could get a batter look, but that triggered another contraction and involuntary pushing which really hurt and I have a fuzzy memory of saying something along the lines of “waaaaaaanna push ahhhhhhh!!” And she told me to get up onto my hands and knees. I had pushed the oxygen mask off when I rolled on to my back and she told me to put it back on as I very gingerly maneuvered up onto my hands and knees. Someone pushed my gown up a bit farther and I suddenly remembered Jenna was around taking pictures and I mumbled something about her being able airbrush the photos (ridiculous where your mind jumps in those few brief moments in between contractions).
At 8:43, THE contraction started. This is the part that I didn’t expect to happen so fast, since LM still took ten or so pushes to actually be born at the end of my three hour labor with her. This contraction was indescribable, the most powerful sensation I’ve ever felt in my life; it started from the base of my neck and forced it’s way down, like squeezing a half-empty tube of toothpaste. I bore down and I could feel the baby’s head descend steadily as I pushed (and yelled) and then a sting as something tore when he crowned and the head came out. Amy called out “nuchal hand!” (which is exactly what LM had, her hand up by her chin, and which had caused identical tearing, on the other side) and I expected the contraction to end, but I only managed to take half a breath when I realized my body was not stopping. It was on a roll apparently, and the position was just right so it kept right on going and I pushed with it and the rest of his body slipped right out.
At 8:44, little Z was born into Amy’s hands, and I finally managed to take that complete breath that had been eluding me for a minute and a half, and then I tried to look over my shoulder at my son. Amy gave him a brief check and made sure he was breathing well, and then put a towel around him so she could pass him back between my legs for me to hold. Holding Z and looking at him after he arrived so suddenly (I’d been standing in our dining room just twenty minutes ago!!) I was overwhelmed and started crying and talking to my son, saying brilliant, memorable things like “Hi baby! Hi baby! I love you!!”
Amy had me carefully turn back over and sit reclined, and as I turned around to face back out into the room, there was a stranger standing in the doorway: Amy’s assistant who had arrived in the 2 minutes between when I got up on hands and knees, and when Z was born. It struck me as really hilarious that she saw my son’s face as his head was being born, before she ever saw my face. At 8:49, the placenta was born and Amy took a look and told me I should probably have sutures for the labial tear. Oh goody.
Everybody was in the room or the doorway and watching as I got Z to latch on for the first time, and Amy was examining the placenta and talking about it for the sake of my mother (who never saw one of her placentas) and for my sister, who despite two home births, never really got a good look at either of hers. After that, everything was sort of a blur, as I cuddled my little Z and let everyone bustle around me. My sister asked if there was anything special I wanted to eat and I couldn’t think of anything except macaroni and cheese, and tres leches cake…so she ran out to the nearest (very close) grocery store and seemed to come back in no time flat with three mac and cheese options, a whole chocolate tres leches cake, a bottle of champagne and a small bouquet of flowers. After Z nursed a little on each breast, DH held Z while I got my sutures, and I partook of my super healthy post-birth meal, Amy finally did the measure and weigh-in with her fish scale; Z came in one ounce and two inches smaller than LM, at 7 lb 14 oz and 20″.
Aside from the few sutures, which I consider utterly insignificant, the whole experience was better than I had even hoped for, and totally worth the wait. Once Amy took a few notes and did a final, thorough exam of Z, everyone packed up and headed out, and we were in our own home and our own bed for Z’s first night earthside. Welcome to the world little Z, you are so loved!
Being born is hard work! Time to nap.
2 Comments leave one →
1. Aimee permalink
May 18, 2012 12:53 am
You are so loved, indeed!! ❤
I loved reading both L and Z's birth stories!
2. May 18, 2012 4:43 am
Love it! Thanks for posting the story 🙂
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} | 2,746 | The Birth Story of Wallace Scott - Oklahoma Birth Photography & Videography
This birth story was a true celebration of FAMILY - with Wallace being the second baby of two cousins born on the same day in the same hospital (on the proud aunt's birthday). All of the grandparents, aunts and uncles, and older cousins were full of so much joy and beautiful emotion that day!
This birth story was a true celebration of FAMILY - with Wallace being the second baby of two cousins born on the same day in the same hospital (on the proud aunt's birthday). All of the grandparents, aunts and uncles, and older cousins were full of so much joy and beautiful emotion that day!
As I shared in my last blog post, reading birth stories has been a significant part of each of my pregnancies... as I have found that soaking in the experiences of other mamas has helped to "normalize birth" for me in a culture where most people never witness a birth first-hand until their own. Birth stories carry so much power... allowing others into a sacred, supernatural space where miracles happen every single day. It is my absolute joy to capture these stories... and I am SO excited to begin a "birth stories" series as I share them on my blog in both written and visual form.
The following story is so precious to me. This mama (a dear friend of mine) was the first to ever open my eyes to the world of unmedicated birth... and I must admit that the first time she told me she was planning one, I thought she had lost her marbles. But as I slowly watched her first pregnancy play out, and heard her birth story after her precious daughter's arrival - I was intrigued and motivated by the complete peace that seemed to surround this process that previously I had always considered more of an "unfortunate right of passage" than something truly beautiful and to be enjoyed.
Being able to be present the second time around was a dream. Kacie labored with so much peace and control (as you'll see in the video) and literally breathed her baby out in a matter of just a couple minutes when the time came. It was a whirlwind of a day, I had been at the hospital since the afternoon before with her husband's brother and sister in law who were welcoming their surprise gender baby... and had been receiving numerous texts from Kacie throughout the day/evening wondering if they were in labor (this mom & dad had decided to keep the event of her labor private until after baby arrived), to which I obviously couldn't reply with any sort of affirmative or negative response. So when I got a call sometime between 3-4am from her husband Kaleb (while momma was in the middle of pushing), I let it go to voicemail, assuming they were probably just having a little bit of insomnia and hoping for an update... knowing they'd text me or call again if it was important.
When the nurse came in the room not long after asking us if "we knew where his brother was," I knew something was up... so I slipped out of the room in an available moment and called Kaleb back to discover that sure enough, Kacie had just checked into triage having gone into labor in the middle of the night. I quickly called my back-up photographer, and let her know there was a slight chance I might be needing her depending on how things played out... and then let my sitter know I'd be at the hospital longer than expected. The next few hours were beautiful and full, heading to the OR with Kacie & Kaleb's sweet sister-in-law to welcome her little one - and then capturing all of the sweet postpartum recovery moments while bouncing across the hall periodically to check in on Kacie (whose labor had stalled temporarily, as if her body/baby knew she needed some time to focus on the health/well-being of her family members). After a couple of hours, I was able to transfer to my "new digs" in Kacie & Kaleb's room full-time, just in time to reflect on the insanely beautiful coincidence of these soon-to-be "twin cousins" before her labor reestablished. I'll let her voice pick up from here...
I can’t really share the birth story without going back to the very beginning.
We found out we were pregnant the day after Thanksgiving and already knew that Kaleb’s brother Nate and his wife Heather were also pregnant and due two weeks before us. We told the family on Christmas morning that they were expecting not one, but two new grand babies over the summer. Heather’s due date was July 26 and mine was August 9. July 26 came and went and Heather was still pregnant. We were all on baby watch as she passed 41 weeks. They weren’t announcing when they were going to the hospital so anytime we didn’t hear from them for a few hours we assumed it was baby time, and then it never was.
On August 3 we went to dinner with Kaleb’s parents and a family friend at Charleston’s and no one had heard from Nate and Heather all afternoon so we all had a sneaking suspicion that it was baby time for them. Kaleb and I actually drove past their house after dinner to see if Heather’s parents were there because we knew they were supposed to be watching their older girls…I don’t much like surprises.
At the restaurant I was feeling really really sore and was waddling around, which I just credited to overdoing it that day. We got Ros from my parent’s and I was super grumpy and finally just walked out and sat in the car because Kaleb was taking too long to get outside. I was so over it. The 100+ degree days were wearing me out. Once we got home I immediately got in the bath, which I did pretty much every day. I noticed I was leaking some colostrum and it was toxic-sludge yellow, so I texted Kaleb from the bath that it was weird. We headed to bed around 10 and at 1 am I woke up to a pretty strong contraction. I got up and went to the bathroom and came back to bed and I had another one, and another one. I was awake enough at this point to not be comfortable in bed anymore. I got up and down to the bathroom a few times because my stomach was feeling crampy and finally decided to get in the tub again.
In the tub I actually downloaded a contraction timer, and in between contractions I e-mailed my assistant an “out of office” response because I hadn’t set one up yet and I guess something in the back of my mind told me I better get my ish together. My contractions were consistently about 4 minutes apart while in the tub. I went back to bed and laid down for a minute and finally woke Kaleb up and told him something weird was happening. He asked if we should finish packing our bags or call the grandparents to come stay with Ros and I said no but finished packing my bag anyway. I think my body knew it was happening but my mind was not on board at all. Finished packing our things and I put on makeup cause Lord knows I couldn’t look ugly if it was baby time. Contractions were still very consistent but I could talk through them and they were manageable.
Kaleb went ahead and called his mom to come over around 3:30 and she headed over right away. We loaded up and Kaleb’s mom arrived to stay with Ros. I was super emotional because she had asked me to cuddle her in our bed that night as a delaying tactic to not have to go to bed like she does every night and I told her no. Mom guilt. So I hugged and kissed her in bed and said goodbye to her.
Once we got to the hospital Kaleb said “that’s Nate and Heather’s car!” and confirmed our suspicions that it was, in fact, their time as well. Which was also weird when we got to triage and told them our last name because they almost got us confused for the other laboring Kinney’s. I just remember thinking, “what on earth are the chances of this happening?!” Here we are 5 days before our due date and they are 9 days over and we are actually here having babies at the same time. What the what.
I got to triage and the nurse said I was dilated to a 5 and that we were going to be admitted. Another bizarre moment because my entire brain still refused to believe the whole event was going down.
This is where it gets weird.
So we get to our room and find out through the nurses and our birth videographer (who was also Nate and Heather’s), that she had been pushing for 6 hours at that point and had to go to get a C-section. (Aside: Our birth videographer literally thought we were just being super nosey about Nate and Heather when we called her at 3 am and hadn’t answered her phone. Like we were so annoying that we actually went to the hospital in the middle of the night to wait for the birth that may or may not have been happening. Still makes me chuckle. ***Brittany's note... mama was in the middle of pushing so I couldn't answer regardless, lol! But did initially assume after a day of calls/texts seeking info that this was another attempt for an update... As Kacie mentioned above, she doesn't like surprises! ;) I do however remember mentioning the call to Kaleb's brother as "odd" and wondering if something was up.*** ) We were walking the halls and Nate came out to the hallway and I just burst into tears. I know Heather’s plans for her birth were changing and it just broke my heart that the birth she had in her mind wasn’t happening. Then it was like a trigger flipped in my body and my contractions all of the sudden majorly spaced out and were not strong AT ALL.
Our bodies are so, so smart. I truly believe my brain told my body that we had other things to worry about at that time and stalled out my labor. It was like this from 6 am to after lunch. Heather came out of surgery, we waddled across the hall to see her and meet our new baby niece, Esther, and I cried more with Heather. We saw her 5-year-old twins come to meet baby sister and all of these events further spaced out my labor. It’s not a bad thing (I actually think it’s really cool), but what are the chances?! It was really special to me that we were able to be a part of their experience (even though it was supposed to be a surprise).
My birth crew was there—Brittany (videographer) had been up all night and switched from one birthing mom to the next, Kris (photographer) and Kylee (Kaleb’s cousin and doula) were all there and there I am feeling nothing. This is where things were getting tricky in my mind. I seriously asked the doctor if I could just go home and come back to try later (mind you I’m dilated to a 6 at this point). I just could not jump back on board. I kept checking my phone for work e-mails because I had fully intended on working all week. Someone had to quote Beyonce for me before I realized I needed to get to work (“Strong enough to bear the children, then get back to bidness.”) So we started walking and using the breast pump to get things going again. I put up my phone and deleted all work apps.
It was around 2 p.m and the birth crew left to get food and I labored in the tub trying to get focused again. Using my visualizations and birth breathing from hypnobirthing helped a lot, but I was still so discouraged because at that time we had been at the hospital 9 hours and I felt like we had a long way to go. We walked, pumped, tried different positions and worked through contractions until my doctor came back just after 5 to check me. I decided I wanted her to go ahead and break my water cause I could tell baby was up and down and hadn’t wedged down like he needed to. Once she broke my water around 5:30 or 6 my contractions definitely picked up. I got in the tub again and things were getting pretty intense. I listened to my music and continued my birth breathing until I was done being in the water.
Got out and got in the bed and things go fuzzy from here. My whole body was convulsing and Kaleb kept asking if I was cold (I couldn’t verbalize that I was in transition so I just kept telling him no). I was laying on my side in bed and I remember saying I needed a break, I was so tired. I think by then it was about 7 p.m. Everything I knew about birth told me I was in transition but still, my brain was really struggling and I think it boiled down to the fact that nothing was happening according to my plans. I told Kaleb very seriously that I wanted an epidural and the nurse pretty much told me ‘no’ so that was out. At this time I felt I needed to sit up a little so they dropped the feet of the bed and raised the back to a 90 degree angle. They pulled over the tray table and raised it high so I could lean over it. I was sniffing peppermint like crack because I was starting to feel nauseous. It was at this point at the end of a contraction that my body did a little push. *this is both the most exciting and most terrifying part of natural labor. Your body totally takes over and there is nothing you can do.
I knew I needed to tilt my hips forward a little bit but I knew it was going to hurt REAL BAD. So I did it. I got into the position I knew was going to bring baby out and I did about 2 contractions here until my body was full on pushing and roaring. I may have been speaking in tongues at this point but I know I was yelling for help and saying I couldn’t do it. ***Brittany's note: What's amazing here is from her birth team's perspective, Kacie was SO calm. Her "roaring" was gentle grunting sounds during contractions - and while we knew birth was getting close, we had NO idea just how close it was! I've never seen a mom be so calm and seemingly relaxed as her baby was making his (very fast) descent. She was seriously breathtakingly beautiful to watch!***All of the sudden I feel major pressure and it feels like I am ripping in half and/or pooping myself. I reach down and sure enough, there is a head halfway out of me! Uhhhh, what do I do?! I yelled “HEAD! HEAD!” and Kris ripped back my covers to reveal that I am not fooling around. Someone calls the doctor and the nurse rushed over and finished delivering the head. Someone asked me to push the rest of the body out but I told them I needed to wait for another contraction. Once the next contraction hit, the body was out and it was over. The whole pushing process took about 3 minutes from start to finish and Wallace Scott was born at 7:56 p.m.
Looking back on the day, I don’t think there was anything that I would have changed except for my own attitude. I needed to give myself a pep talk but instead I wanted to give up. It was like my body said, “Nope, you’re going to do this and you’re going to be okay with it.” I’m so grateful our sweet niece Esther was born that morning and that Heather was okay. We got to have such a great family experience going from room to room in the hospital those next two days which I will never forget. Another amazing example of what women’s bodies are capable of. I am so grateful.
Want to see this birth story on film? Check out the birth story of Wallace Scott below! <3 | http://micahlynnbirthstories.com/blog/2016/10/28/the-birth-story-of-wallace-scott | isPartOf: CC-MAIN-2018-47
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} | 5,559 | Tuesday, October 29, 2013
the real time around {birth story part II}
After being discharged from the hospital for preterm labor, I spent most of my days lying around in bed, walking from the couch to the bed and bed to the couch and trying to play with Ella all while either my mom or my mother-in-law helped out around the house and Russ continued to work. I was basically put on bed rest while still being in active labor. I was so uncomfortable and constantly had pressure. Anytime I tried to do anything that involved more walking or going somewhere other than home, the contractions would start to come on stronger and I thought for sure that the baby would come then. But, the waiting would always continue. I would have contractions, sometimes five minutes apart, thinking we better get ready to go to the hospital...but nothing. They would eventually subside after I would lay down and drink a lot of water. This would go on for weeks. And every week would be another doctor's appointment and I was still staying at a 5 with no progression since the hospital. When I made it to 37 weeks, we all breathed a little lighter. We had made it to full term. We were thankful. My doctor had gone out of town at some point during that week too so I was glad I didn't go into labor (again) while he was gone. We would keep going back for our weekly doctor visits thinking this would be it...this visit is when he will tell us we have progressed a little more and now would be a good time to be admitted, break my water and have this baby. But each visit we had, nothing. Still at 5 cm and no change. I was getting even more uncomfortable and it was getting even harder for me to walk. I really didn't know how much longer I could hold out but I wanted what was best for the baby. One little memory I have is when my very pregnant friend, Lenka and I went to the mall one night (I think I was almost 38 weeks) and we got a pedicure and a blizzard from Diary Queen. We loved some blizzards from Dairy Queen during our pregnancy but I was so uncomfortable that I couldn't even eat mine. After all the walking we did, I came home and started having contractions and thought once again that tonight was the night. We would be going to the hospital. But I laid down and went to sleep and nothing happened. I made it through yet another night. At home.
So, my next doctors visit rolled around and I was almost 38 weeks. Hoping for some change by now, the doctor said I was still the same at 5 cm. He then asked what we wanted to do because he knew I was uncomfortable and it was safe to deliver at any point. Russ and I had already discussed it and pretty much knew that if there was no change, I would want to be admitted the following week and have him break my water. We called family and thought the best time would be the following Thursday to deliver.
After three weeks of being in active labor and on bed rest, I had made it to that Thursday we had planned. It wasn't an induction because I was already so dilated and all he had to do was break my water. We weren't planning on any Pitocin. We were scheduled to be there by 6:30 am on Thursday July 18th (a week before my due date). Our family had arrived the night before (other than my sister and brother who were leaving that morning). We were by all means ready to meet this baby. Everyone was amazed we made it to 38 weeks and 6 days but we did!
We arrived at the hospital early that morning while my mom stayed back with Ella. We had arranged it so my mom could come a little later to be with us and our good friend Kate would watch Ella and bring her to the hospital later that day. I got to the hospital and the staff started to do their thing. All the IV's, questions, monitors and all. This time felt so much better though! I had Russ by my side and we were both so excited. We finally knew today was the day. After all the waiting and anticipating...this was it. We hadn't told too many friends though because we had already told them so many other times on other days that we were having this baby so we didn't want to tell them again until we were actually holding our baby. For real!
The doctor came in shortly after I was settled and checked me. I was still a 5. I then got my epidural and everything was done and ready by 9:30 am. Now, just to wait for the doctor to break my water. I had an epidural with Ella too and I have had such good experiences with both of my births. I am completely aware of everything all while not having any pain. Its what works for me and it has been great. I have been able to actually enjoy the whole process of giving birth and know whats going on because of it. Anyway, I got my epidural and then the doctor broke my water around 10:20 am. The epidural was slightly "one-sided" this time around so I could feel contractions pretty well on the left side of my body. They would at times get pretty intense and strong but we decided not to bolus any and I would just go with it. A short time later the doctor came back to check on me. I completely wasn't expecting him to tell me I was complete and could start pushing at any time now. I remember looking at Russ, shocked and excited all the same time. No wonder those contractions were so strong...they were working and I was complete. This must have been around 1:00 pm because I was still waiting on my sister to get here. Just like with Ella's birth, I wanted my sister in the room so she could capture these moments on camera. My mom called her to see where she was and tell her I was ready to start pushing. My sister got pretty upset because she of course wanted to be here. She wanted my mom to tell me to not start pushing yet :) I'm pretty sure she sped the rest of the way because she made it just in time for me to start. The doctor said I could wait a little longer but soon, the contractions were becoming more intense and I was just ready to meet this little one. I was so ready. So, just as I began pushing, we heard a knock on the door and it was my sister. I could tell she was so relieved she made it on time. She had been crying a little because she thought she was going to miss it.
Anyway, I started pushing around 1:30ish or just after. Things were a little bit more complicated this time around due to the head being tilted a little in a funny position. And, it was a pretty big head at that. So, the pushing continued and would at times take my breath away. I remember Russ at one point grabbing the oxygen mask and putting it on me. Shortly after that, the doctor came back in and said he might have to use forceps due to the head being a little stuck and not moving much. Between that and the oxygen on me, it became a little overwhelming and a few tears started flowing down. I definitely didn't want forceps used and really didn't know what was going on with the oxygen and the baby's heart rate. At times it would dip down with my pushing, which can be completely normal. It was still scary at times. I just really wanted that baby in my arms. I continued pushing and the doctor was soon getting ready for delivery. I was getting really tired and the pushing was getting harder but the adrenaline was there and I knew it would be very soon that I would be holding my baby. The last few pushes came and the head was moving down. Because the head finally started moving down, we didn't have to use forceps. The nurse said "Did your first baby have a lot of hair" and my sister and I both replied with excitement "No, does this one??" We thought she was implying this baby had a head full of hair but she said it had no hair. Ha! We were excited for a minute. I pushed some more and then the nurse told me to stop. She told me to just do one slow push- that the baby was coming and the head was out. I pushed again and knew it was my last one. The baby was coming out. The next thing I knew the doctor was holding the baby up, I looked right where I needed to see whether it was a boy or girl although everything seemed a blur and the doctor says with such excitement "Its a boy"!!!! He was born at 2:59 pm on July 18th. 7 pounds, 3 ounces and 19 3/4 inches of perfectness! I was so relieved that my baby was here and healthy and I could hear him crying. There is nothing better than that. The tears started once again and they put him right on my chest and I just held him. After all that we had been through and all the waiting and anticipation the last 4 weeks, he was here. And he was in my arms. I wasn't all that surprised that I was holding a baby boy. I had a feeling all through pregnancy that it was a boy and then when I had some trouble during labor with the big head, my feeling was even stronger it was a boy. For the first few hours, he was nameless while we decided between the two boy names we had picked out. While I was holding him I told Russ I wanted him to pick the name (knowing full and well which name he would pick out- he liked one the best and I was kind of leaning towards the other name). So, without hesitation, he picked his name. Isaac Garrett Ayers. And I had complete peace about it. I felt we were suppose to have a little Isaac in our family. It just felt right and I didn't think twice when he chose Isaac. It just fit perfectly. A strong meaning behind it and I'm glad Russ wrote about that in his journal. A testimony to God's faithfulness and promises That was actually the name we had picked out for a boy if our firstborn was a boy. So, I knew that was the one Russ wanted to use.
After deciding a name and once the doctor was done stitching me up, it was time to bring in our families. My sister had already sent out a text to them all with a picture of the face but that was all. They still had no clue the gender. With the birth of Ella, we surprised our families by putting a little pink hat on her when we announced the name and gender so with Isaac, we put blue socks on his little feet and wrapped him up. When all the family was in the room, we unwrapped him and Russ announced his name. It was a sweet moment for sure. Everyone cheered and the tears started coming and the smiles were irreplaceable. I looked at Russ' dad at one point and saw tears well up in his eyes. He looked so proud. Then, everyone wanted a turn at holding him. Of course :)
Later on, Auntie Kate and Paige brought Ella to the hospital to meet her new baby brother. She was so excited and loved to say his name. I think she was enjoying all the attention she was getting ;) She didn't want too much to do with him in the hospital or with me for that matter. I think seeing me in the hospital bed kind of threw her off and she didn't know what to think. But, it was so good to see her and be a family of four for the first time. We are so grateful for what the Lord has done in our lives and these sweet gifts He has entrusted us with. May we always bring Him glory and honor because of His love and faithfulness.
Here are pictures of this special day....
the first time around {birth story part I}
I hope I can remember this story since its been 3 months since the birth of our second child. Thankfully, my mother-in-law kept a journal of it all but I want to document it here with pictures.
So, here goes the story of what we thought was going to be the birth day of our second little one. So much to remember and so many emotions to relive and "experience" again...
I was only 34 weeks pregnant when Russ went on his yearly medical mission trip. This year it was to Trinidad. This trip is always planned months and months in advance since its with a mission team so we knew it was going to happen. He would be gone the last two weeks of June. So, June 15th rolled around and Russ was off to Trinidad. With bittersweet feelings, but with confidence that this was His plan at this time.
I was feeling okay as far as pregnancy goes when he left. We had a doctor's appointment the day before he left (on a Friday) and everything was looking really good. I was not dilated at all, my cervix was still closed and I wasn't having any contractions as far as I knew. My doctor felt really good about how things were going and didn't have any concerns. And, since I had no history of pre-term labor, we felt pretty comfortable with Russ leaving to go out of the country for two weeks. However, saying all this, I remember it was about two days before he was leaving and I was feeling a little more uncomfortable than usual. I just had a good bit of pressure and felt a little funny walking but didn't think too much of it. And then having a good doctor's report helped me not to worry too much.
Moving on, the first week Russ was away, life seemed to go on as it should with an active toddler and a big belly. Thankfully, my mom was staying with me for much of the time to help out with Ella. I wanted to stay busy and pass the time so I wouldn't think too much of Russ not being here. I usually get pretty lonely when he goes on these trips and with my hormones and emotions a little more crazy, I didn't want to think too much of things. I remember I would take Ella to the pool, try to hang out with friends, go to the mall with my mom, buy some baby stuff, let Ella take extra long bubble baths and go to the park and to the gym to keep busy. Looking back, I probably did a little too much even with the help of my mom. I just didn't want a lot of time to be still and think. Looks like all that caught up with me. The first weekend, my mom was still with me and we hung out with some good friends in town and went to their friends pool most of the weekend. We had a good time. That was probably the last of my "normal" fun in the sun summer time days. A few days later, (I think it was on Monday) I started to have some symptoms that concerned me. Then, that following Wednesday (June 26th) I had a friend come over for lunch who just so happens to see the same doctor I see and was pregnant as well. She had an appointment with him after our lunch date and I had told her about the few symptoms I had that concerned me. After she left, I became more concerned when the symptoms returned. So, at her visit, she told the doctor but by this point I already made a decision to go see him (I talked to his nurse on the phone). I called another friend (Lenka) who would take me there and I called my mom (she had gone home for just a few days) and told her I thought she needed to come back and stay. She pretty much left immediately. In the meantime, my doctor did call me (he actually called me and left a message because I was on the other line talking to his nurse) and was willing to work me in, my friend Lenka came to take me and my other friend who came over for lunch came back to watch Ella until my mom came back.
As I was waiting to see the doctor, I was feeling pretty uncomfortable and looking back, I realized I was having some contractions in the office. Finally, my doctor saw me and checked me. I was 3 cm dilated and I could tell my doctor was pretty surprised by this, as was I. Then, I had some tightening and a little bit of pain and he told me that indeed I was having a contraction. With there not being much that we could do, I went home to just rest. My mom was already there to help with Ella. I remember trying to eat some dinner but I just couldn't. I was so uncomfortable and just didn't feel right. I tried just laying on the couch but Ella wanted all my attention and wanted me to do everything for her. I think she knew something was going on. I put her to bed and then went to lay on the couch. In between this time, I was able to contact Russ (he had a special phone on him just for me in case anything happened). Thank goodness he answered when I called him. I told him all that was going on. (I didn't tell him anything earlier in case all this was really nothing and I didn't want him to worry). He was concerned but was also at a very important dinner so it was hard for him to talk. After I told him what was going on, he got to work telling a friend there on the trip to make some calls and help get an early flight back. A friend that was here in the States (the MCO administrator) received the call and got busy trying to get him a flight. The team in Trinidad gathered together to pray for us- the baby, myself and Russ flying back. I found out later (through a friend) that Russ had gotten pretty emotional during that time. I just think its so sweet to know so many from across the world were praying for us.
As I was lying on the couch (while all this was happening), I couldn't move much without feeling very uncomfortable and now that I knew exactly what a contraction felt like (thanks to my office visit earlier), I was probably having them every 15-20 minutes. They didn't hurt bad- they were just tight and uncomfortable. And, I was more scared and uncomfortable because Russ was not with me. My anxiety was getting worse and my body started to shake (something I do when I get really scared). I was never able to eat dinner (or anything for that matter).
Russ called back and I told him what was going on and he told me to go ahead and call the on-call doctor which I had already paged him and was waiting on him to call me back. While waiting, I remember looking over at my mom and seeing the concern on her face. She later told me she thought for sure the baby was coming very soon. The doctor called back, told me he wasn't sure if I was in true labor but if anything, I could come in, get checked and get some fluids to hopefully slow down labor. By that point, I knew I had to go. I called one of my best friends (again- she's the one that took me to the doctor's office earlier that day) and without hesitation, she said she was coming over to take and be with me. She's a great friend :) So, my mom stayed with Ella and off Lenka and I went to the hospital. The funny thing is, we were both pregnant at the same time and both pretty huge so as we walked up to the triage floor in the hospital, the nurses were very confused on which one was coming to be treated and triaged! But, I'm sure they could look at my face and tell it was definitely me. I was put in a room and the nurses started doing their thing- IV's, fetal monitor hook up, admission history and all that good stuff. They checked me and I was dilated to a 4. When they hooked me up, I was contracting still about every 15 to 20 minutes but very irregular. The nurses thought for sure I was in labor and began to bring in all the sterile equipment needed for the delivery. I remember throughout the night, Lenka and I would periodically just look at each other with wide eyes. Neither one of us needed to say anything. We knew what the other was thinking...this baby is coming tonight. And Russ isn't here. We even discussed creative ways to tell Russ the gender of the baby. Lenka for sure thought she would be there to witness the birth of this child and be the first to know whether it was a boy or girl (this all happened on Wednesday, June 26th when I was admitted for preterm labor. My due date wasn't until July 26th).
At this point, because I was almost 36 weeks ( I was 35 weeks and 5 days), there was not much the medical staff could do to slow the labor. They did give me Terbutaline to try to slow the contractions down. It worked for maybe an hour but then the contractions started to pick up again. During this whole time, my body was still shaking uncontrollably because I was so scared. But I also remember realizing that I was (what I thought) going to have this baby within the next few hours so I just had to accept it and at that point, I had. I had this peace that overcame me and I just wanted to try to stay calm. All I could hope for at this point was for a healthy baby because it would be a preemie. I had come to accept that. Russ called soon after I got there and he was so upset. He too thought at this point the baby was coming that night/early morning. I felt like I had to stay calm for him and I remember God just gave me this strength and courage to talk to Russ and tell him everything was going to be okay and we just needed to pray for a healthy baby.
At some point, the nurse came back to check me and I had dilated to a 5. At this point, I was considered to be in active labor. The contractions were coming on stronger and a little more frequent. I could feel them. They would ask me from time to time if I wanted an epidural but I wanted to hold off a little longer. They did give me Demerol/phenegran combo to calm my nerves (shaking) and discomfort I was feeling. It definitely worked and I was out of it and talking crazy within minutes. It helped me sleep for a few hours. Lenka was still there with me (she stayed until around 5am when my mother-in-law arrived) so we got a few hours of sleep.
So Thursday morning rolled around, I was still 5 cm, my mother-in-law was now with me, I was still contracting, in active labor, no epidural, and Russ was on his way to catch his first flight back. The on-call doctor came in and thought I might still possibly be in false labor and could even at some point go home later that day. I thought that was kind of weird but held out hope that that could be true. But then at some point my doctor came in and thought differently. When I asked him if I could possibly go home today, he looked at me and laughed saying "absolutely not". He thought I was in true labor and would have the baby that day. So....the waiting game continued. For the rest of the day. My mom and mother in law were both there throughout the day visiting me and watching Ella. I had some friends come and visit. I talked to Russ a lot throughout the day and he was giving me updates with where he was and his flights etc. My sister came after work to stay as well. We were all getting prepared for the baby to come. Throughout the day, my doctor would come up and check me and see how I was progressing. And at this point, I wasn't really progressing at all. I remained 5 cm still and the contractions started to just slow down on their own. Russ was still catching flights and doing his best to get here as fast as he could. The waiting game continued. Lenka came back up to see me and painted my toenails for me since I wasn't at all ready ;) I think by now Russ had gotten an earlier flight then originally scheduled and he was going to arrive around 9pm (still Thursday). We were beginning to think that he might just make it in time. So, throughout Thursday, I never dilated any more and my contractions never picked up again. This, I was told, was very unusual. Labor usually doesn't just stop like that. I told Russ on the phone this and I could tell he was excited and I knew that he believed without a doubt that he was going to make it in time and wasn't going to miss the birth after all. Its funny looking back because I remember all my friends checking in on me through phone calls and texts, wondering if the baby had arrived yet. They were all concerned and praying. We had so many people praying for us. Constantly checking in on us. And they were all surprised when we kept telling them no baby yet. The medical staff at the hospital was great too. They were all concerned as well that Russ would probably miss the birth and kept checking in on me and were so kind. They all got so excited when I told them he got an earlier flight back. They went out of their way to make sure I was comfortable and was always checking to see where Russ was. Everyone was just about on pins and needles waiting and couldn't believe nothing more had happened throughout the day. At some point on Thursday evening, before Russ got there, my doctor, after checking me again and no progression still, thought that maybe I could go home on Friday (the next day) if things continued this way. I remember feeling so relieved. I was so amazed that my labor had slowed and basically stopped. I was so excited to see Russ come through those doors soon and have him close by again.
Russ arrived at the hospital around 9:30 pm on Thursday. The nurses cheered when he got there and I cried tears of joy when he walked in my room. He did too ;) I was so very relieved. I remember thinking that at this point, whenever the baby came, everything would be okay. Really okay. It was such a sweet time and a time I will never forget.
We left the hospital the next morning, still very pregnant. Very uncomfortable but still very pregnant with a healthy baby inside. All we could ask for. I was still in active labor and was pretty much on bed rest for the remainder of my pregnancy. But I was so glad to be going home with Russ and hoping the baby would last until at least 37 weeks when I would be full term. We texted or called all our family and friends who were actually awaiting the arrival of our little one; waiting to get a text whether we had a boy or girl but instead we thanked everyone for praying for us and that God had graciously answered our prayers- Russ made it home safely without missing anything :) and the baby was still healthy and active...and inside my belly!! The truth is, God is so gracious and I felt it most during these few days. He really did answer all our prayers, every little detail He had worked out according to our requests. I remember the text that Russ sent out to our friends as we were leaving the hospital "thank you for all your prayers. God has graciously answered" I am forever grateful. For this time, for how the Lord worked in our lives through this story He was writing and I felt Him ever so near those few days in the hospital without my husband and with so many unknowns.
So, to wrap up this ended-up-to-be-a-crazy-long-post, we went home at 36 weeks, healthy and happy. And together. We went home on a Friday and the next day was my birthday. We were all wondering if I was going to share it with the little one. My mom and sister and mother-in-law were still at the house and we had an early birthday dinner cooked by my mother-in-law. It was especially delicious considering all the hospital food I just had. My sister and mom went to a local cake shop and brought us back some yummy cake and we did a little celebration. I even remember Ella singing "happy birthday to kar-win" with her toy carrot and a candle in it :) I was feeling pretty drained and exhausted and very uncomfortable at 5 cm but sure happy to be home.
It would be another three weeks until we would meet our little one and know whether we would be adding another little girl or bringing home a son. The excitement was getting unreal and was that much more anticipated considering everything we had just been through. But I will save the best part of the story for the next post since this one is crazy long and I went into more detail than I thought. I know its important for me to write this down and remember it. I feel like I can't tell this birth story without telling this part of it. Not just for the memories, which some were definitely made, but to be reminded of how gracious our loving Father was and is and how He is able. And just when all the doubt and all the unknowns become so overwhelming, He is there and will most definitely show Himself faithful. I will never forget the sense of peace I felt during that time. And I love looking back and seeing how He worked in our lives. Because little did we know what an amazing story He was already writing for our soon to be precious little one.
Yet the Lord longs to be gracious to you; he rises to show you compassion. Isaiah 30:18
(This was our verse during this time and one that we certainly felt during those days. We held on to it and it became our encouragement and hope. May we always be reminded of His graciousness and compassion).
And because why not add a picture. Of me in the hospital. Lenka took this picture of me shortly after being admitted. We were both scared and didn't know what to do other than just laugh and try to make the most of the situation (when we all thought for sure the baby was coming soon). Glad I had her there with me to make some fun memories with!
Friday, October 18, 2013
its been awhile....
Soooo, its been awhile since I last blogged. No surprise there. But, I hate that I haven't blogged about one of the most special moments of our lives. Our baby boy! (more on the birth in another post). We welcomed our sweet son into the world three months ago today. Really, three months? I'm in denial. Anyway, I hate that I haven't blogged about his birth yet because I know I will always want to look back and read and remember just how amazing (and hard) it all was. I don't want to forget. I thought I was done with this blogging stuff. But, I realize more and more how meaningful it is for me to "journal" and remember things and have this to look back on. For me, for my husband and for my kids. So many days I just sit here and stare at my babies, knowing each day they are changing a little more, growing a little more, and they will be just a little different than the day before. Because it all goes by so fast. And they grow up so fast. I really want to try harder to document these days- the hard, exciting, trying, happy, weary, crazy days because I know I will forget. And these will be some of the sweetest moments I will ever know- even if I can't fully see it now.
So, here's to remembering my baby girl, my firstborn, becoming a big sister and the way she jumped with excitement when her "auntie" friends brought her to the hospital to meet her little brother. And the few days in the hospital after birth wondering how in the world I was going to transition to a mother of two and not just do my new role, but do it well. And coming home as a family of four and sister being so excited to have us all there- especially the newest addition. And all the sweet moments, from the very beginning, that she loved on her new brother and read to him, cooked "specialables" aka vegetables from her kitchen for him, ran to get his paci for him, would be so excited to help change his diaper and if you didn't let her help, she would get so upset, and talking so sweet to him saying "its ok baby Isaac".
I want to be able to look back and remember these days of raising little ones. I know I will long for it all again one day. And I know I will cherish having these memories to remind me and make me smile.
And just because...I need a picture.
And he's already 3 months old.
And really cute and irresistible.
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levi's birth story
It's almost been four weeks now that our second son entered our little world...and once he decided to come, he was quick and he was ready to introduce his sweet little self to us. So, this birth story was quite different and pretty eventful compared to our other two. And very fast!
It was Wednesday, January 14th and Russ and I were going about our normal day. I was feeling some contractions but this was nothing new. I had been feeling contractions since about 32 weeks and they were non-painful and very irregular so I wasn't in the least concerned. Just the common Braxton Hicks. I also had a little pressure but again, nothing new. I had been feeling this pressure for awhile as well and it was nothing different. I was 39 weeks and 1 day. At my last appointment (which was right when I turned 38 weeks, so just over a week ago from the 14th), I was only 1 cm dilated and 20% effaced. My next appointment was scheduled for Friday the 16th and my doctor and I would possibly talk about setting up an induction date depending on my dilation.
So, back to Wednesday...things were normal...Russ at work, me at home with the kiddos. Our good friend Kate was coming over around 6 so Russ and I could have our "last" date night before baby. We had a few date nights already thinking the baby would have come by now but sweet Kate offered to watch the kids for us since I was still pregnant and give us another date night. Couldn't pass that up ;)
So, Kate came over and the kids were excited she was here. Russ and I went on our way to one of our favorite restaurants- Tako Sushi. We ordered quite a lot of food and it was good! We really enjoyed our time there, just talking and eating and being together. I was still feeling "normal" for being my pregnant self. After we finished with Tako Sushi, we headed over to Target to get Ella some new pajamas for her school the next day. They were having "pajama day" in her class and she needed some new ones to wear (that wasn't a gown or footies). We found some pajama's and got a few extra little things but did a good bit of walking around the store. I remember telling Russ I was having a few contractions, but again, they weren't painful and weren't regular so I didn't think much of it...this was nothing new in this pregnancy.
We went home after Target and Kate had the kids in bed and we talked for a bit to her and then she left. Russ and I stayed up a little longer and watched a show on T.V. before heading upstairs to get ready for bed. Russ went up first to shower and I cleaned up some in the kitchen just in case we went to the hospital during the night or the next day....I wanted to have the house clean and dishes put up etc. (my crazy nesting). I definitely was feeling a bit more pressure at this point and thought I better not do anymore and should just go upstairs and get ready for bed. I was a little more uncomfortable than usual but I didn't know if it really meant anything at this point. I think I finished cleaning up for the most part and then headed up to shower. This was around 11:15 or 11:30.
I remember thinking, as I was getting ready for bed and in the shower that maybe I should just not shower and leave my hair and make up as is in case we had to go to the hospital because of the pressure I was feeling. Ha! Kind of crazy! But, I showered and then got in bed which Russ was already in. It was just before midnight.
Well, as soon as I laid down in bed, the contractions started immediately. I felt the first one and thought it was a little more intense then any I had felt during my whole pregnancy so I just waited to see if there would be another. Another one came, maybe 5 or 10 minutes later and still, more intense than I had experienced before. I told Russ what I was feeling. He was already asleep and told me to wake him up in 5 minutes if it happened again. I waited and I had another intense contraction but I didn't wake Russ up....I just didn't know if this was it and this is when you're suppose to head to the hospital or if it was just false labor (which I had been in before with my second pregnancy). At some point, I woke Russ up again and he again told me to start timing them and wake him up in 5 more minutes. The contractions kept coming and they were still intense and just different feeling. I never did time them because I basically didn't need to...they were consistent and coming about every 5 minutes. They finally were strong enough to where I was moaning or deep breathing while lying in bed and I woke Russ up (who had at the same time woke up because he heard me and was becoming a little concerned at this point). He decided he better go ahead and check me. I was 4 cm and my cervix was very very thin. He said he could feel the water sack. So, he immediately got up and said we better go to the hospital while staying pretty calm. I knew that if he thought it was time to was time to go! So, we got up and dressed and got our bags and I made Russ make the bed ;). He called our neighbors, Brian and Chelsea while I got some last minute things together. I was still able to walk and do things but the contractions were still coming. Our neighbor came over and got the monitor to watch the other kids and Russ and I were out the door. This was around 1:00 am. We called my mom on the way to the hospital and told her we were on our way and to just be ready and that we would call her again once we got through triage. She was excited and I'm pretty sure already ready! We didn't call Russ' parents because we didn't want them traveling from Carrollton in the middle of the night.
We got to the hospital just after 1:00 am and Russ dropped me off at the doors while he parked the van. I waited for him and then we went straight up to L&D triage. We walked around for a minute, not able to find a nurse. It was pretty quiet up there and there weren't any patients in triage from what we could tell. Russ finally found a nurse and told her that his wife was in labor. They put me in a triage room, asked a few questions and then told me to change into a gown and left for a few minutes. Another nurse came back and checked me. I was 6 cm at this point and now the contractions were getting stronger and I remember having to hold Russ' hand when they would come. They were definitely more painful now. Russ was already telling the nurse they should page my doctor because I was going to go fast once my water broke. She didn't listen though. We knew they had certain protocol to follow but we also knew that things were happening and happening fast...and from my past pregnancies, I was gonna go quickly. I also made it clear to her that I wanted an epidural. But, I already had a feeling from the time I got there that this whole thing was gonna happen fast and there probably wasn't going to be time for my doctor or an epidural for that matter. But, I held out hope ;)
They immediately put me in a wheelchair and took me to a delivery room. I remember there were like four nurses in there when I got there, all busy doing stuff in the room to get it set up...moving pretty fast.
I got in the bed and one nurse wanted me to lay down so she could hook me up to the monitor. At that point, I was in so much pain and the contractions were in full force that I really didn't think I could lie down like that. I somehow did and she hooked me up. Then another nurse attempted my IV, missed and another nurse got it in the other arm and drew labs as well. They said they needed the labs in order to get an epidural...This whole time I was squeezing Russ' hand and couldn't let go. I told them I couldn't lay like that so the nurses told me to turn on my side. I did but it didn't help much. The contractions were just so bad. I later found out the nurses wanted me on my side so no baby would come out! I remember I kept asking for my epidural. We knew the anesthesiologist was in house and just got done with a surgery but they would not page him. I also kept asking if they had paged my doctor but that was a no as well. Then, at some point, I remember looking at my nurse and saying I wasn't going to have time for the epidural and she just kind of looked at me with pity and said I was doing a good job and everything would be okay. I knew what that meant and I also knew things were moving way fast. Things kind of get blurry for me here and I don't remember too many details...other than the pain ;) But, I kept feeling this crazy, painful, weird feeling that something was coming out of me and I couldn't stop it. It was like my body was pushing something out and I wasn't doing anything. I couldn't stop it or control anything that my body was was just happening and it was such a weird feeling. I wasn't pushing or trying to but my body was taking over and there was nothing I could do. I remember yelling to the nurses multiple times, "something is coming out" and I was looking at Russ...very scared! A nurse checked me again around this time and apparently, I was complete. I was still on my side and there was no doctor yet. The nurses would check to see if my water had broke in which at that point, it had not. Russ says that once I was complete is when they paged the on-call doctor and my doctor as well. They never did page the anesthesiologist. Anyway, I was complete and the pressure was unreal, the contractions non-stop and I was (what felt like to me) yelling and telling everyone that I just couldn't do this. I kept saying that and really didn't know how I was going to make it and have this baby without an epidural. It didn't seem possible for me. But, Russ stayed by my side and I just squeezed his hand and never let go. He said at one point, he had rolled up his sleeves and was ready in case he had to help deliver the baby.
The next thing I knew, I turned over in the bed (my back was to the door) and there was a doctor, gowning up quickly telling me her name and also that she was going to deliver my baby. I just remember looking at her with this awful, dreadful look and thinking to myself...I don't care who you are or what you're doing but you better help and get this baby out of me now! When she got there, I still remember yelling that something was coming out and finally at some point, my water broke and the head was basically out...Russ could see it. It was so painful and the doctor was still gowning up but they told me to put my legs in the stirrups so I managed to do that. Then, the doctor was ready and they told me to wait for my next contraction because the baby was coming out. I remember asking her to please get it out! I waited and it felt like years but was really only seconds (I guess) and then the contraction came, I pushed and out came the baby. With just that one push. It was January 15th. He was born at 2:05 in the morning. I was looking trying to see if it was a boy or girl. Since my doctor did not make it in time to deliver me, the doctor who did didn't realize we didn't know the gender so it wasn't a big deal to anyone but Russ and I. I was looking but then I heard Russ say "Its a boy"!! Levi Thomas Ayers. He was here and he was big weighing in at 8lbs and 8 ozs. Our biggest baby by far! I was a little surprised since neither of us had strong feelings on what the gender would be but at the same time, I was in so much shock and pain that I couldn't really focus on anything else...not even my new baby. I remember asking if everything was okay with him and it was. I remember hearing him cry and Russ snapping a picture real quick of him and the nurses taking him over to the warmer. But that's pretty much it. I was kind of in a daze and still hurting. Then, my doctor and the on-call doctor came. The on-call doctor peeked in, realized he was too late and left. My doctor stayed to stitch me up. The doctor who had delivered me had already started stitching me up. She had numbed me but I could still feel what she was doing. My doctor took over and had to numb me again until I finally couldn't feel it anymore. I apologized to the delivery doctor for anything I might have said while delivering. It was pretty crazy. The nurse asked me if I wanted to hold him but I just couldn't. I felt so disconnected from him those first hours because I was in so much pain and couldn't believe we had just had a baby. I do remember Russ holding him with a big smile on his face and that made me feel better. I just remember feeling no emotions when the baby came because it was so crazy...quite the experience for sure.
After getting stitched up, they wheeled us into a postpartum room. My mom got there sometime around 4 in the morning. She came to our room and then went to look at Levi in the nursery where he was getting cleaned up. She then went back to our house so Chelsea, who ended up sleeping on our couch to be with the kids, could go home. We were so exhausted but also unable to sleep from everything that just happened and happening so fast. We were just thankful that we had made it to the hospital in time and that the labor happened as fast as it did and that Levi was healthy and here. And we were ready for some rest!
Looking back, I still can't believe what all took place that morning. I know labor can happen fast but I never really prepared myself for what I went through. I'm grateful though and although I wouldn't want to do natural again, it is kind of an amazing experience to have and have gone through...but thank goodness it was super fast cause I don't know how I could have lasted another minute. Some say you'll forget about the pain you felt....I'm not sure about that yet but I know I will never forget this birth story. Every story is certainly a miracle and I thank God for these little ones He has entrusted us with. Levi was and is definitely worth every bit of pain I felt and I would do it all over again just to have him in my arms...right where he belongs.
Ephesians 3:20
It's a boy!!!
welcome to the world sweet Levi Thomas!!
first time holding my little guy
first photo with Levi right after his birth with mommy and daddy
sweet BIG boy!!
This was right when Ella and Isaac came to the hospital to meet Levi. When I called her on the phone later that morning, I told her mommy had her baby. She asked me "what kind did you have?" I told her we had a baby Levi and she said "but what kind" and I told her "baby boy Levi" and she almost cried to me "but I wanted a baby sister"and then right after that she said "when can I come see him, I want to see him now"....
This was the first time she saw him. She was sure to hold him right away and didn't want to put him down. She was all smiles and such a proud big sister. She never mentioned anything about a baby sister since. She also told me "mommy, you love Isaac...this is my baby"!!! Melts my heart! I love how she loves her brothers so. She wanted to be near him the whole time and hug and kiss him constantly. For awhile, she would call him "baby Eli" ;)
my three sweet little loves! My heart is full!
first family of five photo...I have a feeling this will be how it is for awhile trying to get a pic of us all...a new normal :)
just loving on her littlest brother
checking him out
Isaac loves to pat his head
more loving from the siblings...they couldn't get enough of little brother
Auntie Kate brought Ella and Isaac to the hospital. Here she is meeting Levi for the first time. The kids love her!
they love him already ;)
more head patting ;)
a happy big sister
Auntie Lenka meeting Levi for the first time!
proud big sister with her sticker on and she really liked that little balloon Auntie Lenka brought..she had to take it home with her
sweet boy
Nana helping sissy hold Levi
those cheeks....
checking out Nana...;)
Grandma and Nana with their 3 grand babies
more alert now and checking out my baby
this is Ella's big sister bear that Nana bought for her in the hospital gift store...Ella put it right up there with Levi in the bassinet when she came into the room (the second day) so Levi could snuggle it ;)
lovin on her brother
she is in love and my heart is overflowing
these are pictures that Auntie Kate took...just more of the siblings meeting Levi
i love Isaac's face here and how happy he is
pretty intense brother interaction ;)
all ready to take this sweet boy home!!
i just love this face
daddy and his newest little boy
mama love
first car ride...home!
we are home and Levi's siblings were sooo excited to love on him more...
big brother lovin...looking so proud
this is one loved little boy!!!
Welcome little Levi! We love you so much and you are the perfect addition to our family! We praise God for you, a good and perfect gift from Him! You will be forever loved and cherished, sweet boy! | http://karenandrussayers.blogspot.com/2015/02/ | robots: classic
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He's Here.
Last Picture as a Family of 3
It's so surreal going to bed and knowing you're going to have a baby the next day. The night before my induction, I didn't sleep... at all. Maybe a combined 2-3 hours? When my alarm went off at 4:50am, my stomach was full of butterflies.
The day had finally come.
We got to the hospital at 6:30am... it was so weird just showing up at the hospital and walking in like, "Hi, we're here to have a baby." I was very nervous - never nervous about the actual labor and delivery, just nervous about whether or not the baby and I would be okay.
I changed into my gown and settled into the hospital bed. I was immediately poked and prodded to check my platelets since I'd stopped my blood thinner injections the morning before. The doctor came in and checked my progress - 1cm, which is what I had been at my 39-week checkup two days earlier. They started some cervix softening meds, and said they'd come back in four hours or so to see if things were progressing. So, we waited. I tried to sleep, but was too anxious and started having cramps and contractions that were just uncomfortable enough that I couldn't fall asleep. So, we waited. I tried to catch up on my celebrity gossip magazines, and browse Facebook and Instagram, and read some blogs - but mostly I just kept watching the clock, saying prayers, trying to stay calm. And we waited.
And then, there was a knock on the door. I saw someone trying to peek into the room and thought, "Well obviously that person is in the wrong place." And then the door opened, and I saw her - my (co-) best friend, my big sister. My Lu. Who had driven 6 hours the day before with her family of 5 to surprise me and be there for Rocky's birth. I was so shocked and touched and immediately cried in her arms, repeating, "What are you doing here?! What are you doing here?!" Seeing her walk into that room is a moment I will never forget, and I immediately felt more at peace knowing she was there with me. <3
After a bit she left to go back to her three kiddos at the hotel, and we continued to wait. The doctor finally came back to check my progress and I was 3cm. The first round of meds had worked! I have to admit I was relieved, as I'd been worried that my body wouldn't respond to the induction. So far, so good. We decided to start the pitocen to really get the party started. My OB and I opted to wait on breaking my water, so that the pitocen could help my body ease into true labor. Shortly after the pitocen, the contractions started getting pretty regular, increasing in intensity. I knew that getting an epidural too soon could slow down my progress... so while I wasn't trying to be superwoman, I had decided that as long as I could handle the contractions, I would wait on the pain meds.
So... we waited.
My mom and stepdad got there soon after the pitocen and, again, I immediately felt more at ease with them in the room. We talked, I breathed through contractions, we watched tv, I breathed through contractions.
I then had another surprise visitor - my friend Amanda! I was totally shocked when she walked in the door with the biggest smile on her face, telling me she just couldn't stay away. Amanda is the type of person who comes into your life, instantly making it better and you better for knowing her... I met her ten months ago and feel like we've been friends our whole lives. And again, having her presence there in that room meant the world to me.
My sister returned with her three kiddos in tow, and the delivery room became pretty busy pretty quickly. I loved it! It distracted me from my nerves, from the pain of the labor, from the reality of what was about to happen. But then we got in trouble, because apparently I missed the memo where kids under 12 weren't allowed in the delivery room unless they were siblings. So, the Lutons unfortunately had to relocate to the waiting room.
Finally, at about 5:00pm, they checked me again. 5cm! I was glad to have made progress, but based on the contractions, I had hoped I'd be a little further along. My doctor had told me, though, that during an induction it's usually slow to get to 5cm, and then it tends to go quickly from there.
And FYI, we had opted to keep CK at home with my sister-in-law and mother-in-law all day on Wednesday. We did this for a few reasons... We weren't sure how long the process would take and didn't want her sitting around the hospital for hours. Also, we wanted to make sure "Rocky" and I were both okay before we brought her around. And lastly, we felt this baby deserved to be the center of our universe on his/her birthday - we wanted Wednesday to be all about him/her. :) I am so incredibly thankful to have had CK in such good care. We received a lot of pictures of our girl throughout the day, and I knew she was in the best possible hands.
So, my doctor decided it was time to break my water and call in the epidural. She said as soon as she broke my water, things were going to get really painful, really quickly. And she wasn't kidding. Within 10 minutes of my water breaking, things got REAL. Luckily the anesthesiologist was right behind her. The epidural was in at about 5:45pm, but it took a solid 30 minutes to take full effect and whew, it was intense!
All was well... and then it wasn't. The nurse came in with a concerned look on her face and told me we needed to get me on oxygen and change positions asap. The baby's heart rate had dropped from the 140s to the 80s. I knew that wasn't good. And then, all of a sudden, I felt so weird. And nauseous - oooooh the nausea. I had an oxygen mask on and a throw-up bag and I was so scared for our baby. At this point it was just T and me in the room - he was by my side, squeezing my hand and assuring me everything would be okay. They pumped some Zofran into my IV which worked quickly, thank goodness. So the nausea subsided and with a few positions changes the baby's heart rate came back up. Of course, I then wept from the worry that had gripped my heart during those tense minutes... it was exactly what I had been fearful of during the weeks that led up to the birth - so scared that something would still go wrong.
The doctor came in and checked me again, and I was 7cm. Good progress! I finally felt well enough to have some of our family come back into the room... my hub's mom and stepdad brought dinner so everyone ate and hung out in the room and I basically just focused on my ice chips and the baby's heart rate on the monitor. I guess there was a change in the heart rate again, because the nurse busted up the McDonalds party and said she needed to check me because the baby seemed to be distressed again.
So a little after 9:00pm, T stuck his head outside of our door and said to our anxiously awaiting family: "It's go time."
All of a sudden, I was completely overcome with nerves. Literally shaking in fear and anticipation. And the nausea came back. And I was the most thirsty I had ever been in my whole life. It was all so weird. With another throw-up bag in tow, I was given a second dose of Zofran to curb the nausea. It completely caught me off guard... how nervous I was. T held my hand and I just kept telling him, "I'm so scared." Again, I wasn't scared of the pushing or the delivery, I just wanted our baby to be okay.
The nurse paged our doctor to tell her it was time and got the room "delivery-ready." This meant breaking down the bed, turning on these huge ceiling spotlights, and setting up a mirror (my request).
Then, the nurse said we should try a practice push while we waited for Dr. T. It's funny, trying to push when the entire bottom half of your body is completely numb. I literally couldn't feel a thing. But, one practice push and the nurse said, "Ok STOP! The baby is right here. We gotta get the doctor here quick or I'm going to be delivering this baby without her."
"Did you see hair?!" I asked.
"I did!" She said.
Finally Dr. T showed up and it really was go-time. I pushed three times through a contraction, and the head was almost out. And yes, I watched it all in the mirror and y'all - it was probably the coolest experience of my entire life. So once the head was almost out, the heart rate started dropping, and it started dropping fast. In the 70s and 80s. The doctor said maybe the baby was just behind the pelvic bone, but I could see the look of concern on both her and the nurse's face.
"Ok," Dr. T said, "We can't wait for the next contraction. We need to get this baby out now. Push."
So that's what I did. I pushed with all my might, closing my eyes from the effort but also trying to peek in the mirror and watch my progress. I could see the baby coming, which motivated me to keep the push going, even though I had no breath. But I didn't care, I knew that for the baby's sake, I had to keep pushing and not stop, and that was all the motivation I needed. I couldn't feel any pain, but I could feel pressure mounting and knew I was almost done. All of a sudden, I felt the relief of pressure and looked up and immediately saw all I needed to see. I looked over at T, and by the light in his eye I knew he'd seen it, too...
IT'S A BOY!!!!!!!!!!!!!!!
We both exclaimed simultaneously.
We were both so shocked, so excited.
It literally felt like a dream.
They immediately put him on my chest, a moment I had always wanted to experience. I remember thinking he was so warm, and so, so perfect. "Hey buddy, hey buddy" was all I could muster as I was lying there in total disbelief while T cut the cord...
We had a son.
I have never, ever in my life seen my husband so overjoyed. Of course he was happy when CK was born, and was completely taken over by his emotions when we had her. But now, he was in total disbelief that he had a son - he honestly didn't think he'd ever have a little boy, and I could see so many dreams coming true just by the look in his eyes.
I held my little boy for awhile, then they took him to clean him up and get his stats.
Everette Lawrence Peele
Named after his great-grandfather, Lawrence Everette.
And his daddy and PaPa, who are both Terry Everette.
20.5" long, 9lbs 15oz.
Born at 9:41pm on Wednesday, November 5th, 2014
One more ounce and he would've been in double-digits! And he was a week early!!
I looked over at T and he was texting. "What in the world are you doing?!" I asked.
"I have to tell my dad, he has to be the first to know." he replied. :)
They finally gave me my baby back, my little boy, my son. We did skin-to-skin for awhile, and T and I just kept looking at each other -- we didn't have to speak, we knew exactly what the other was thinking.
I was able to nurse for a bit, and T went to the waiting room to announce the news to our waiting families. When he came back into the room, he finally scooped up his little guy and stared at him, so proud... "Hey son! Hey son!" he kept repeating.
We welcomed family into the room and watched them all fall in love with our boy.
Once everyone had gotten in their hugs and kisses, it was just me, my hub, and our son.
They took Everette to the nursery to clean him up and keep an eye on him for a little while, and T refused to be anywhere but by his side. He stayed in the nursery the entire time, making sure E was okay and well taken care of. Meanwhile they were tending to me and my battle wounds, and trying to get some of my postpartum bleeding under control. They were forced to continue the pitocen for a little while to try to keep my uterus contracting to cut off the extra blood loss that seemed to be occurring. So, we ended up having to hang out in the delivery room for quite awhile before we moved into our actual hospital room.
Sometime after midnight, we were relocated to a room where we continued to stare at each other in disbelief. Y'all, we were so happy. I can't even put it into words. It was like every single worry, hardship, tear, disappointment, heartbreak of the past two years came together and told the story of how we met our son, our Everette. Of how our family was completed. Of how 3 became 4 and how we knew we've been through all we've been through because God knew we needed this baby, this child, this perfect miracle.
And let me tell you, a miracle he is.
You see, when he was born there was an audible gasp from both the doctor and nurse.
"A complete knot in the umbilical cord... wow." I heard someone say.
We're not sure when it happened, but Everette's umbilical cord was tied in a complete and very tight knot.
One look at the doctor's face told us this could have and in most cases would have had a much different ending.
"This happens in about 1 out of every 2,000 births."
That's what they told us.
That is why, they said, his heart rate kept dropping.
That is why he is our "Rocky," our fighter, our gift from God, our miracle. A little guy I am already so proud to call my son.
I can't think too much about that umbilical cord, or the implications of what could-have-been... but I can thank YOU for the prayers because there is no doubt that God had his hand in making sure that Everette is here, and that he is okay.
"For this child, I prayed..." (1 Samuel 27)
On November 5th at 9:41pm, my whole world changed. My heart met the piece it has been missing, our family of 3 became 4, my husband met his son, my sweet CK became a big sister...
Everette Lawrence, we've been waiting a long time to meet you, and you've been worth the wait. I love you so much, buddy, and it is already a joy and privilege being your mama. You are an answered prayer, an absolute dream come true, a gift from above. God has big plans for you, my boy, and I can't wait to watch life unfold through your eyes. <3
1. Oh holy cow. I am absolutely sobbing! What a beautiful post, an amazing gift, a perfect boy, and so many answered prayers. Praising God and rejoicing with you.
1. Thank you so much. To God be the glory! <3
2. Congratulations Jessie! He is adorable and I am so glad to hear that everything went well! I can't wait to see future pics of the brother/sister duo!!!
3. Replies
1. Incredibly scary. We are so blessed! | http://cupcakesandrunningshoes.blogspot.com/2014/11/hes-here.html | robots: classic
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} | 3,291 | Monday, September 8
Lucy Marie Parker: A Birth Story
Saturday evening was spent at Tyson's parents house with the Cleveland side of the family. As soon as we arrived I noticed my stomach had dropped significantly. It was so much more comfortable. I knew it was only going to be a matter of time until Lucy made her appearance, if anything within the next week. I was so anxious to meet her, but decided to not stress anymore when she was going to come. After eating a delicious dinner it was time to go home. I was tired and couldn't wait to put my feet up.
Tyson had invited his friends over to watch a movie. We put Penelope down for bed and waited for his friend Mike and girlfriend to arrive. We decided that while we waited we would Google ways to induce labor. I had always heard that acupuncture and foot rubs could do just that. At 9:35pm we decided to give it a shot. If anything else, it would feel good to get my feet rubbed. Tyson found a YouTube video and began following the step by step instructions. After only a few minutes of Tyson pressing on the pressure points of my toes and ankles I felt a large trickle. I looked at him in the eyes and said, I either peed my pants or my water just broke. We both started laughing. Could it have really worked.
I jumped up from the couch, remembering the mess that was made the last time my water broke. I ran to the bathroom and sure enough more water came. I noticed a little blood this time, which did not happen the last time. I knew for sure it had to be my water, even though it wasn't a ton. I told Tyson to call Mike and let him know there has been a change of plans. While I was sitting on the toilet I could hear him talking to him and telling him he could quickly come by and say hi. I was on the phone with my mom letting her know what had just happened and had to stop talking with her to ask Tyson what he was thinking?! I told him I didn't think it was a good idea to be catching up with friends, because your wife's water just broke. I was laughing while I told him this of course. Men....
Tyson gave his parents the call to come to our house because P was sleeping. Luckily my hospital bag and diaper bag were packed. There were just a few last toiletry items to grab. It felt good to be so prepared this time. The house was clean and I had just finished all of the laundry. Tyson and I wanted to say goodbye quietly to P before we left. I couldn't let myself get emotional, when really all I wanted to do was pick her up out of her crib and hold her, while I let the tears roll. We told her we loved her and quickly left her room.
I asked Ty to give me a blessing before we left to the hospital. The blessing left me feeling peaceful and ready to take on whatever was to come our way. Shortly after the blessing my in-laws arrived. I am so grateful they live so close and are willing to help us at the drop of a hat. Ty asked his dad for a blessing before we left. I loved glancing over and seeing his dads hands on his head. I know that it left Tyson feeling ready to help assist me in the labor. We said our goodbyes and walked out to the car. It was surreal looking into the back seat of our car and seeing two car seats. It was crazy to think we would be coming home with another baby.
The drive to the hospital was quick. We live less than five minutes away, what a relief. The contractions had started and they were coming on strong. We parked in the ER parking lot and made our way into the hospital. I had luckily pre-registered for my delivery, which supposedly sped things along. We waited in the ER waiting room for transportation to triage, for what felt like ages. I decided to have a seat because my legs were tired and I knew it was going to be a long night. Apparently I sat in the wrong spot, this guy came up and sat next to me and started throwing a fit, because I had taken his seat. His wife apologized to me. I told him to relax, I was in labor and would be leaving shortly. Don't mess with a pregnant woman in labor....
Transportation arrived, thankfully they brought a wheel chair because the ride to triage was a long one. They got me into a bed and confirmed that sure enough my water had broke. The nurse checked me and let me know that I was dilated to a 3 and was 80% effaced. They got my IV set into place and hooked me up to the monitors. Hearing my baby's heart beat could never get old.
While we waited to be admitted to a room, I struggled going back and forth to the bathroom. I couldn't wait to get a catheter. The contractions were getting closer and closer together and had me wondering when they were going to give me the epidural. I asked the nurse and she said it would be another 20 minutes. In the mean time I was transferred to the delivery room. The sweetest nurse greeted us. I knew that I was in good hands. Shortly thereafter the anesthesiologist arrived. I was slightly nervous for the epideral, but knew I needed to rest from the pain. He waited for a break in my contractions and got ready to do his thing. At 1:27 am I leaned over and hung onto Tyson and instantly felt the shock go down my spine. It was immediate relief. I thanked the man deeply. This epidural worked. I now knew what a good epidural felt like. It completely took away the pain from my contractions and allowed Ty and I to get some rest. I never before understood how people slept through labor. It was heavenly.
At 3:45 am the nurse checked me again and I was at a 6/7, she wasn't sure. In my head I thought things were moving rather smoothly. I was going to have that quick easy labor that I had heard so much about. I started feeling nauseous and was sure it was going to be time to push. The nurse got me a popsicle and some crushed ice. Soon after, it all came up. Poor Tyson almost got hit with a gush. After everything was cleaned up the nurse checked me and I was at an 8. She also administered me some Zofran to take away the nausea. The nurse guessed sometime in the 4:00 hour we would have our baby. I couldn't wait to start pushing. She even notified the doctor that I was getting close.
That was when things started to slow down. I wasn't worried just yet, but started wondering why everything was slowing down. With P things only took off from that point. She said there was still a remainder of amniotic fluid in front of the baby's head and that was possibly keeping me from dilating to a 10. She said to give her a call once I felt the gush.
Around 7:00 am it was time for the nurses to rotate shifts. I was sad to see my sweet nurse go. My new nurse was quit a bit different. She checked me again and confirmed the remaining bit of amnio was still present. At 7:20 am I finally felt the remainder of my water break. It came a gushing. I was finally dilated to a 9. Tyson text our family and let them know that I was soon to start pushing. I was looking forward to this last step and getting to hold my baby in my arms.
Once the nurse found out that Ty was an almost 12 lb. baby and I was over 9lbs. she had a little worried look on her face. She said that my baby was definitely a big one and wanted to make me aware that she might not fit. She didn't come right out and say I was going to have to have a c-section, but I knew what she was hinting towards. She thought it would be a good idea to start pushing before I got to a 10 because it would help the baby move down some. She also started the stretching process. I seriously thought she was going to rip me in half. She was anything but gentle. As soon as I started pushing she let us know that the baby had hair. Tyson and I couldn't believe it. I loved hearing those words. Ty looked and said sure enough there was lots of hair. I seriously couldn't wait to see for myself.
My epidural was great in the sense that I had feeling in my legs. I still felt a lot of pressure and knew when to push. The nurse made me do a lot of the work, which slowly started to wear me down. I had to hold my own legs, which felt like a ton of bricks. With each push I began to get more and more worn out. The epidural also started wearing off. The nurse paged the anesthesiologist and let him know I needed some more drugs. Soon after he came in, I felt good and ready to push some more. The nurse even had me on my hands and knees pushing. I couldn't help but laugh while I was doing it. I felt like I could beat Miley Cyrus at a twerking contest, because my butt and legs were shaking so badly from pain and exhaustion. After pushing for over and hour, I finally asked the nurse how much longer she thought it was going to be. She told me it would at least be another hour or so. I wanted to break down at that point. I didn't know how I was supposed to find the strength to keep pushing. I tried to eat some shaved ice and chicken broth to give me some more energy, but it only lead me to throw up again.
I pushed with every fiber of my being for another hour. By this time I was royally spent. I was about done. The nurse said we were going to push for another 30 minutes and then she would call the doctor to assess me. I didn't know how I was going to make it through another minute of pushing. I asked Tyson to give me another blessing. I needed the strength to get through whatever else was ahead. He gave me the sweetest blessing, that gave me that extra boost I needed to give it my all. It led me to tears.
I pushed again for another thirty minutes. I couldn't even open my eyes at that point. I was exhausted. The nurse called in the doctor and without even a seconds pause he checked me and confirmed that this baby was not coming out of me. Apparently she was posterior (sunny side up). I never even knew that was a problem. He said the words that I never thought I would hear, c-section. Before I let any of my emotions get to me I told him okay. I was so tired from pushing, I was willing to do whatever it took.
The nurse and doctor walked out of the room, which thankfully gave Tyson and I some time to have a slight break down. It was then that all of our emotions caught up to us. We both burst into tears. Hearing Ty get so emotional added to my heart break. Tyson's words came quickly thereafter and were so comforting. He told me to never think I didn't do enough. He knew how hard I had tried. He told me I was amazing and gave me the sweetest kiss. I also knew within my heart I did everything I could. The nurse came back in and said you gave it your all and more than most people would have done. I signed the surgery release form, the nurse handed Tyson his surgical attire and had me take a picture. I could barely hold up the camera. He gave me another kiss told me he loved me and would be right there.
(I had luckily just witnessed my friends c-section a few weeks prior, which was a total blessing in disguise. I knew what room we would be going to and the step by step process, that was about to take place. This put me at a lot more at ease, as I usually freak out when it comes to surgery).
They wheeled me down the hallway into the operating room. I knew that the end was in sight. I was keeping my fingers crossed that I would not have to be put under general anesthesia and that the spinal would work correctly. The room was so bright that it was causing me a migraine. I had them put a blanket over my face, to help ease the tension. As soon as they laid me on the surgical table, my body started to shake uncontrollably. My teeth were chattering and I seriously thought I was going to have a nervous break down. It didn't help that Tyson was not in the room yet. They put some warm blankets on me and that seemed to help a little bit. After about 20 minutes the doctors and nurses had prepped me for surgery. They let Tyson in the room and it was finally go time. He came and sat right by my head and told me he would not leave my side. I loved having him there. I don't really remember too much after that. I had to take my mind to another place to help me from shaking myself off the table.
The doctor let me know that he had poked me three times and wondered if I had felt anything. I didn't feel a thing. I was so thankful my spinal worked. Without even telling me they began the surgery. I smelled my flesh burning. I realized they had just made the incision. I luckily didn't feel a thing. The anesthesiologist let me know that I would feel some tight tugging and pulling. It didn't hurt at all. I anticipated it to be much worse. All of a sudden I could hear the doctors gasp. They said that in over 25 years they had never seen that before. I wasn't quit sure what they were talking about. They said the baby's two hands popped right out of my incision and there was her face. They said she came out with spirit fingers. They told Ty he could look over and watch them pull her the rest of the way out. It took only a few more seconds and she was out.
At 11:33 am I finally heard that cry I so longed to hear. I heard and saw the tears in Tyson's eyes. It was the same sweet reaction that he had with Penelope. The nurses all gasped at how cute she was. I couldn't wait to lay my eyes on her. The quickly held her over the curtain for me to see. She was just that, the cutest baby I had ever seen, cone head and all. I loved her immediately and was so thankful she arrived safely. My love for Tyson grew even deeper as I gazed into the eyes of our new creation. There was no longer a question if I could love another child as much as I love P. My heart just grew bigger.
I closed my eyes again while Tyson went to cut the cord and have her measured and weighed. She weighed 8 lbs, 2 oz and was 20 inches long. She was pure perfection, in my eyes. They cleaned her up and brought her by my side. I wanted so badly to be able to hold her, but I hardly had the strength to lift my eye lids. I remember giving her sweet soft skin a kiss and telling her that I loved her so much. I smiled for one picture, but thought it was going to make me fall off the table. I was so queasy. Tyson got to hold Lucy while the doctors finished sewing me up. I began shaking again and threw up one last time. I have never been so exhausted in my life. I couldn't wait for it all to be over with. Everything was finally done. They put Lucy in between my legs and wheeled me off to recovery. I still had the blanket over my eyes and was ready to pass out from exhaustion.
I remember feeling terribly guilty because I couldn't soak up every minute of my baby's first day. I wanted so badly to snuggle her and hold her tight to my skin. Tyson let me know that our family was all in the waiting room. After a little skin to skin time it was time for our family to meet our new bundle of joy. I knew my mom was back there and so was my little P. I couldn't wait to see all their faces.
I had Ty go back and get my mom first. I had wanted her to be with me so badly through my labor, but there weren't any earlier flights available for her to catch. In the end she made it in perfect timing. She had tears in her eyes the moment she saw me. She thought something terrible had happened to me because apparently she didn't receive any of the labor updates. Once she landed she thought for sure there would be a picture of the baby, but there was nothing. She tried calling Tyson and his parents, but couldn't get ahold of anyone. She was extremely worried. She thankfully got ahold of my sister, who informed her that I went in for a c-section. Soon after Ty's parents picked her up from the airport and brought her to me. We both couldn't wait to see one another. She kissed and hugged me before even looking at the baby. She said she wanted to make sure her baby was okay first. It felt so good to have her there by my side.
Once I had spent a few moments with my mom it was time for the rest of the family to come back. I had to put on my happy face because I knew it was going to be a lot for P to take in, but I couldn't wait to see her face. Her face look concerned but I reassured her with my smile. I gave her a kiss and introduced her to her new baby sister, something I had waited so long for. It was the best feeling in the world to have my little family all together.
The rest of the day was pretty much a blur. Lucy was snuggled and loved by all of the visitors. It killed me to not hold her as much as I wanted, but was thankful she got plenty of love from others. It was physically and emotionally the hardest day of my life, but the reward was oh so sweet. There is nothing and I mean nothing like a newborn baby. I truly believe they are sent straight from heaven. I know that my Heavenly Father and dad were watching over me that day. I felt of their love and strength throughout the entire day. I had my amazing husband to lean on and many prayers going out in my behalf. Although nothing seemed to turn out how I anticipated, I still wouldn't change a thing. I am so grateful for technology, doctors and nurses who brought my baby into this world safely. If I had been born in an earlier time, the doctor said both me and the baby both would not have made it. The baby and I are healthy and oh so happy! I can honestly say I loved being pregnant with my Lucy girl and have really enjoyed the journey. We love our new addition so much and love the way she has added so much love and joy to our family.
I cant believe it, we are a family of FOUR!!!!
To read Penelope's birth story click HERE
Also, a huge thank you to Tyson for capturing this day perfectly!
photo signature_zpsc2e4f28b.png
1 comment:
1. Congratulations Nessa! What a beautiful family. I felt the same way about my csection. So grateful for technology, wished I could have snuggled my baby more, the nausea.. and the overwhelming joy. Such a rush of emotions. I'm so glad all went well in the end! | http://tysonandjanessaparker.blogspot.com/2014/09/lucy-marie-parker-birth-story.html | robots: classic
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} | 3,408 | Thursday, August 1, 2013
I've waited, hoped and prayed I would be doing this post one day. Hason's birth was the most amazing thing I've ever done and will probably ever do in my whole life : ) I've had a lot of anxiety about this post cause I have no idea how I'm supposed to put into words what this day, the people there and that moment meant to me.
It changed my life.
Here I am...Headed out the door to the Hospital at 4 am. After 26 hours of labor.
In the Brielle picture that's how I really felt..happy not in much pain but my contractions were happening close and that's when they told me to go in.
The Hason a bunch of bull lol, I just came out of a huge contraction, I was in so much pain, my doula laughed when I got up and smiled for the camera...she said I was such a faker haha, and I was but I really wanted a picture before we left since I took one with Brielle. Look how saggy my belly is! Was that cause he was so much lower or just gravity...would it be at my mid thigh next time if we decided to have another? lol!
I always posted my month to month belly pics on myspace (yes myspace) with Brielle but I didn't post this last one, didn't want to scare people or force anyone to see something they didn't want to see haha, so I'm happy to have my blog to document everything, read at your own risk :)
With Brielle I gained 47lbs.......With Hason 45lbs.....So it would have been the exact same amount I'm sure if I would have made it another week. I can't catch a break...gained the same amount of weight with both kids and my stinkin labor was 2 hours longer with Hason. Nobody would have guessed that. Everyone even myself said it wouldn't be as long as hers. She was 35 hours, Hase 37.
We made it....The hospital was a 30 minute drive and the Lord was good to me...all day I was having two types of that hurt extremely bad and one that made me want to smash my head against the wall cause that would have felt like bliss. I prayed I didn't have the later of the two while in the car. Lindsey rode with us to help me deal with the contractions, I only had 3 on the way there and none were the really bad ones, thank you Jesus!
My goal was a Vbac....I would have liked to have done it natural but that wasn't my biggest concern. We got to the hospital and I was in pain and tired. I wanted to enjoy the end result and not run out of energy and live in fear of what might happen if I didn't get an epidural. I cried cause I wanted one but didn't want it to hinder my vbac. Dr. Cummings came in and I asked him if it would decrease my chances and he said it would not so I felt ok caving and having it done. I had full and complete trust in that man! I had the BEST anesthesiologist!!! The reason I say that is because I could still feel my legs through the whole process and with help I could stand up! Can you believe that, even my doula and nurses were blown away!
I could still feel some contractions here and there.
I loved that, I hated being totally numb with Brielle.
Here we are discussing me getting an epi...I know the nurses and my doula didn't want me to, they knew I could do it without one...I knew that too, just didn't want to anymore. It was strange having nurses pushing me in the other direction rather than wanting me to get the pain meds. I was dilated to a 6 by then so I was happy to have made it that far. On a side note, the labor and delivery department at my hospital had their own anesthesiologist who was always on the floor at all times if we needed him, how nice was that!
With Brielle the nurses scared me into getting my epi way too soon...they said "The anesthesiologist is on the floor right now so if you want one you probably want to get it cause we don't know when he will be back." They failed to mention that the reason my contractions all the sudden got way worse was because I was laying flat on my back on that stupid hospital bed which is the worst position to labor in and it intensifies you contractions. They should have suggested me walk around or sit on a ball or something else instead of jumping straight to the drugs, especially since I was only dilated to a 3 or 4. Just another part of the domino effect that sent me into a c section.
Where would I be without Landon, he is my world.
What a nurse helping me out!? This didn't happen with my first birth!
I wish I would have gotten pictures of all my nurses. I had 3 total because of shift change and one was in training. Since I was a vbac patient those nurses were specifically assigned to me and only me which was awesome. They were all soooo incredibly sweet, they genuinely cared for me and were so excited and happy to be involved in my journey and this special day!! Landon made sure to write down all their names so we could send thank you cards and give them some acknowledgement!
They surely deserve it!
This nurse even hunted me down the next day to congratulate me since she went home at 7 that morning and wasn't there for the birth. That meant so much to me! I felt so cared for!
The minute Dr. Cummings stepped in to the room I lost it...everyone was worried "Diana, what's wrong, you ok?" I was just overwhelmed with gratitude for this man. I can't believe how lucky I am to have found him and moved to Dallas so close to where he practices. I KNOW this was one of the main reasons God put us here. People drive from all over to birth with him. (one of the nurses told me they had a lady come from California in her last trimester to be his patient and birth with there isn't anyone with his amount expertise in between here and there?!) He is the best in his field and one of the only Dr's that will actually give a C-sectioned mom or a multiples mom a fighting chance, a REAL HONEST to goodness not lying to you fighting chance to have a vaginal birth! If you ended up with a c section from this man you would know 100% it was for medical reasons and absolutely would have no regrets!
I wasn't gonna post this picture...I mean have you ever seen an uglier crying face...It's soooo embarrassing!!! But it's part of my story so it's in's ok, you can go ahead and laugh.
I just cried and told him how much he meant to Landon and I and thanked him over and over for giving me a chance, a gift and having faith that I could do what God designed me to do.
ok so maybe there's one person with an uglier crying face than me....
Now that I look at it I'm afraid we might be tied lol!
This man gave me a rare gift, I will cherish that and hold him dear to my heart for the rest of my life!
God bless Dr. Cummimgs. I love this man so much, I will forever be thankful for him.
Here I am draped over the bed after the epidural cause I was still able to move!
They kept moving me to all sorts of different positions to get baby to drop even further and move the process along without the medical interventions. Look at my sweet Dr. helping me as well. The nurses came in and said that he wanted to start me on a low dose of Pitocin. Well Pitocin makes me nervous so I asked it they would check me again and then ask him if I could skip it. I had progressed a little more so he said I didn't have to have it...I was so glad, no pit for me!
Brielle was positioned a bit wrong but that's cause they had me in that bed the whole time in pretty much the same position...and they had me pushing way too soon as opposed to waiting for her to drop some. The Dr. also told me she was probably too big and I was too small to push her out.
Brielle weighed 7lbs 15oz
Hason weighed 8lbs 10oz
I showed them.
If a Dr. ever says they want to induce because baby may be big...that's a red flag, they already have a csection on the brain.
Breathing in my essential oils my doula brought for me...I loved every scent.
Now what can I say about that husband of mine. I am more than blessed to be married to that man and to have his support through all of this. I know of women wanting to attempt vbacs who's family and husbands are opposed to it. How difficult it must be to not have a husband that is on board or supportive of something so important. I couldn't imagine not having Landon cheering me on and being there for me every step of the way. He saw first hand the physical and mostly emotional pain, the anger, the regrets and guilt I carried with me from my first birth. I couldn't imagine having a husband who didn't feel for me in those times and who would minimize those feelings.
He wanted this as badly as I did, he loved Dr. Cummings and had so much peace with him the way I did. He felt cheated by the hospital system the first time like I did. He will never know how much it meant to me to have had him completely on my side me... what it meant to me that he felt the pain that I felt. He did everything in his power to make sure this happened for us. He spent money on everything he could to up our chances at a vaginal birth. I am forever thankful for my husband and his unconditional love for me, he shows me everyday what true love looks like. I've always said he's my dream come true. Because of him all my other dreams have also come true.
Everyday I am so proud to be the wife of such a good hearted, funny, strong, Christian, hard working, super good looking, loving, smart man!
He is the deepest love in my heart and the greatest blessing I will ever have in this life. There's no greater man, our kids are so blessed.
Can you tell I'm feeling so much better : )
The nurses were incredibly happy with Hason! He did so well and responded really good to any and every position they put me in. They kept saying "oh the baby likes that" haha.
Then the back pain crept in. My back muscles started to spasm and wouldn't release. It was horrible!!! They massaged me and did warm compresses that hardly helped. It was above my epidural line so there was no numbing the pain from the epidural. I'm not sure how long I went on like this but it felt like forever! The pain was so bad it cause me to throw up a couple times.
I loved the sign in our room and the Big "VBAC and WELCOME BABY HASON" written on it!
I kept seeing VBAC and it got me all excited and pumped up!
I was still in pain but got to a place where I could focus, where I was quiet and everyone else was quiet and I just sat there trying not to move or think about the pain. I had the silliest song in my head but it kept my mind off of everything. I didn't tell anyone what I was thinking cause I felt stupid's a song from one of Brielle's cds we listen to in the car. I kept repeating it over and over......
I am a C
I am a C-H
and I will L-O-V-E love him
all the T-I-M-E time.
Funny huh...I like that song though and it wasn't one I ever sang growing up. It was a good song to have stuck in my head cause I had to really concentrate to not misspell any of the words HA!
Eventually they had the anesthesiologist come back in and she gave me a shot of something in my back and it took the pain away...Thank goodness!
I was getting closer to pushing time and I didn't want to look awful in pictures of course. I had obviously not noticed my photographer taking all the previous photos ha.
Lindsay wanted to look pretty too! It was a fun moment in my labor where all us girls, my nurses, photographer Bethani and doula were just talking and laughing and having a little girl time! How fun is that!
Poor Landon, I'm sure he was thinking good Lord, I didn't know this was gonna turn into a girly sleepover haha.
It was sooo neat to feel Hason drop down towards the end. I never felt a thing with Brielle. They kept telling me it would feel like I'd have to go to the bathroom and it did. I would feel him move down and a lot pressure down there....then it would go away...then come back with every contraction till the end when I felt it and it didn't go away. That was soooo cool! I got to the point where I was completely effaced and dilated to a 10 but they didn't want me to push they wanted me to "labor down" Which meant letting my body do the pushing for me so I wouldn't get tired doing it all myself when the time came.
When I started pushing Dr. C asked if I wanted a mirror...I said yes. I was a little worried at what I may see but so happy I chose to have the mirror there. After a few times of pushing we could see Hason's hair and the top of his head... Dr. C asked if I wanted to touch it and of course I did and Landon did to...such a surreal moment!
My contractions spaced quite a bit during the pushing process, maybe like 5 or more minutes apart. So we just chatted in between and Cummings would just laugh and joke and tell stories. I don't remember anything he talked about of course but Landon and I thought it was so funny how he was so not serious and laid back in that moment. Until it was time to push again...then he was all sorts of serious haha. Oh I love him!
Halfway through pushing Dr Cummings said "you're gonna push this baby out, You're getting your VBAC!"
Landon and I could hardly stop crying from the sound of those words! I never doubted that I would...all through pregnancy I kept asking Landon if I was setting myself up for disappointment and if I was being completely unrealistic about this. My Dr. just gave me such confidence from the beginning that I felt in my heart of hearts it was going to happen!
My brother in law Colt is in the Army and unfortunately been deployed again, this time to Africa. We miss him dearly when he's gone and my heart hurts for my sister but we are happy he is in a safer place this time around. We are so proud of him! Anyways...this is what he put on my facebook page...just made my day when I read it.....
COLT: "I gave an african shaman 5 bucks, some camel cigs, and a bottle of water yesterday after Kasey told me you went into labor, so that he would do a spiritual song and dance to make sure everything went all right with the delivery. I guess he produced, and although I can't take full credit I'm doing what I can over here ; ) lol. Congratulations. Miss ya'll. Can't wait to meet him. Love ya'll."
Isn't that sweet, Love him!
Little did we know...10 more minutes....
What I'm about to type is TMI so move on if you don't like gross things ha.
We had a funny moment during pushing, I don't remember when exactly but at one point amniotic fluid came spraying out and got all over my Dr, Landon and my doula lol!!! Everyone just laughed and brushed it off except for Lindsay...she ran to the sink to wash herself off. You can't tell me I'm the first who's done that to you Linds! Come on, how many births have you done? I'm glad my husband isn't weak stomached and can take that stuff in stride lol. Embarrassed? I was trying to push out a baby, Ain't nobody got time to be embarrassed!
This was it, this was my moment, the moment I had dreamed about and cried about and felt so robbed of for almost 4 years.
My beautiful healing baby......this birth healed his mommas heart!
There are no words to describe what this picture means to me!
I gasp and cried and just stared the first time I saw this photo, my heart is full.
This was my VBAC moment!!! I DID IT!!!
Look how gently he pulled him out.
I was surprised at first that Bethani didn't get a picture of them laying Hason on my belly until I saw this photo. It's like at a don't want to capture the brides reaction or anyone else for that matter when she first enters the want to see how the groom reacts. It's my favorite thing...I love to watch the face of the groom when he first sees his bride.
Well that's what Bethani was trying to do...she wanted to capture dads reaction to seeing his son born and I love it. Landon doesn't so much cause he thinks he looks a little silly but it's how he felt...he wanted to cry and laugh all at the same time. God is sooo good! I'm so happy she captured this moment.
Wow I did it. That's all I kept saying. I pushed him out in 27 minutes. His little head looked really good cause he wasn't in the birth canal that long. Hason came out a bit purple but after a couple of seconds there was no doubt that boys lungs were developed like a two year olds, not a two week early baby. That boy can cry and cry loud he did! I was a bit surprised that when they laid him on my chest he didn't immediately calm down at the sound of his mommas voice or touch of my skin. Isn't that what happens on the baby story and in the movies lol!
We left his cord in place until it stopped pulsing and then Landon got to cut it. Another special moment we didn't get the first time around but should have.
Elated with joy!
Our hearts were so full! Still can't believe this happened. Still can't believe I did it. I want to relive that day and moment over and over and over agian! It was soooo fun! So freeing!
They let him lay on me as long as I wanted. I got to nurse him and get acquainted.
I was extremely excited to nurse again!
After a while they took him for his weight and height.
Since he was two weeks early (no the due date wasn't off, I was tracking every bit of it so I know 100% his due date was July 18th) none of us guessed he'd be so huge!!! We just laughed, could not believe it..Can you imagine if he was on time! AHHH!
Landon guessed 7lbs 10oz
I guessed 7lbs 11oz
Lindsays guessed 6lbs something
Sweet Hason Louis Gann
Born July 5th 2013 at 2:47pm
8lbs 10oz
20 1/2 inches long
He was the same length as Brielle
Proud daddy holding his son for the first time.
My nurses brought us ice cream to celebrate Hason's birthday!
My wonderful Doula Lindsay, Thank God for her!
. We couldn't have been happier. It was such a marvelous day. Absolutely marvelous, I am still in awe.
I DID IT!!!!!!!
Thank you Jesus for so sweetly answering our prayers.
1. So while I was reading this post, I thought of like 10 comments to leave. But, all I can say is God is good all the time! (And.... I love me a good ugly cry face! Hahahahaha)
1. You exactly right! I'm glad my cry face could brighten your day lol!
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} | 1,348 | The GOP Tax Cut Plan Opens A New Front In The War On Obamacare
Jonathan Cohn
Here we are again, talking about a Republican proposal that would rattle health insurance markets, increase overall premiums and leave millions without coverage ― all while freeing up money for tax cuts that would disproportionately benefit corporations and wealthy Americans.
The new twist this time is the context. Full repeal of the Affordable Care Act is off the agenda, at least for the moment. Instead, Senate Republicans are talking about a bill, the “Tax Cuts and Jobs Act,” whose primary purpose is to reduce taxes. Until recently, health care wasn’t really part of the conversation.
Then math intervened. The GOP’s tax cut will end up costing somewhere in the neighborhood of $1.5 trillion, according to official government projections, and finding offsets that will get 50 votes has been difficult. Desperate to find a source of money that can work politically ― and, perhaps, to take a shot at Obamacare while they can ― Republicans have set their eyes on the Affordable Care Act’s individual mandate.
The mandate is the requirement that people get insurance or pay a fine. Without that mandate in place, projections suggest, the federal government would end up spending $338 billion less.
But that savings would appear only because fewer people were signing up for Medicaid or subsidized private insurance. Overall, the number of people without coverage would rise ― by 4 million initially, and by 13 million within a decade, according to the nonpartisan Congressional Budget Office.
Republicans are already trying to sell their plan by emphasizing what they consider the upsides of this deal ― like the fact that millions of people on the hook for the penalty would no longer have to pay it and that people who resent the mandate as an intrusion on liberty would no longer have an intrusion to resent. Both claims are true.
But insurers would almost surely react by raising premiums even higher than they would otherwise and, in some cases, abandoning markets where they were planning to keep selling coverage. As for the millions without insurance, they would be newly exposed to crippling medical bills. By and large, they would be lower- and middle-income people ― who almost certainly would also benefit the least from the broader tax cuts Republicans have in mind.
Why the mandate exists
The mandate has always been among the Affordable Care Act’s least popular features. But it also helps the law’s other, more popular features to function.
With the penalty in place, healthy people are more likely to sign up for coverage, allowing insurers to spread the financial burden of medical bills broadly. That tends to keep premiums lower. Without the penalty in place, healthy people are more likely to take their chances without coverage, at least temporarily. That leaves insurers with a pool of people in relatively worse health. And the more the pool tilts toward people with serious medical bills, the higher premiums must go to cover their expenses.
Taking away the mandate would likely set off a chain reaction, with insurers raising premiums in order to compensate for a deteriorating risk pool. By design, the Affordable Care Act’s tax credits rise along with premiums, so the people who qualify for those credits ― anybody with household income of less than four times the poverty line, or roughly $98,000 for a family of four ― would be shielded from the effects, at least for the short term.
Those making more would face the brunt of the increase, to the point that some would drop coverage and make the problem worse. Insurers unable to find an equilibrium where premiums covered their expenses would drop out altogether.
Nobody really disputes that this dynamic would play out. The question is just how far it would go ― and how much it should matter.
What ending the mandate would mean
Conservatives have long said that the CBO overestimates the effect of the mandate. Although the agency’s projections track closely those of other widely respected models, the CBO has said it is reevaluating its model. When that process is over, it might end up predicting that the coverage loss is lower than it says now.
Conservatives also say that coverage losses shouldn’t matter when people are choosing not to get health insurance ― since, after all, it’s merely people getting to act on their preferences. Those opting not to get coverage would end up keeping more of their wages instead of handing over those penalty payments to the federal government.
But even if the real effect of repealing the mandate is significantly lesser than the current CBO projections suggest, that would still mean the number of people without health insurance would rise by several million. In other words, it would be a lot of people.
And many of those going without insurance would be people who found it less affordable because of higher premiums ― or because, absent the mandate, they didn’t know to investigate their options. Sometimes people check out prices because of the mandate only to discover, happily, that they are eligible for deeply discounted private insurance or Medicaid, which is basically free.
Also, some of those people passing up coverage are bound to get injured or sick anyway ― and will be on the hook for medical bills that, absent health insurance, they won’t be able to pay.
A key factor, difficult to pin down, would be how insurers react. Over the last year, the Trump administration has carried on its war against Obamacare by trying to undermine it at every turn ― whether it’s cutting the funds for advertising and outreach or stopping some payments designed to offset the cost of special, more generous policies for lower-income consumers.
The effect of these moves has been mixed; as it turns out, many lower-income people can now get cheaper coverage because of how insurers reacted to the end of those payments. But together these moves have taken a severe toll on insurer confidence that the federal government will manage newly reformed insurance markets responsibly. If Congress passes a mandate repeal and Trump signs it, still more insurers are likely to abandon coverage markets.
Sen. Ron Wyden (D-Ore.) speaks during a Senate Finance Committee session Tuesday on the GOP tax reform bill. Senate Republicans announced their intention to include a repeal of the Affordable Care Act's mandate for taxpayers to have health insurance in the tax bill. (Win McNamee via Getty Images)
Sen. Ron Wyden (D-Ore.) speaks during a Senate Finance Committee session Tuesday on the GOP tax reform bill. Senate Republicans announced their intention to include a repeal of the Affordable Care Act's mandate for taxpayers to have health insurance in the tax bill. (Win McNamee via Getty Images)
The availability of those tax credits, which rise as premiums do, would still guarantee carriers millions of customers ― enough, perhaps, to keep at least one insurer in every market. And, without actual repeal legislation, the Affordable Care Act’s reforms would remain in place, still helping a substantial number of Americans get coverage.
But, with coverage levels dropping by the millions, the net effect would almost certainly be some combination of worse access and more financial hardship from medical bills.
Why Republicans want to do this now
All of this would be for the sake of that huge GOP tax cut. Republicans are desperate to pass it because they have strong philosophical objections to taxes and they believe, sincerely, such taxes hobble the nation’s economy. Republicans are also desperate to produce a significant piece of legislation ― a problem they have mainly because their attempts repeal the Affordable Care Act have not succeeded.
Those efforts have failed, so far, in no small part because the public reacted badly to what repeal would entail. Americans are well aware of the law’s shortcomings, which include coverage that is already unaffordable for many, and large majorities would support real efforts to fix those problems. Undoubtedly many would like a tax cut, as well.
But for all of the misgivings about Obamacare, the public appears to have no stomach for undoing what the program has achieved. And that’s precisely what yanking away the mandate would accomplish.
• This article originally appeared on HuffPost.
What to Read Next | https://sports.yahoo.com/gop-tax-cut-plan-opens-104530487.html | robots: classic
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} | 668 | Republicans celebrate before TV cameras after they rammed a near $1.5 trillion package overhauling corporate and personal taxes through the House, edging President Donald Trump and the GOP toward their first big legislative triumph this year. (Nov. 16) AP
When congressional Republicans began their first earnest attempt to repeal Obamacare in March, Democrats howled that scuttling the health care law would empower evil insurance companies to soak consumers. “The Congressional Republican repeal plan puts insurance companies back in charge,” said Sen. Tammy Baldwin.
Now that Senate Republicans are using a broad tax bill to repeal Obamacare’s mandate requiring individuals to purchase health care, Democrats have suddenly become the insurance industry’s most effusive lobbyists. On Tuesday of this week, a group of major insurers wrote a letter to congressional leaders predicting disaster if the mandate were removed. Democratic Senators argued against repealing the mandate by citing the insurance companies’ opposition as a reason to keep it.
Of course, the anti-insurance company rhetoric by Democrats has always been a smokescreen. Insurance companies lobbied hard for Obamacare — who wouldn’t want a law requiring every American to buy your product? In effect, Obamacare turned insurance plans into something no rational person would buy, then forced people to buy them anyway.
If the Senate tax plan succeeds in repealing the mandate, individuals won’t be forced to purchase an inferior product. Those poor insurance companies will have to persuade people their plans are worthwhile, and that includes keeping premiums and deductibles low — which is how the free-market system is supposed to work.
As usual, Democrats continue to predict catastrophe if Senate Republicans move forward on the mandate repeal. Armed with tax tables purporting to show a large tax increase on low-income earners if the mandate is tossed, Democratic senators have argued, paradoxically, that refusing to force people to purchase health insurance they don’t want will cost them more money.
According to the Senate’s scoring estimates, eliminating the mandate will save taxpayers $338 billion over the next 10 years — funds Republicans would plow back into tax cuts for all income levels. Under current law, the government provides generous subsidies for those on Medicaid or forced to purchase insurance on the individual market. If those individuals don’t buy health insurance, they no longer get the subsidies, which the Senate’s cryptic numbers reflect as a tax increase on individuals making between $10,000 and $30,000 in the year 2021.
Yet an alternate estimate by the Joint Committee on Taxation shows that without repealing the mandate, the phantom tax "increase" disappears. In fact, those making between $20,000 and $30,000 would see taxes drop 11.2%, the largest cut of any bracket. That would be, of course, on top of any savings realized either by not purchasing health insurance or being able to purchase more affordable insurance.
That doesn't mean the estimates are perfect: According to the Congressional Budget Office, 13 million people would choose not to buy health care if the mandate were lifted. But that number likely overstates the number of people who would suddenly, after years of purchasing health care under Obamacare's mandate, drop their health insurance altogether. The CBO believes 5 million people will suddenly drop out of Medicaid, which is already free.
If a large number of people continue to buy their own health insurance, the $338 billion Senate Republicans want to parlay into tax cuts won't materialize. But mandate repeal is only one provision in a bill with dozens of moving parts. If both the individual and corporate tax cuts in the bill stimulate the economy in the way Republicans expect, new government revenue won't be a problem.
Earlier this week, House Republicans passed their own tax plan that didn't include repeal of the individual mandate. When the two houses agree on a final package, it should adopt the Senate provision, ending consumer coercion in health care,
If we want citizens to have leverage over insurance companies, it's time to make them compete for our business.
Read or Share this story: | https://www.jsonline.com/story/opinion/columnists/christian-schneider/2017/11/17/repeal-obamacare-individual-mandate/874271001/ | isPartOf: CC-MAIN-2018-39
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} | 691 | Opinion: Republican tax plan is right to kill Obamacare's individual mandate
Christian Schneider
View Comments
House Ways and Means Committee chairman Kevin Brady, R-Texas, joined by Speaker of the House Paul Ryan, R-Wis., right, discusses the GOP's far-reaching tax overhaul, the first major revamp of the tax system in three decades, on Capitol Hill on Nov. 2.
When congressional Republicans began their first earnest attempt to repeal Obamacare in March, Democrats howled that scuttling the health care law would empower evil insurance companies to soak consumers. “The Congressional Republican repeal plan puts insurance companies back in charge,” said Sen. Tammy Baldwin.
Now that Senate Republicans are using a broad tax bill to repeal Obamacare’s mandate requiring individuals to purchase health care, Democrats have suddenly become the insurance industry’s most effusive lobbyists. On Tuesday of this week, a group of major insurers wrote a letter to congressional leaders predicting disaster if the mandate were removed. Democratic Senators argued against repealing the mandate by citing the insurance companies’ opposition as a reason to keep it.
Of course, the anti-insurance company rhetoric by Democrats has always been a smokescreen. Insurance companies lobbied hard for Obamacare — who wouldn’t want a law requiring every American to buy your product? In effect, Obamacare turned insurance plans into something no rational person would buy, then forced people to buy them anyway.
If the Senate tax plan succeeds in repealing the mandate, individuals won’t be forced to purchase an inferior product. Those poor insurance companies will have to persuade people their plans are worthwhile, and that includes keeping premiums and deductibles low — which is how the free-market system is supposed to work.
As usual, Democrats continue to predict catastrophe if Senate Republicans move forward on the mandate repeal. Armed with tax tables purporting to show a large tax increase on low-income earners if the mandate is tossed, Democratic senators have argued, paradoxically, that refusing to force people to purchase health insurance they don’t want will cost them more money.
According to the Senate’s scoring estimates, eliminating the mandate will save taxpayers $338 billion over the next 10 years — funds Republicans would plow back into tax cuts for all income levels. Under current law, the government provides generous subsidies for those on Medicaid or with lower incomes forced to purchase insurance on the individual market. If those individuals don’t buy health insurance, they no longer get the subsidies, which the Senate’s cryptic numbers reflect as a tax increase on individuals making between $10,000 and $30,000 in the year 2021.
Yet an alternate estimate by the Joint Committee on Taxation shows that without repealing the mandate, the phantom tax "increase" disappears. In fact, those making between $20,000 and $30,000 would see taxes drop 11.2%, the largest cut of any bracket. That would be, of course, on top of any savings realized either by not purchasing health insurance or being able to purchase more affordable insurance.
That doesn't mean the estimates are perfect: According to the Congressional Budget Office, 13 million people would choose not to buy health care if the mandate were lifted. But that number likely overstates the number of people who would suddenly, after years of purchasing health care under Obamacare's mandate, drop their health insurance altogether. The CBO believes 5 million people will suddenly drop out of Medicaid, which is already free.
If a large number of people continue to buy their own health insurance, the $338 billion Senate Republicans want to parlay into tax cuts won't materialize. But mandate repeal is only one provision in a bill with dozens of moving parts. If both the individual and corporate tax cuts in the bill stimulate the economy in the way Republicans expect, new government revenue won't be a problem.
Earlier this week, House Republicans passed their own tax plan that didn't include repeal of the individual mandate. When the two houses agree on a final package, it should adopt the Senate provision, ending consumer coercion in health care,
If we want citizens to have leverage over insurance companies, it's time to make them compete for our business.
View Comments | https://www.floridatoday.com/story/opinion/2017/11/22/opinion-republican-tax-plan-right-kill-obamacares-individual-mandate/889332001/ | isPartOf: CC-MAIN-2021-25
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} | 604 | Obamacare Again? Senate Tax Plan Aims to Repeal Mandate
Obamacare Again? Senate Tax Plan Aims to Repeal Mandate
© Nathan Chute / Reuters
The Obamacare repeal debate is on again. Senate Republicans decided on Tuesday to include the elimination of the Affordable Care Act’s individual mandate in their tax plan, a risky move that would raise hundreds of billions of dollars to help pay for their desired tax cuts but is also sure to reignite intense clashes over health care coverage. Here’s a quick look at this latest twist in the tax reform effort:
Why They’re Doing It: Repealing the mandate, which requires individuals to buy health insurance or pay a penalty, helps solve the difficult math problems Senate tax-writers faced. The Senate tax bill can add up to $1.5 trillion to the debt over 10 years, and it can’t add to the deficit after that period. President Trump and some Senate Republicans had urged that the mandate repeal be included in the tax plan since it saves a projected $338 billion over 10 years, according to the Congressional Budget Office.
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“Repealing the mandate pays for more tax cuts for working families and protects them from being fined by the IRS for not being able to afford insurance that Obamacare made unaffordable in the first place,” Sen. Tom Cotton (R-AR), who had proposed the move, said after the decision was announced. And if the repeal passes as part of a tax cut package, Trump and congressional Republicans would deliver on two promises to voters in one bill.
What It Means: Repealing the mandate may help Republicans chalk up a big win on taxes, but it also comes at a cost. The move raises revenue because it would lead to 13 million fewer people having health insurance, according to the CBO, and thus reduces the amount the government must shell out for insurance subsidies and care. Analysts also warn that, without the mandate, premiums will rise and some insurers might not participate in Obamacare markets that require them to cover pre-existing conditions. “Eliminating the individual mandate by itself likely will result in a significant increase in premiums, which would in turn substantially increase the number of uninsured Americans,” a coalition of insurers, hospitals and doctors wrote in a letter to congressional leaders on Tuesday.
Those expected effects carry significant political risk. For one thing, it could reawaken the liberal base that mobilized so effectively against Obamacare repeal and turn their focus to the tax bill. Democratic leaders are already slamming the decision. "Republicans just can’t help themselves,” Sen. Chuck Schumer said. “They’re so determined to provide tax giveaways to the rich that they’re willing to raise premiums on millions of middle-class Americans and kick 13 million people off their health care." Liberal policy expert Michael Linden tweeted, “Reducing the corporate tax rate to 23% instead of 20% generates the SAME savings as repealing the ACA mandate. They could cut taxes for corporates just a little less, but instead they're cutting health care.”
Will It Pass? A “skinny” Obamacare repeal bill that would have eliminated the individual mandate failed in the Senate in July when Republican Sens. John McCain, Lisa Murkowski and Susan Collins voted against it. But Senate Majority Leader Mitch McConnell told reporters that including the repeal provision would make it easier for the tax bill to pass. As part of the deal, the Senate would also reportedly vote on another bill to restore federal payments to insurers that the president halted last month. Sen. John Thune (R-SD) said that a whip count had been done and expressed confidence that Republicans had the 50 votes they need. | http://abzhun.com.www.thefiscaltimes.com/2017/11/14/Obamacare-Battle-Returns-Now-Part-GOP-Tax-Plan | robots: classic
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} | 455 | Trump says Congress should include a repeal of Obamacare's 'very unfair and unpopular' mandate in the tax bill
• President Donald Trump tweeted that the GOP tax bill should include a repeal of Obamacare’s penalty for not having insurance.
• This would likely lead to a destabilization of the individual insurance market, but also save the government money.
President Donald Trump offered a policy suggestion to congressional Republicans via Twitter on Wednesday, suggesting the forthcoming GOP tax bill should include a repeal of the Affordable Care Act’s individual mandate.
“Wouldn’t it be great to Repeal the very unfair and unpopular Individual Mandate in ObamaCare and use those savings for further Tax Cuts for the Middle Class.” Trump said. “The House and Senate should consider ASAP as the process of final approval moves along. Push Biggest Tax Cuts EVER.”
The individual mandate, which stipulates that people must have insurance or face a penalty from the IRS, is one of the most unpopular parts of the ACA, also known as Obamacare, but also one of its most critical.
Most experts agree that the mandate helps to encourage younger, healthy people to sign up for coverage which improves the risk mix in the Obamacare exchanges. This keeps costs down for sick people and helps improve market conditions for insurers.
Without the penalty, according to experts, the market conditions in the exchanges would likely deteriorate, costs would increase for sicker people, and insurers would flee from the market.
On Monday, GOP Sen. Tom Cotton floated the idea as a way to generate revenue for the tax plan.
According to a report from the Congressional Budget Office, a repeal of the mandate would decrease the federal deficit by $US416 billion over 10 years. This would be mostly due to the decrease in what the federal government pays in subsides for people’s insurance premiums who get coverage on the Obamacare exchanges.
According to the CBO, 15 million more people would be without insurance under the plan compared to the current baseline. This means the government would not assist in paying their insurance premiums, offsetting the lost revenue from the mandate repeal and eventually saving the government money.
The tweets also come as the open enrollment period beings for Obamacare, during which people without coverage through an employer or a government program like Medicaid or Medicare can access health insurance.
Whether the tax bill will include a repeal of the mandate remains to be seen. The roll out of the bill was pushed back by House GOP tax writers from Wednesday to Thursday due to disagreement on some key elements of the plan.
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} | 439 | Trump says Congress should include a repeal of Obamacare’s ‘very unfair and unpopular’ mandate in the tax bill
Donald Trump
Donald Trump
Mark Wilson/Getty Images
President Donald Trump tweeted that the GOP tax bill should include a repeal of Obamacare’s penalty for not having insurance. This would likely lead to a destabilization of the individual insurance market, but also save the government money.
President Donald Trump offered a policy suggestion to congressional Republicans via Twitter on Wednesday, suggesting the forthcoming GOP tax bill should include a repeal of the Affordable Care Act’s individual mandate.
“Wouldn’t it be great to Repeal the very unfair and unpopular Individual Mandate in ObamaCare and use those savings for further Tax Cuts for the Middle Class.” Trump said. “The House and Senate should consider ASAP as the process of final approval moves along. Push Biggest Tax Cuts EVER.”
The individual mandate, which stipulates that people must have insurance or face a penalty from the IRS, is one of the most unpopular parts of the ACA, also known as Obamacare, but also one of its most critical.
Most experts agree that the mandate helps to encourage younger, healthy people to sign up for coverage which improves the risk mix in the Obamacare exchanges. This keeps costs down for sick people and helps improve market conditions for insurers.
Without the penalty, according to experts, the market conditions in the exchanges would likely deteriorate, costs would increase for sicker people, and insurers would flee from the market.
On Monday, GOP Sen. Tom Cotton floated the idea as a way to generate revenue for the tax plan.
According to a report from the Congressional Budget Office, a repeal of the mandate would decrease the federal deficit by $416 billion over 10 years. This would be mostly due to the decrease in what the federal government pays in subsides for people’s insurance premiums who get coverage on the Obamacare exchanges.
According to the CBO, 15 million more people would be without insurance under the plan compared to the current baseline. This means the government would not assist in paying their insurance premiums, offsetting the lost revenue from the mandate repeal and eventually saving the government money.
The tweets also come as the open enrollment period beings for Obamacare, during which people without coverage through an employer or a government program like Medicaid or Medicare can access health insurance.
Whether the tax bill will include a repeal of the mandate remains to be seen. The roll out of the bill was pushed back by House GOP tax writers from Wednesday to Thursday due to disagreement on some key elements of the plan. | http://www.businessinsider.sg/trump-tweets-on-obamacare-aca-mandate-and-the-gop-tax-plan-bill-2017-11/ | robots: classic
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Trump: Repeal individual mandate in tax reform
President Trump wants to repeal the individual mandate. AP Photo/Evan Vucci
President Trump weighed in this morning on the internal GOP debate over whether to try to repeal the Affordable Care Act's individual mandate as part of a tax reform bill.
Wouldn't it be great to Repeal the very unfair and unpopular Individual Mandate in ObamaCare and use those savings for further Tax Cuts.....— Donald J. Trump (@realDonaldTrump) November 1, 2017
Why it matters: This move would likely open up the exact same rifts that sunk Republicans' health care efforts earlier this year, making tax reform even harder and imperiling the party's next-best chance for a legislative victory.
What it means: According to the Congressional Budget Office, repealing the ACA's individual mandate would increase the number of uninsured Americans by about 15 million; cause premiums to rise; and save the federal government roughly $380 billion over a decade. (Because fewer people would have insurance, the government would spend less on the ACA's subsidies.)
• That's a lot of savings to help make up for the revenue the government would lose through big tax cuts.
• And the individual mandate is an unpopular part of the ACA — with voters overall, and especially with conservatives.
• But because it would come at the cost of an unstable insurance market, it'll be a hard sell for the same moderate Republicans who opposed their party's repeal-and-replace bills.
Go deeper | https://www.axios.com/2017/12/15/trump-repeal-individual-mandate-in-tax-reform-1513306601 | isPartOf: CC-MAIN-2022-49
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} | 438 | What repealing Obamacare's individual mandate means
GOP tax bill includes repeal of Obamacare's individual mandate
GOP tax bill includes repeal of Obamacare's individual mandate
Republican lawmakers have long wanted to kill Obamacare's individual mandate, one of the least popular provisions of the health reform law. Now, GOP senators are trying to do the deed by repealing the mandate in their tax reform bill.
Senators say eliminating the individual mandate would give them an additional $338 billion over 10 years for their proposed tax cuts. Doing so would also fulfill their vow to dismantle Obamacare, at least in part.
Axing the mandate, which requires nearly all Americans to have health insurance or pay a penalty, would likely wreak havoc on the Obamacare market.
Some 4 million fewer people would be covered in the first year the repeal would take effect, the Congressional Budget Office said last week. That number would rise to 13 million by 2027, as compared to current law. Meanwhile, premiums would rise by about 10% in most years of the decade.
Related: Axing Obamacare individual mandate would save $338 billion: CBO
But most importantly, repealing the mandate would remove the stick that Obamacare wields to prod younger and healthier Americans to sign up for coverage. While experts have mixed views on how effective the mandate has been, many feel that removing it would cause the Obamacare market to tilt even more towards sicker and older consumers.
That, in turn, could make insurers think twice about participating in the exchanges, especially since they would still be required to cover those with pre-existing conditions and not charge them more based on their medical history.
A coalition of physician, hospital and health insurance industry associations called on Congress Tuesday to keep the individual mandate. The group, including the American Medical Association, the American Hospital Association, America's Health Insurance Plans and the BlueCross BlueShield Association, warned the Republican and Democratic leaders of the House and Senate that there would be "serious consequences" if Congress simply repeals the mandate while leaving Obamacare's other regulations in place.
Related: Individual mandate repeal to be included in Senate's tax bill
Personal Finance
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CBO Lowers Savings Projections For Individual Mandate Repeal
Cheryl Sanders
November 8, 2017
The House is unlikely to repeal the mandate to buy insurance under ObamaCare as part of its tax-reform bill, GOP sources say, though the issue could return down the road.
Given that several Republican bills aimed at unraveling the ACA have failed, Trump and his deputies are now seeking other ways to scale back the requirement for health-care coverage. "I want to make sure we have reasonable assumptions in the process for growth estimates". The U.S. House of Representatives unveiled its tax plan last week, and the Senate's plan is expected to be released on Thursday.
Walker said "a lot of" GOP lawmakers advocated for repealing the mandate during a closed-door conference meeting Tuesday.
Republicans are considering repealing the coverage rule in the Affordable Care Act as a way to pay for far-reaching changes in the tax code.
Internal Revenue Service (IRS) data suggests that 6.5 million Americans paid penalties for failing to maintain health insurance coverage in 2015.
Brady said on Monday that the repeal of the certain Obamacare taxes would not be included in the tax reforms.
Mr. Brady noted that efforts to repeal the mandate couldn't get through the Senate, which rejected a "skinny repeal" of the health care law over the summer. Tom Cotton (R-AR) pushed to include a repeal of the individual mandate in the Tax Cuts and Jobs Act.
"When given the opportunity to actually address even part of an Obamacare repeal with a simple majority, our leadership consistently finds excuses to justify their failure", said a conservative House lawmaker.
Eliminating the individual mandate outright would spark a political firestorm among Democrats as well as some centrist Republicans, because it is seen as a powerful incentive to encourage healthier consumers to sign up for health insurance.
Republicans say the money saved could go towards tax reform if the legislation passes.
The Republican, who was granted anonymity to speak candidly, said that top leaders eyeing the vote counts had voiced concerns about losing as many as a dozen GOP votes in the House and three or four in the Senate.
Other reports by iNewsToday | http://inewstoday.net/2017/11/cbo-lowers-savings-projections-for-individual-mandate-repeal/ | robots: classic
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} | 1,161 | The Republican tax plans are suddenly looking a lot more like health-care bills, with provisions that may affect coverage and increase medical expenses for millions of families.
The House version of the tax bill, which President Donald Trump endorsed on Tuesday, would end a deduction that allows families of disabled children and elderly people to write off large medical expenses. The Senate plan would repeal the Obamacare requirement that most Americans carry insurance, a move that insurers promise would raise premiums in the nationwide individual insurance market.
The provisions would help offset the cost of large tax cuts for corporations and individuals. But the move has sparked a new wave of opposition from the health-care industry and others who are concerned about its impact -- the same political headwinds that tanked Republican efforts to repeal the Affordable Care Act earlier this year.
Either proposal, if signed into law, "could be devastating for some families with disabilities," said Kim Musheno, vice president of public policy at the Autism Society, a Bethesda, Maryland, organization that advocates for people with autism. "Families depend on that deduction. And if they deal with the individual mandate, that's going to cut 13 million people from their health care," she said, citing a Congressional Budget Office estimate.
Republicans and some conservative groups, though, argue that removing the penalty for uninsured individuals would represent a tax cut for many low-income people who pay it now. Americans for Tax Reform, the group led by anti-tax crusader Grover Norquist, said that Internal Revenue Service data from tax year 2015 show that 79 percent of households that paid the penalty earned less than $50,000 a year.
Most Americans already think the tax legislation is designed to benefit the rich and oppose the bill by a two-to-one margin, according to a Quinnipiac University poll released on Wednesday. The survey was conducted between Nov. 7 and Nov. 13 -- before the repeal of the Obamacare mandate was introduced -- and has a margin of error of 3 percentage points. Some of the details in both tax plans have changed since the survey, and the Senate tax-writing committee is still working on its draft.
Few Republicans have spoken out about the House bill's repeal of the medical-expense break. The bill faces a vote on the House floor Thursday. But some criticism has begun to surface as advocacy groups including the AARP and the American Cancer Society have highlighted the harm the House bill could have on families battling diseases and on the elderly. People with tens of thousands of dollars in annual medical expenses often rely on the tax deduction to make ends meet.
Rep. Walter Jones, a North Carolina Republican, said Wednesday he'll vote against the House bill in part because it eliminates the deduction for out-of-pocket medical expenses.
"There are a lot of seniors in my district and this is life and death for them," he said.
The deduction is allowed under current law if medical expenses exceed 10 percent of a taxpayer's adjusted gross income. Almost 9 million taxpayers deducted about $87 billion in medical expenses for the 2015 tax year, according to the IRS.
Rep. Greg Walden, an Oregon Republican who chairs the Energy and Commerce Committee, said some of his constituents who live in expensive elder-care facilities could be harmed if the deduction is scrapped.
He declined to elaborate.
On the other side of the Capitol, Senate Republican leaders' sudden decision to add a partial Obamacare repeal to their bill has energized Democratic opposition.
"You don't fix the health insurance system by throwing it into a tax bill and causing premiums to go up 10 percent," Senator Sherrod Brown, an Ohio Democrat, told reporters Wednesday.
Were the ACA's insurance mandate repealed absent a new policy to compel the purchase of coverage, the CBO projects that premiums would rise 10 percent for people who buy insurance on their own and more than 13 million Americans would lose or drop their coverage.
But a reduction in the number of people with insurance also translates to less taxpayer money spent to provide subsidies for premiums under the ACA. Ending the requirement as of 2019 would save the government an estimated $318 billion, helping to offset the cost of lowering the corporate tax rate.
In addition, the Senate's tax plan could trigger sharp cuts to Medicare and other programs in order to meet budget deficit rules, according to CBO.
The move to target Obamacare comes after Republicans lost elections in Virginia and other states earlier this month. Health care was a significant factor in those races and Republicans will face punishing campaign ads if they try to chip away at Obamacare or end the medical-expense deduction while cutting taxes, said political analyst David Axelrod, a former top adviser to President Barack Obama.
"The thing that makes it more of a potent issue is that it's all being done to facilitate what essentially is a massive corporate tax cut and an individual tax cut that's skewed to wealthy Americans," he said in an interview. "You don't have to work very hard to make those ads."
The White House argues that the ACA's insurance mandate isn't popular and disproportionately affects low- and middle-income Americans who are forced to buy insurance that may be more expensive than they can afford.
"The President's priorities for tax reform have been clear from the beginning: make our businesses globally competitive, and deliver tax cuts to the middle class," White House spokesman Raj Shah said in a statement. "He is glad to see the Senate is considering including the repeal of the onerous mandates of Obamacare in its tax reform legislation and hopes that those savings will be used to further reduce the burden it has placed on middle-class families."
Trump, though, has said proceeds from repealing the insurance mandate should be used to cut taxes even further for wealthy people.
"How about ending the unfair & highly unpopular Indiv Mandate in OCare & reducing taxes even further?" Trump said Monday in a tweet. "Cut top rate to 35 percent w/all of the rest going to middle income cuts?"
Like Republicans' failed attempts to repeal the ACA, the tax plan is amassing a growing list of opponents from the world of medicine.
Insurers, hospital groups and disability advocates have spoken out forcefully against the health-care proposals in the bill. Hospitals and insurance groups wrote a letter to Congressional leaders on Tuesday warning of dire health-care outcomes if the tax measure becomes law.
"Repealing the individual mandate without a workable alternative will reduce enrollment, further destabilizing an already fragile individual and small group health insurance market on which more than 10 million Americans rely," said the letter, signed by six health-care groups, including the American Hospital Association and America's Health Insurance Plans.
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Nation & World
Q&A: Tax bill impacts on health law coverage and Medicare
WASHINGTON — The tax overhaul Republicans are pushing toward final votes in Congress could undermine the Affordable Care Act's health insurance markets and add to the financial squeeze on Medicare over time.
Lawmakers will meet this week to resolve differences between the House- and Senate-passed bills in hopes of getting a finished product to President Donald Trump's desk around Christmas. Also in play are the tax deduction for people with high medical expenses, and a tax credit for drug companies that develop treatments for serious diseases affecting relatively few patients.
The business tax cuts that are the centerpiece of the legislation would benefit many health care companies, but there's also concern among hospitals, doctors and insurers about the impact on coverage. Here are some questions and answers on how the tax bill intersects with health care:
Q: Trump has said he won't cut Medicare, and the program doesn't even seem to be mentioned in the tax bill. Why is AARP saying that health insurance for seniors could be jeopardized?
A: The tax bill would increase federal deficits by about $1 trillion over 10 years, even after accounting for stronger economic growth expected from tax cuts. More red ink means higher borrowing costs for the government, and that would reduce the options for policymakers when Medicare's long-postponed financial reckoning comes due.
Medicare's giant fund for inpatient care isn't expected to start running short until 2029. That's still more than a decade away, but a federal anti-deficit law currently in effect could trigger automatic cuts as early as next year — about $25 billion from Medicare.
House Speaker Paul Ryan, R-Wisc., and Senate Majority Leader Mitch McConnell, R-Ky., said in a joint statement last week that such speculation is unfounded. “This will not happen,” the GOP leaders said. Congress has previously waived such cuts, they explained, and there's no reason to think this time would be different.
Nonetheless others see an increased risk to Medicare.
“The greater concern is even if the automatic cuts don't take place, the tax bill just exacerbates the pressure on the federal deficit and Republicans have been pressing for cuts in Medicare for some time,” said Paul Van de Water, a policy expert with the Center on Budget and Policy Priorities, which advocates for low-income people.
Q: How did “Obamacare” wind up in the tax bill?
A: The Senate version repeals the Affordable Care Act's tax penalties on people who don't have health insurance. That would result in government savings from fewer consumers applying for taxpayer-subsidized coverage, giving GOP tax writers nearly $320 billion over 10 years to help pay for tax cuts.
What's more, repealing the fines would deal a blow to the Obama-era health law after a more ambitious Republican takedown collapsed earlier this year.
Q: Those fines have been very unpopular, so how could repealing them undermine the health law? Other parts of the ACA will remain on the books.
A: Premiums will go up, and that's never popular. The fines were meant to nudge healthy people to get covered. Because insurance markets work by pooling risks, premiums from healthy people subsidize care for the sick.
Without some arm-twisting to get covered, some healthy people will stay out of the pool. That's likely to translate to a 10 percent increase in premiums for those left behind, people more likely to have health problems and need comprehensive coverage, says the Congressional Budget Office.
The CBO also estimated that 13 million more people would be uninsured in 2027 without the penalties. If they have a serious accident or illness, uninsured people get slammed with big bills, and taxpayers wind up indirectly subsidizing the cost.
Q: So just taking away an unpopular penalty would destabilize the health insurance law?
A: Repealing the fines is part of a broader context.
The Trump administration slashed the advertising budget for ACA sign-ups this year, at the same time that it cut the enrollment window in half. The administration is working on rules that would allow broader sale of skimpy insurance plans with lower premiums, which would also draw healthy people away from the health law markets.
“The program would still exist, but it would be quite hobbled at this point,” said Larry Levitt of the nonpartisan Kaiser Family Foundation.
A separate bipartisan bill to stabilize health insurance markets is still pending in the Senate, and it remains unclear where the markets will settle out.
Q: Taxes and health care are connected. Anything else to flag in the GOP bills?
A: The House bill repeals the tax deduction for people with high medical expenses not covered by insurance. The Senate bill would make the deduction more generous than what's currently allowed. People could deduct amounts that exceed 7.5 percent of their income. The differences would have to be resolved in conference.
In order to raise money to pay for lower tax rates, the House bill eliminates a tax credit available to drug companies that develop medications for people with rare diseases; the Senate bill scales back the tax credit. Organizations representing patients are pushing to keep the credit intact.
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Fetching stories… | http://www.medina-gazette.com/Nation-World/2017/12/05/Q-A-Tax-bill-impacts-on-health-law-coverage-and-Medicare.html | robots: classic
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} | 838 | The tax overhaul Republicans are pushing toward final votes in Congress could undermine the Affordable Care Act’s health insurance markets and over time add to the financial squeeze on Medicare.
Lawmakers will meet this week to resolve differences between the House- and Senate-passed bills in hopes of getting a finished product to President Trump’s desk around Christmas. Also in play are the tax deduction for people with high medical expenses, and a tax credit for drug companies that develop treatments for serious diseases affecting relatively few patients.
The business tax cuts that are the centerpiece of the legislation would benefit many health care companies, but there’s also concern among hospitals, doctors and insurers about the impact on coverage. Here are some questions and answers on how the tax bill intersects with health care:
Q: Trump has said he won’t cut Medicare, and the program doesn’t even seem to be mentioned in the tax bill. Why is AARP saying that health insurance for seniors could be jeopardized?
A: The tax bill would increase federal deficits by about $1 trillion over 10 years, even after stronger economic growth expected from tax cuts. More red ink means higher borrowing costs for the government, and that would reduce options for policymakers when Medicare’s long-postponed financial reckoning comes due.
Medicare’s giant fund for inpatient care isn’t expected to start running out until 2029, more than a decade away. But an anti-deficit law currently in effect could trigger automatic cuts as early as next year — about $25 billion from Medicare.
House Speaker Paul Ryan, R-Wisc., and Senate Majority Leader Mitch McConnell, R-Ky., said in a joint statement last week that such speculation is unfounded. “This will not happen,” the GOP leaders said. Congress has previously waived such cuts, they explained, and there’s no reason to think this time would be different.
Nonetheless others see an increased risk to Medicare.
“The greater concern is even if the automatic cuts don’t take place, the tax bill just exacerbates the pressure on the federal deficit and Republicans have been pressing for cuts in Medicare for some time,” said Paul Van de Water, a policy expert with the Center on Budget and Policy Priorities, which advocates for low-income people.
Other safety net programs, including Medicaid and Children’s Health Insurance would also come under greater pressure.
Q: How did “Obamacare” wind up in the tax bill?
A: The Senate version repeals the Affordable Care Act’s tax penalties on people who don’t have health insurance. That actually saves the government money, since fewer consumers would apply for taxpayer-subsidized coverage. GOP tax writers got nearly $320 billion over 10 years to help pay for tax cuts.
Repealing the fines would deal a blow to “Obamacare” after a more ambitious Republican takedown collapsed earlier this year.
A: Premiums will go up, and that’s never popular.
A: Repealing the fines is part of a broader context.
The Trump administration slashed the advertising budget for ACA sign-ups this year, while also cutting the enrollment window in half. The administration is working on rules that would allow broader sale of skimpy insurance plans with lower premiums. That, too, would also draw healthy people away from the health law markets.
“The program would still exist, but it would be quite hobbled at this point,” said Larry Levitt of the nonpartisan Kaiser Family Foundation.
A separate bipartisan bill to stabilize health insurance markets is still pending in the Senate, and it remains unclear where the markets will settle out.
Q: Taxes and health care are connected. Anything else to flag in the bills?
In order to raise money to pay for lower tax rates, the House bill eliminates a tax credit available to drug companies that develop medications for people with rare diseases; the Senate bill scales back the tax credit. Organizations representing patients are pushing to keep the credit intact. | https://www.pressherald.com/2017/12/06/qa-how-the-tax-bill-could-affect-obamacare-medicare/ | isPartOf: CC-MAIN-2018-51
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} | 1,165 | Q&A: Tax Bill Impacts on Health Law Coverage and Medicare - NBC 10 Philadelphia
President Donald Trump
President Donald Trump
The latest news on President Donald Trump's presidency
Trump has said he won't cut Medicare, and the program doesn't even seem to be mentioned in the tax bill, but the AARP is saying that health insurance for seniors could be jeopardized
Senate Narrowly Passes Tax Reform Bill
The tax overhaul Republicans are pushing toward final votes in Congress could undermine the Affordable Care Act's health insurance markets and add to the financial squeeze on Medicare over time.
Lawmakers will meet this week to resolve differences between the House- and Senate-passed bills in hopes of getting a finished product to President Donald Trump's desk around Christmas. Also in play are the tax deduction for people with high medical expenses, and a tax credit for drug companies that develop treatments for serious diseases affecting relatively few patients.
The business tax cuts that are the centerpiece of the legislation would benefit many health care companies, but there's also concern among hospitals, doctors and insurers about the impact on coverage. Here are some questions and answers on how the tax bill intersects with health care:
Q: Trump has said he won't cut Medicare, and the program doesn't even seem to be mentioned in the tax bill. Why is AARP saying that health insurance for seniors could be jeopardized?
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A: The tax bill would increase federal deficits by about $1 trillion over 10 years, even after accounting for stronger economic growth expected from tax cuts. More red ink means higher borrowing costs for the government, and that would reduce the options for policymakers when Medicare's long-postponed financial reckoning comes due.
Medicare's giant fund for inpatient care isn't expected to start running short until 2029. That's still more than a decade away, but a federal anti-deficit law currently in effect could trigger automatic cuts as early as next year — about $25 billion from Medicare.
House Speaker Paul Ryan, R-Wisc., and Senate Majority Leader Mitch McConnell, R-Ky., said in a joint statement last week that such speculation is unfounded. "This will not happen," the GOP leaders said. Congress has previously waived such cuts, they explained, and there's no reason to think this time would be different.
Nonetheless others see an increased risk to Medicare.
"The greater concern is even if the automatic cuts don't take place, the tax bill just exacerbates the pressure on the federal deficit and Republicans have been pressing for cuts in Medicare for some time," said Paul Van de Water, a policy expert with the Center on Budget and Policy Priorities, which advocates for low-income people.
Q: How did "Obamacare" wind up in the tax bill?
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A: The Senate version repeals the Affordable Care Act's tax penalties on people who don't have health insurance. That would result in government savings from fewer consumers applying for taxpayer-subsidized coverage, giving GOP tax writers nearly $320 billion over 10 years to help pay for tax cuts.
What's more, repealing the fines would deal a blow to the Obama-era health law after a more ambitious Republican takedown collapsed earlier this year.
Q: Those fines have been very unpopular, so how could repealing them undermine the health law? Other parts of the ACA will remain on the books.
A: Premiums will go up, and that's never popular. The fines were meant to nudge healthy people to get covered. Because insurance markets work by pooling risks, premiums from healthy people subsidize care for the sick.
Without some arm-twisting to get covered, some healthy people will stay out of the pool. That's likely to translate to a 10 percent increase in premiums for those left behind, people more likely to have health problems and need comprehensive coverage, says the Congressional Budget Office.
The CBO also estimated that 13 million more people would be uninsured in 2027 without the penalties. If they have a serious accident or illness, uninsured people get slammed with big bills, and taxpayers wind up indirectly subsidizing the cost.
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Q: So just taking away an unpopular penalty would destabilize the health insurance law?
A: Repealing the fines is part of a broader context.
The Trump administration slashed the advertising budget for ACA sign-ups this year, at the same time that it cut the enrollment window in half. The administration is working on rules that would allow broader sale of skimpy insurance plans with lower premiums, which would also draw healthy people away from the health law markets.
"The program would still exist, but it would be quite hobbled at this point," said Larry Levitt of the nonpartisan Kaiser Family Foundation.
A separate bipartisan bill to stabilize health insurance markets is still pending in the Senate, and it remains unclear where the markets will settle out.
Q: Taxes and health care are connected. Anything else to flag in the GOP bills?
(Published Thursday, Oct. 11, 2018)
A: The House bill repeals the tax deduction for people with high medical expenses not covered by insurance. The Senate bill would make the deduction more generous than what's currently allowed. People could deduct amounts that exceed 7.5 percent of their income. The differences would have to be resolved in conference.
In order to raise money to pay for lower tax rates, the House bill eliminates a tax credit available to drug companies that develop medications for people with rare diseases; the Senate bill scales back the tax credit. Organizations representing patients are pushing to keep the credit intact. | https://www.nbcphiladelphia.com/news/national-international/Tax-Bill-Impacts-Health-Law-Coverage-Medicare-462055133.html | isPartOf: CC-MAIN-2018-43
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News & Views
How GOP tax legislation would affect health policy
Share this:
Kaiser Health News
Having failed to repeal and replace the Affordable Care Act, Congress is now working on a tax overhaul. But it turns out the tax bills in the House and Senate also aim to reshape health care.
Here are five big ways the tax bill could affect health policy:
1. Repeal the requirement for most people to have health insurance or pay a tax penalty.
Republicans tried and failed to end the so-called individual mandate this year when they attempted to advance their health overhaul legislation. Now the idea is back, at least in the Senate’s version of the tax bill. The measure would not technically remove the requirement for people to have insurance, but it would eliminate the fine people would face if they choose to remain uninsured.
The Congressional Budget Office has estimated that dropping the requirement would result in 13 million fewer people having insurance over 10 years.
It also estimates that premiums would rise 10 percent more per year than they would without this change. That is because healthier people would be most likely to drop insurance in the absence of a fine, so insurers would have to raise premiums to compensate for a sicker group of customers. Those consumers, in turn, would be left with fewer affordable choices, according to the CBO.
State insurance officials are concerned that insurers will drop out of the individual market entirely if there is no requirement for healthy people to sign up, but they still have to sell to people who know they will need medical care.
Ironically, the states most likely to see this kind of insurance-market disruption are those that are reliably Republican. An analysis by the Los Angeles Times suggested that the states with the fewest insurers and the highest premiums — including Alaska, Iowa, Missouri, Nebraska, Nevada, and Wyoming — would be the ones left with either no coverage options or options too expensive for most consumers in the individual market.
2. Repeal the medical-expense deduction.
The House-passed tax bill, although not the Senate’s, would eliminate taxpayers’ ability to deduct medical expenses that exceed 10 percent of their adjusted gross income.
The medical expense deduction is not widely used — just under 9 million tax filers took it on their 2015 tax returns, according to the Internal Revenue Service. But those who do use it generally have very high medical expenses, often for a disabled child, a serious chronic illness or expensive long-term care not covered by health insurance.
Among those most vehemently against getting rid of the deduction is the senior advocacy group AARP. Eliminating the deduction, the group said in a statement, “amounts to a health tax on millions of Americans with high medical costs — especially middle income seniors.”
3. Trigger major cuts to the Medicare program.
The tax bills include no specific Medicare changes, but budget analysts point out that passing it in its current form would trigger another law to kick in. That measure requires cuts to federal programs if the federal budget deficit is increased.
Because the tax bills in both the House and Senate would add an additional $1.5 trillion to the deficit over the next 10 years, both would result in automatic cuts under the Statutory Pay-As-You-Go Act of 2010, known as PAYGO. According to the CBO, if Congress passes the tax bill and does not waive the PAYGO law, federal officials “would be required to issue a sequestration order within 15 days of the end of the session of Congress to reduce spending in fiscal year 2018 by the resultant total of $136 billion.”
Cuts to Medicare are limited under the PAYGO law, so the Medicare reduction would be limited to 4 percent of program spending, which is roughly $25 billion of that total. Cuts of a similar size would be required in future years. Most of that would likely come from payments to providers.
4. Change tax treatment for graduate students and those paying back student loans.
The House bill, though not the Senate’s, would for the first time require graduate students to pay tax on the value of tuition that universities do not require them to pay.
Currently, graduate students in many fields, including science, often are paid a small stipend for teaching while they pursue advanced degrees. Many are technically charged tuition, but it is “waived” as long as they are working for the university.
The House tax bill would eliminate that waiver and require them to pay taxes on the full value of the tuition they don’t have to pay, which would result in many students with fairly low incomes seeing very large tax bills.
At the same time, the House tax bill would eliminate the deduction for interest paid on student loans. This would disproportionately affect young doctors.
According to the Association of American Medical Colleges, 75 percent of the medical school class of 2017 graduated with student loan debt, with nearly half owing $200,000 or more.
5. Change or eliminate the tax credit that encourages pharmaceutical companies to develop drugs for rare diseases.
Congress created the so-called Orphan Drug Credit in 1983, as part of a package of incentives intended to entice drugmakers to study and develop drugs to treat rare diseases, defined as those affecting fewer than 200,000 people. With such a small potential market, it does not otherwise make financial sense for the companies to spend the millions of dollars necessary to develop treatments for such ailments.
To date, about 500 drugs have come to market using the incentives, although in some cases drugmakers have manipulated the credit for extra financial gain.
The House tax bill would eliminate the tax credit; the Senate bill would scale it back. Sen. Orrin Hatch (R-Utah), chairman of the tax-writing Finance Committee, is one of the original sponsors of the orphan drug law.
The drug industry has been relatively quiet about the potential loss of the credit, but the National Organization for Rare Disorders called the change “wholly unacceptable” and said it “would directly result in 33 percent fewer orphan drugs coming to market.“
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} | 1,009 | Republicans are in a hurry to get their “repeal and replace” health care bill to the House floor.
In just the week since it was introduced, two committees have approved the “American Health Care Act,” and a floor vote is planned before month’s end.
But in the rush to legislate, some facts surrounding the bill have gotten, if not lost, a little buried. Here are five things that are commonly confused about the health overhaul effort.
1. The GOP bill would replace the health law’s subsidies with tax credits.
Not really.
The GOP bill would replace the Affordable Care Act’s tax credits with different tax credits.
Under the ACA, people with income above the poverty line (about $12,000 for an individual in 2017) and under four times the poverty line (about $47,000) who buy their own insurance are eligible for advanceable, refundable tax credits. “Advanceable” means they don’t have to wait to file their taxes, so the money is available each month to pay premiums; “refundable” means credits are available even to those with incomes too low to owe federal income tax. The ACA’s tax credits are based on income and the actual price of health insurance available to each individual.
The GOP bill also has advanceable, refundable tax credits. They are based on different criteria, though. The Republican tax credits would increase with age (from $2,000 for youngest adults to $4,000 for older adults not yet eligible for Medicare), and would gradually phase out with income (starting at $75,000 for individuals and $150,000 for families). They would not vary by geographic region or the cost of coverage. And while older adults would get credits twice as large as younger adults, another change in the bill would let insurers charge those older customers premiums that are five times as high. In the current law, the difference is 3-to-1.
There are actual subsidies in the ACA — they help people with incomes between 100 and 250 percent of poverty ($12,060 to $30,150 for an individual) pay their deductibles and coinsurance or copays. These subsidies are the subject of an ongoing lawsuit filed by the House against the Obama administration. Those subsidies would be repealed under the GOP bill.
2. Republicans have left popular provisions of the ACA in their bill because they are popular.
Not necessarily.
True, the public supports the provisions of the health law that allow adult children to stay on their parents’ health plans until they turn 26 and that prohibit insurers from rejecting or charging more to people with preexisting health conditions. Those things remain in the GOP bill.
But even if Republicans had wanted to get rid of those provisions, they likely could not. That’s because the budget rules Congress is using to avert a filibuster in the Senate forbid them from repealing much of the ACA that does not affect government spending.
3. This bill is one part of a three-part effort to remake the health law.
This is true.
Republicans continually refer to their health care effort as having three “buckets.” One is the budget bill currently under consideration. A second is the power of Health and Human Services Secretary Tom Price to make administrative changes that would undermine the ACA. The third is follow-up legislation that would allow things like selling insurance across state lines and limiting damages in medical malpractice lawsuits. House Speaker Paul Ryan (R-Wis.) referred to that in a Thursday press conference as “additional legislation that we feel is important and necessary to give us a truly competitive health care marketplace.”
What Republicans usually don’t say, though, is that the second and third parts are complicated. Changing federal regulations generally requires a cumbersome process of advertising the changes, soliciting comments and revising the rules. Controversial changes also can bring lawsuits and lengthy legal proceedings. In addition, any subsequent bills on the law would require 60 votes to pass the Senate because they would not be covered by the budget rules Republican are using for this first legislation. Republicans currently have a 52-48 vote majority in that chamber, and Democrats have so far been united in opposing the GOP’s health changes.
4. The bill’s Medicaid provisions just scale back the program’s expansion.
In truth, the Medicaid portions of the GOP bill would fundamentally restructure the Medicaid program.
The Affordable Care Act allowed states to expand Medicaid, whose cost is shared between the states and federal government, to everyone with incomes under 138 percent of poverty. Previously, eligibility was restricted to those in specific categories (primarily low-income pregnant women, children, seniors and those with disabilities). Because Medicaid was already a significant financial burden for states, the federal government offered to pay the entire cost for the expansion population for the first three years, eventually dropping back to 90 percent, which is still more than states get for traditionally eligible populations.
The GOP bill would end new enrollment in that expanded program in 2020. It would continue to cover people who had already qualified — but since many people in Medicaid churn in and out of the program, the number of enrollees is likely to gradually decline.
But that’s just the beginning of the Medicaid changes. The Republican bill would, for the first time ever, limit the amount the federal government provides to states for Medicaid spending. It would make payments based on the number of enrollees in each state and that “per-capita” cap is expected over time to shift more financial responsibility for the program to the states. The left-leaning Center on Budget and Policy Priorities estimates that states could be on the hook for an additional $370 billion over 10 years if the bill becomes law.
5. The GOP bill is a huge tax break for the wealthy.
This is technically true —
the bill would provide nearly $600 billion in tax breaks over the next decade, almost all of it going to the wealthy, according to the nonpartisan Committee for a Responsible Federal Budget.
But that’s not because Republicans set out to lower taxes on wealthy people. It’s because they are repealing nearly all the taxes that helped pay for the health law’s benefits, and the Democrats had targeted many of those to higher-income people. | http://www.freepressonline.com/Content/Download-the-current-issue-as-a-pdf/Features/Article/Say-What-Fact-Checking-the-Chatter-Behind-the-GOP-Health-Insurance-Bill/93/78/51032 | robots: classic
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} | 1,143 | Five ways the GOP health bill would reverse course from the ACA
March 8, 2017 | By | Reply More
By Julie Rovner
Kaiser Health News
After literally years of promises, House Republicans finally have a bill they say will “repeal and replace” the Affordable Care Act.
Some conservative Republicans have derided the new proposal — the American Health Care Act — calling it “Obamacare Lite.”
It keeps intact some of the more popular features of the ACA, such as allowing adult children to stay on their parents’ health plans to age 26 and, at least in theory, ensuring that people with preexisting conditions will still have access to insurance.
In some cases the elements of the law that remain are due to political popularity. In others, it’s because the special budget rules Congress is using — so Republicans can avoid a Senate filibuster — do not allow them to repeal the entire law.
Tax Credits To Help Buy Insurance
Both the GOP bill and the ACA provide tax credits to help some people pay their premiums if they don’t get insurance through work or government programs. And in both, the credits are refundable (meaning people who owe no taxes still get the money) and advanceable (so people don’t have to wait until they file their taxes to get them). But the GOP’s tax credits would work very differently from those already in place.
Under current law, the amount of the credit is tied to a person’s income (the less you earn the more you get) and the cost of insurance where you live.
But the bill would go further as well, making changes to the underlying Medicaid program that House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) described as “the biggest entitlement reform in the last 20 years.”
“Capping federal contributions to the Medicaid program will likely force states with already tight budgets to limit eligibility and cut benefits to at-risk Americans,” said the American Public Health Association in a statement.
Help For Wealthier People
The bill would also provide new tax advantages for those who can afford to save — including allowing more money to be deposited into health savings accounts, and lower penalties for those who use those accounts to pay for non-medical needs.
In addition, the plan would lower the threshold for deducting medical expenses on income taxes and allow people with job-based tax-preferred “flexible spending accounts” to put away more pretax money. It would also restore over-the-counter drugs as eligible for reimbursement from those accounts.
Mandates To Buy Or Provide Coverage
The GOP plan doesn’t actually repeal either the requirement for individuals to have coverage or for employers to provide it. That’s because it can’t under budget rules. Instead, the bill would reduce the penalties in both cases to zero, rendering the requirements moot.
The individual requirement was used by the health law to force healthy people into buying coverage to help improve insurers’ risk pools since they could no longer bar customers with preexisting conditions. Instead of the requirement that most people obtain health insurance or pay a penalty, the Republican plan would provide a penalty for those who do not maintain “continuous coverage.” Those with a break in insurance coverage of more than 63 days could still purchase insurance without regard to preexisting health conditions, but they would be required to pay premiums that are 30 percent higher for 12 months.
How To Pay For It
“We are still discussing details, but we are committed to repealing Obamacare and replacing it with fiscally responsible policies that restore the free market and protect taxpayers,” said the Republican fact sheet that accompanied the release of the bill.
Category: Health Policy, Insurance, Medicaid, Medicare
Leave a Reply | http://localhealthguide.com/2017/03/08/five-ways-gop-health-bill-reverse-course-aca/ | robots: classic
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} | 802 | Explainer: What you should know about the Republicans’ bill to replace Obamacare
Acton Institute Powerblog
Last night Congressional Republicans released two bills (here and here) which together constitute the current plan to “repeal and replace” the Affordable Care Act (aka Obamacare). Here’s what you should know about the legislation known as the “American Health Care Act” (AHCA).
Does this legislation “repeal and replace” Obamacare?
Yes and no (but overall, not really).
No, the AHCA does not completely repeal Obamacare in toto and it merely replaces some aspects of the current law. But yes, it does repeal certain aspects of Obamacare and in some cases replaces them with new mandates and requirements.
Why doesn’t the GOP put forward a bill that simply repeals and replaces all of Obamacare?
The short answer is that Republicans in Congress don’t think they could pass such a bill. They would need 60 votes in the Senate to break a filibuster by the Democrats, and they only have 52. Instead, the GOP plans to use a process called “budget reconciliation” that allows them to make changes to federal revenue and spending with only 51 votes (which they may not be able to get since some Republicans in the Senate oppose the bill). The problem with this approach, as Avik Roy notes, is that “reconciliation can only repeal Obamacare’s taxes and spending; it can’t replace most of the law’s premium-hiking insurance regulations.”
What’s actually in the bill?
Here are some key changes that are included in the bill:
• Removes the “individual mandate,” the tax under Obamacare that people had to pay if they chose not to buy health insurance. However, the bill includes a “Continuous Health Insurance Coverage Incentive,” that provides a disincentive to dropping coverage and then picking it back up when a person gets ill. Those who reenroll would have to pay an “amount that is equal to 30 percent of the monthly premium rate.” (For example, if someone bought a policy that cost $6,000 a year ($500), they’d have to pay an additional $150 a month for one year before returning to the standard rate.)
• Rather than immediately repealing Obamacare’s Medicaid expansions, the bill allows them to remain in place until January 1, 2020. After that time, states will no longer be able to add new people to that program.
• Repeals almost all Obamacare-related taxes (e.g., tanning tax).
• Removes the regulation that prevented insurers from charging older enrollees more than three times as much as younger ones.
• Adds a per capita cap on states, which caps the federal funding per enrollee in the programs.
• Changes the structure of the Obamacare tax credits from being based solely on income to a means-based credit based mostly on age and partially on income.
• Prohibits almost all groups that provide abortions (e.g., Planned Parenthood) from receiving federal funds or Medicaid reimbursements. Also prohibits insurance policies that pay for abortions from being eligible for tax credits.
• Almost 10 percent of the bill (seven pages) is dedicated to a provision that prevents lottery winners who win over $80,000 from getting Medicaid. (This seems to be a cause championed by Rep. Joe Pitts, R-Penn.)
What major parts of Obamacare does it leave unchanged?
The two major provisions left unchanged are that parents will still be able to keep their kids on their insurance plans until the children reach age 26 and insurance companies will still be required to ensure everyone, regardless of preexisting conditions.
How much will it cost and how many people will be affected?
No one knows just yet. The Congressional Budget Office (CBO), a non-partisan independent group that provides analyses of budgetary and economic issues as it pertains to legislation, has not yet had a chance to “score” the bill. The CBO will consider the legislation and make a estimate about how much it will cost taxpayers and how many citizens will be affected by the changes.
Who opposes this bill?
Generally speaking, both liberals and conservatives. Liberals are concerned that the changes will reduce access to health insurance for the poor while cutting taxes for the wealthy. They are also concerned that it dismantles Obamacare, the most significant liberal policy victory this century. Conservatives are concerned that it will explode the deficit and leave Obamacare largely intact. “It’s Obamacare in a different format,” said Rep. Jim Jordan, R-Ohio.
Because of opposition from both sides of the political aisle, the AHCA is unlikely to pass the Senate in its current form.
Joe Carter
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What does GOP Obamacare fix really do?
Remember when Obamacare was before Congress and Democratic Rep. Nancy Pelosi famously said the bill should be passed so taxpayers could find out “what’s in it”?
After Democrats passed the 2,300-page legislation, the Obama administration crafted tens of thousands of regulations and rules. Then, Obama issued a series of executive orders to make the failing plan work.
Now, with the Republicans proposing yet another “repeal and replace” plan, it’s clear that unraveling such a complex piece of legislation isn’t easy.
One of the groups that has battled the takeover of the American health care system from the beginning is the American Center for Law and Justice. Its experts have complied a big list of the bill’s changes and their potential impact.
ACLJ calls the current Graham-Cassidy-Heller-Johnson bill the “final attempt” by the GOP to repeal Obamacare this year.
The group warns that time is of the essence because the reconciliation process that allows the Senate leadership to pass the reform with a simple majority vote expires on Sept. 30.
“After this, there is no chance that the unified left will allow any reform through Senate,” ACLJ said.
“In short, Graham-Cassidy converts $1.2 trillion of Obamacare subsidies and spending into block grants for States to craft healthcare plans to address the needs of its citizens. The bill also ends Obamacare mandates and defunds Planned Parenthood.”
What do YOU think? Who’s right on Obamacare-repeal vote? Sound off in today’s WND poll.
The organization cited six major changes:
1. It would end the individual and employer mandates to obtain health care insurance by simply eliminating the penalties.
2. The GOP would convert Obama’s Medicaid expansion into block grants to the states. First, the aid would be allocated on a per capita basis instead of favoring Democratic-leaning states. It also would provide a short-term assistance program for providing health benefits and access during a transition period and end up providing “merit-based” funding to states for “nearly any legitimate healthcare need.”
3. It could end three key Obamacare taxes: the medical device tax, the tax on over-the-counter medication and the tax on health savings accounts. It would leave in place other taxes, specifically on people making over $200,000, investment income and health insurers.
4. It would require coverage for pre-existing conditions and ban annual or lifetime caps but would allow states to apply for waivers if they protect those who would be affected. The states could do this by providing premium assistance programs or subsidizing out-of-pocket expenses.
5. The plan would boost health savings accounts, to which taxpayers can contribute tax-free and then use for expenses. Under ObamaCare, the amount was limited to $3,400 for individuals and $6,750 for families. Instead, Graham-Cassidy would increase this to $6,650 for individuals and $13,300 for families. The report said those funds also could be used for premiums.
6. And the changes would defund Planned Parenthood, because “it defines abortion providers with more than $1 million in annual Medicaid reimbursements as a ‘prohibited entity’ for one year, denying them from being reimbursed by Medicaid. It effectively would prevent approximately $400 million of taxpayer funding from flowing to Planned Parenthood. It also would bar any plan that covers abortions, except in the case of rape, incest or the health of the mother, from reimbursement. The ACLJ analysis said those two abortion defunding tracks “provide the strongest pro-life protections of any of the recent Obamacare repeal efforts.”
Politico reported the president was warning Republicans that anyone who opposes the changes would be known as the “Republican who saved Obamacare.”
One current opponent is Sen. Rand Paul, R-Ky., who said the bill doesn’t go far enough. Other swing votes are Sens. Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona.
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Republicans Risk Passing New Health Bill by Defunding Planned Parenthood
© Nathan Chute / Reuters
Details of the House Republicans’ proposal to repeal and replace the Affordable Care Act leaked out late last week, including some that are certain to spark a political firestorm on Capitol Hill.
Many aspects of the House proposal for dismantling the taxpayer-subsidized health insurance program already are widely known, particularly the elimination of the unpopular individual mandate requiring people to purchase insurance or pay a penalty, tax credit subsidies based on an individual’s income, and hundreds of billions of dollars’ worth of tax increases aimed primarily at upper middle-income earners, the wealthy and businesses.
The latest version of the House GOP plan disclosed by Politico on Friday would also gradually phase out expanded Medicaid coverage for able-bodied low-income people in 31 states and the District of Columbia by 2020, convert the regular Medicaid program to a block grant state system, and provide states roughly $10 billion a year to create so-called high-risk pools for older and sicker people.
The Republicans would preserve some elements of Obamacare, including allowing children to stay on their parents’ health care plan until age 26 and allow people to sock away far more in their tax-exempt health savings accounts than the law currently allows.
Some portions of the plan would take effect immediately upon passage of the legislation while others would take until 2020 to implement.
But precisely how House Speaker Paul Ryan and other Republican leaders go about raising revenues to replace the Obamacare taxes and underwrite the cost of a replacement plan -- including premium subsidies and incentives to the insurance industry to stay in the market -- are likely to spark resistance from many Republicans as well as Democrats.
Here are a few of the highlights of the House GOP plan to replace Obamacare:
• In place of the Obama taxes, the GOP replacement plan would be financed by limiting federal tax breaks on generous health care plans that employees obtain through their employers. The tax exclusion costs the federal government an estimated $260 billion in income and payroll taxes in 2017, which makes it the single largest tax expenditure. The Republicans would cap the tax exemption for workers paying premiums on high-end health care policies.
• Republicans would preserve the ban on discriminating against people with pre-existing conditions in one form or another, but they will impose a “continuous coverage exclusion” to protect insurers from excessive losses.
• In place of Obamacare’s income-based tax subsidies that help low and middle-income people the most, Republicans would create “refundable” tax credits that vary by age and help older Americans the most. The tax credit would be stepped, beginning with $2,000 a year for people under the age of 30, and would increase by increments of $500 for each successive age group. The highest annual credit -- $4,000 – would go to people 60 and older.
• To help relieve insurance companies saddled with risk pools top heavy with older and sicker people, the GOP plan would provide states with a total of $100 billion over the coming decade to provide coverage to these people who may have trouble acquiring policies in the individual market. Whether that would be nearly enough to meet the cost is a point of contention.
Insurers complain that many people wait until they are sick to purchase health insurance instead of when they are healthy and not in need of costly medical attention. The House GOP proposal includes penalties for individuals who fail to maintain continuous coverage. If they permit their insurance to lapse and then decide to re-enroll, they would be hit with a 30 percent boost in premiums for a year.
Related: Americans Sour on Trump and Congress as Replacing Obamacare Flounders
A major wild card in the unfolding debate was the House leadership’s decision to include a provision to defund Planned Parenthood and other health organizations that provide abortions, according to The Hill. The one-year ban on Medicaid funding to Planned Parenthood has long been sought by congressional Republicans and anti-abortion forces and would be a major victory for them.
Planned Parenthood provides sexual and reproductive health care, education, information, and outreach to 2.5 million women and men in the United States every year. About three percent of all Planned Parenthood health services are abortion related, according to the organization, but federal dollars cannot be used to fund those services.
Still, anti-abortion activists argue that all funding for Planned Parenthood is fungible, and they want to make sure federal funding doesn’t indirectly facilitate abortions.
According to The Hill, the Republicans would have a tough time passing Obamacare repeal and replace legislation if it includes a ban on Planned Parenthood funding. The Republicans hold a slender 52 to 48 majority in the Senate, and Republican Sen. Lisa Murkowski of Alaska said last week she would not vote for any repeal that defunds Planned Parenthood.
“Taxpayer dollars should not be used to pay for abortions, but I will not vote to deny Alaskans access to the health care services that Planned Parenthood provides,” she said. It would take the defection of just three Senate Republicans to halt the repeal and replace movement in its tracks. | http://abzhun.com.www.thefiscaltimes.com/2017/02/26/Republicans-Risk-Passing-New-Health-Bill-Defunding-Planned-Parenthood | isPartOf: CC-MAIN-2020-05
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Read exactly what's included in GOP's health care bill
Republicans work to sell plan to American people
Read exactly what's included in GOP's health care bill
Republicans work to sell plan to American people
Republican leaders embarked on an ambitious plan Tuesday to try to sell their new health care proposal to rank-and-file lawmakers and the public, absent specifics on costs or how many Americans will be covered.
President Donald Trump's early morning tweet praising "our wonderful new Healthcare Bill" started off the day, and GOP leaders planned a news conference to promote the plan ahead of Wednesday's committee action.
Click here to read the full health care act
The new bill aims to replace "Obamacare" with a system designed along conservative lines. Primarily affected would be some 20 million people who purchase their own private health plans directly from an insurer and the more than 70 million covered by Medicaid, the federal-state program for low-income people.
White House budget chief Mick Mulvaney said Tuesday it's unfair to compare how many people would have health insurance under the new Republican plan to those under the existing health law that Republicans have long derided as "Obamacare."
"What Obamacare did was make insurance affordable, but care impossible to actually afford," Mulvaney said on NBC's "Today Show." ''The deductibles were simply too high. So people could say they have coverage but they couldn't actually get the medical care they needed when they get sick."
Obamacare plans did typically come with high deductibles, but the law also provided cost-sharing subsidies to people with modest incomes. Those subsidies will be eliminated under the Republican plan, and it's unclear how high the deductibles would be under the new approach.
Mulvaney said that while the nonpartisan Congressional Budget Office hasn't yet determined the cost of the new health care bill, it will bring "tremendous long-term savings" by giving states more control over Medicaid, the joint federal-state program for low income Americans.
The Republican legislation would limit future federal funding for Medicaid, which covers low-income people, about 1 in 5 Americans. And it would loosen rules that former President Barack Obama's law imposed for health plans directly purchased by individuals, while also scaling back insurance subsidies.
House Democratic Leader Nancy Pelosi said Tuesday that Republicans are underestimating the high costs of health care for people living with pre-existing medical conditions. Pelosi told "CBS This Morning" that coverage of people with pre-existing conditions can't be done easily and without ensuring healthy people also buy into insurance pools.
There are no easy answers, said Dan Mendelson, CEO of the consulting firm Avalere Health. "Health care is expensive and it becomes more expensive every year," he said. "Under the GOP plan, it will be more expensive every year just like it was under the Democratic plan."
Nonetheless, he called the Republican proposal a feasible alternative.
Over the next few days, stakeholders will be dissecting the GOP proposal, which may become the second major shift on health care policy in less than a decade. Democratic and Republican governors, hospital executives, physician groups, insurers, drug makers and consumer groups will have their say.
House committees planned to begin voting on the legislation Wednesday, launching what could be the year's defining battle in Congress and capping seven years of GOP vows to repeal the 2010 Affordable Care Act. It's unclear if Republicans can manage to overcome divisions within their own party and deliver a final product.
The plan would repeal the unpopular fines on people who don't carry health insurance. It would replace income-based subsidies the law provides to help millions of Americans pay premiums with age-based tax credits that may be skimpier for people with low incomes. Those payments would phase out for higher-earning people.
Senate Finance Committee Chairman Orrin Hatch, R-Utah, wouldn't rule out changes by his chamber, where significant numbers of moderate Republicans have expressed concerns that the measure could leave too many voters without coverage.
Thirty-one states and the District of Columbia opted to expand Medicaid coverage under the Obama-era law to an estimated 11 million people. Around half those states have GOP governors, who are largely reluctant to see that spending curtailed.
In another feature that could alienate moderate Republicans, the measure would block for one year federal payments to Planned Parenthood, the women's health organization long opposed by many in the party because it provides abortions.
A series of tax increases used to finance the Obama overhaul's coverage expansion would be repealed as of 2018.
In a last-minute change to satisfy conservative lawmakers, business and unions, Republicans dropped a plan pushed by Ryan to impose a first-ever tax on the most generous employer-provided health plans. Instead, a similar tax imposed by Obama's law on expensive plans set to take effect in 2020 would now begin in 2025.
Popular consumer protections in the Obama law would be retained, such as insurance safeguards for people with pre-existing medical problems, and parents' ability to keep young adult children on their insurance until age 26.
To prod healthier people to buy policies, insurers would boost premiums by 30 percent for consumers who let insurance lapse. | http://www.kcra.com/article/read-exactly-whats-included-in-gops-health-care-bill/9101494 | robots: classic
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} | 793 | Iran says it, world powers must end nuclear stalemate
DUBAI (Reuters) - Iran's foreign minister said on Monday a way must be found to end the deadlock with major powers over its nuclear programme, an Iranian news agency reported, but he offered no new initiative on how to achieve this.
Israel, widely believed to be the Middle East's only nuclear-armed power, has threatened military action to prevent its arch-enemy from acquiring nuclear weapons. Iran denies any such goal and says it would hit back hard if attacked.
"The two sides (Iran and world powers) have reached a conclusion that they must exit the current stalemate," Salehi was quoted as saying by the Iranian Students' News Agency.
The West suspects Iran is trying to develop the means to build atomic bombs under the cover of a declared civilian nuclear energy programme. The Islamic Republic says it is enriching uranium as fuel for civilian energy, not bombs.
Iran and the six powers - the United States, Russia, France, China, Britain and Germany - have expressed readiness to revive efforts to find a negotiated solution. But Salehi said he did not know when the next meeting would be held.
The powers, known as P5+1, said last week they hoped soon to agree with Iran on when and where to meet. There have been suggestions it could happen already this month, though January now seems more likely, Western officials say.
Analysts and diplomats believe there is a window of opportunity for a new diplomatic initiative with Iran after last month's re-election of U.S. President Barack Obama.
The powers want Iran to scale back its uranium enrichment programme and cooperate fully with U.N. nuclear inspectors.
The priority for Iran, a major oil producer, is for the West to lift punitive sanctions increasingly hurting its economy.
Three rounds of negotiations earlier this year - the last one in Moscow in June - failed to achieve a breakthrough.
The big powers have prepared an updated version of package that was rejected by Tehran in the previous talks, Western diplomats say, without giving details.
Their immediate priority is for Iran to halt higher-grade enrichment that could relatively quickly be further processed to bomb-grade material, close the Fordow underground plant where this work is carried out and ship out the stockpile.
Iran has hinted at flexibility regarding its enrichment to a fissile concentration of 20 percent, but it wants substantial sanctions easing in return, something the powers say would be premature before Tehran makes significant concessions.
Iran also wants recognition of what it says is its "right" to refine uranium, which can have both civilian and military purposes. "Iran demands its inalienable, legal and legitimate right and wants nothing more," Salehi said.
One Western official said it was too early to say whether the new diplomatic attempt may yield results: "We see that sanctions do have an economic impact on Iran and it is a matter for Iran to really take this offer seriously."
Iran's economic minister was quoted on Sunday saying the country's oil revenues had been cut in half as a result of sanctions.
Another Western diplomat said the powers were increasingly concerned about Iran's expanded enrichment capacity at Fordow, and wanted to address this issue in the new proposal. This could mean, he said, asking Iran to partially dismantle the facility.
"Shutting Fordow is not enough," the diplomat said, adding it would take longer to restart the facility if the enrichment installations had been taken apart.
The world powers hope to gain momentum in dealings with Iran by introducing "confidence-building measures" before approaching a final agreement at a later date, diplomats say.
They say the powers are likely to offer Iran some form of sanctions relief in return but any measures may be limited.
Salehi spoke a few days after the International Atomic Energy Agency and Iran both said progress was made in talks last Thursday on resuming a long-stalled IAEA investigation into suspected atomic bomb research in the country.
A senior Iranian legislator said on Monday that Iran would expect some sanctions relief in return for granting IAEA inspectors access to the disputed Parchin military complex.
The IAEA believes Iran has conducted explosives tests with possible nuclear applications at Parchin, a facility southeast of the Iranian capital, and has repeatedly asked for access.
"They must certainly give some incentive in return, and in my opinion a reasonable and equal incentive would be lifting the sanctions," said Alaeddin Boroujerdi, who chairs the national security and foreign policy committee in the Iranian parliament. (Additional reporting by Fredrik Dahl in Vienna and Justyna Pawlak in Brussels) | http://www.firstpost.com/world/iran-says-it-world-powers-must-end-nuclear-stalemate-560927.html | robots: classic
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World powers coax Iran into saving nuclear talks
Thursday - 2/28/2013, 4:24am ET
Associated Press
ALMATY, Kazakhstan (AP) -- World powers offered broader concessions than ever to Iran in attempts Wednesday to keep alive diplomatic channels that seek to rein in the Islamic Republic's nuclear program and prevent it from building an atomic weapon.
The offer was hailed by Saeed Jalili, Iran's top official at diplomatic talks in Kazakhstan, who said it represented a "turning point" by world powers to compromise on Tehran's uranium enrichment program after years of delicate negotiations that nearly dissolved last June.
The proposal allows Iran to keep a limited amount of highly enriched uranium -- but not make any more -- stops short of demanding the full shutdown of an underground nuclear facility, and offers to remove some trade sanctions that have hurt Iran's economy.
Still, a senior U.S. official said, crippling sanctions on Iran's oil and financial industries would remain in place as negotiations continue. The official spoke on condition of anonymity to discuss the sensitive talks more candidly.
The latest offer marked a small but significant shift from earlier, harder-line proposals that prompted Iran to dig in its heels amid fears that an arms race in neighboring states could sow yet more instability in the already turbulent Mideast. Israel has repeatedly hinted its readiness to strike Iranian nuclear facilities -- a military venture the United States likely would be dragged into.
The new offer also is expected to force Iran to respond with a reasonable plan of its own -- or be seen as a recalcitrant negotiator unwilling to compromise.
The proposal "was more realistic than before and had tried to get closer to the Iranian viewpoint in some cases," Jalili told reporters at the end of two days of negotiations in Kazakhstan's largest city, Almaty. "We consider this positive -- although there is a long distance to reach the suitable point."
British Foreign Minister William Hague called the talks "useful" and said the new proposal aimed "to build confidence on both sides and move negotiations forward."
"I look forward to further progress," Hague said in a statement.
Iran maintains it has the right under international law to enrich uranium to 20 percent -- a level that can quickly be elevated into use for nuclear warheads. Tehran claims it needs that level of enriched uranium for reactor fuel and medical isotopes, and has signaled it does not intend to stop. U.N. nuclear inspectors last week confirmed Iran has begun a major upgrade of its program at the country's main uranium enrichment site.
Iran also insists, as a starting point, that world powers must recognize the republic's right to enrich uranium, and Jalili repeated Wednesday that Tehran must be able to enrich to 20 percent.
"Whatever we need, we will of course pursue that -- whether it is 5 percent or 20 percent," Jalili said. "It is important to us to have the 20 percent."
However, that remains a red line to negotiators from the world powers -- the United States, China, Russia, Britain, France and Germany -- who put their continued demand that Iran end any uranium enrichment that nears or reaches 20 percent at the heart of the new offer.
The senior U.S. official said Iran would be required to restrict its current stockpile of 20 percent enriched uranium but, in a new development, would be allowed to keep enough to fuel a research reactor in Tehran. Also, Iran would have to suspend operations at its underground nuclear facility at Fordo -- and make it difficult to restart it quickly -- but would no longer be required to fully shut it down.
In return, the official said, the U.S. and EU would lift a number of unspecified sanctions on Iran, which was hit with harsh trade restrictions last year in Western hopes they would force Tehran to bend on its nuclear program. Additionally, the U.N. Security Council and the EU would impose no new nuclear sanctions against Iran.
However, the hardest-hitting sanctions -- on Iran's oil and financial industries -- will remain in place during the negotiations, the official said. The tough sanctions have caused unemployment and inflation in Iran to skyrocket, while depressing its daily oil output and value of its currency, the rial.
There was no deadline on when the new offer might expire, but the official urged Iran to respond quickly because "time is not on their side in many ways."
"There is a cost to Iran for every day that they wait to solve this problem," the U.S. official said. "And they will keep paying those costs, and the cost will go up."
1 2 - Next page >> | http://www.wtop.com/220/3234995/Iran-Nuclear-negotiations-end-on-positive-note?nid=1229 | robots: classic
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} | 797 | Iran's Rouhani: Nuclear deal possible by July 20 with goodwill
Reuters News
Posted: Jun 14, 2014 7:18 AM
By Parisa Hafezi
ANKARA (Reuters) - President Hassan Rouhani urged world powers on Saturday to cut a deal with Iran by a July 20 deadline to end a dispute over its nuclear program, arguing that in any case sanctions meant to restrict its atomic activity have frayed beyond repair.
He told a news conference in Tehran that the economic curbs had been softened by his government's policy of detente, replacing one of confrontation with the West, and "will not be rebuilt" even if the Islamic Republic and the six big powers fail to reach a final agreement by July 20.
"The disputes can be resolved with goodwill and flexibility ... I believe that the July 20 deadline can be met despite remaining disputes. If not, we can continue the talks for a month or more," he said.
"During the nuclear negotiations we have displayed our strong commitment to diplomacy," Rouhani went on, in comments broadcast live on state television. "(But even) if a deal can't be reached by July 20, conditions will never be like the past. The sanctions regime has been broken."
Iran and the powers will hold another round of talks in Vienna on June 16-20 to tackle a deadlock which has raised the likelihood that the deadline will lapse without a deal meant to head off the risk of a Middle East war over the nuclear issue.
An outright failure of the faltering talks would strengthen the position of conservative hardliners in Iran's clerical establishment against Rouhani, who has endeavoured to improve relations with the United States. The countries severed ties during a hostage crisis after the 1979 Islamic Revolution.
"The West should use this opportunity to reach a final deal in the remaining weeks. American hawks and Israel will be blamed for (any) failure of the talks," Rouhani said.
Israel, Iran's regional arch-foe, has cast doubt on whether diplomacy is capable of curbing in Iranian nuclear activity and, if it cannot, has threatened to bomb Iranian nuclear sites. Its scepticism is shared by hawkish supporters in the U.S. Congress.
The latest round of negotiations in Vienna last month ran into difficulties when it became clear that the number of centrifuge enrichment machines that Iran wanted to maintain was well beyond what would be acceptable to the West.
Iran says it needs to maintain a domestic uranium enrichment capability to produce fuel for a planned network of nuclear power plants without having to rely on foreign suppliers.
Wary Western officials believe Iran will need many years to build any nuclear power station and that its underlying goal in enriching uranium is to be able to yield material for nuclear bombs at short notice, an allegation the Islamic state denies.
Iran, the United States, Britain, France, Germany, Russia and China set the July 20 deadline to reach a comprehensive agreement in an interim deal they reached in Geneva on Nov. 24.
The November pact - in which Iran suspended some sensitive nuclear activities in return for limited relief from sanctions - allowed a six-month extension if more time were needed for a final deal. The preliminary accord went into effect on Jan 20.
It is increasingly improbable that six world powers and Iran will meet the deadline, officials and analysts say.
While an extension is possible, experts believe both sides may come under pressure from critics at home to seek better terms during this extra period, further clouding the outlook.
In another sign of Iranian determination not to negotiate away its enrichment work, a top aide to clerical Supreme Leader Ayatollah Ali Khamenei said Iran would never renounce its peaceful nuclear rights under pressure.
“The Islamic Republic of Iran will never be influenced by pressure exerted by others who seek to deprive Iran of its nuclear rights and will never back down from its rights,” Ali Akbar Velayati told the official IRNA news agency.
The two sides said last month that they had intended to start writing the text of a final agreement but the full-scale drafting did not actually begin.
Rouhani, a former chief nuclear negotiator for Tehran, said on Saturday that Iran and the powers might start drafting the final agreement in next week's talks.
"The major powers and Iran have agreed on two issues with Iran: We will continue our uranium enrichment activities and all sanctions on Iran will be lifted," he said, adding that no one would benefit from the collapse of the talks.
Iran now has about 19,000 centrifuges installed, of which roughly 10,000 are operating, according to the U.N. nuclear watchdog. Enriched uranium can have both civilian and military uses, depending on the degree of refinement.
(Writing by Parisa Hafezi, Editing by William Maclean and Mark Heinrich) | https://townhall.com/news/politics-elections/2014/06/14/irans-rouhani-nuclear-deal-possible-by-july-20-with-goodwill-n1871668 | robots: classic
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Iran 'final' nuclear talks deadline likely to be extended
Iran 'final' nuclear talks deadline likely to be extended
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Iran has said it would resist Western pressure to make what it considered to be excessive concessions in nuclear talks in Vienna.
Negotiators from Tehran and six world powers are pushing to end a 12-year dispute over Iran’s nuclear programme.
The talks aim to reach a settlement that would curb Iranian atomic activities in return for the phasing out of sanctions, but officials admitted that that the November 24 deadline is unlikely to be met.
France, China, Russia, Germany, the United States and Britain want Iran to scale back its capacity to refine uranium, to prevent the production of a nuclear bomb, a key concern of neighbouring power Israel.
Tehran says that it is enriching uranium to make fuel for nuclear power plants.
Iran’s negotiator said any solution must respect Iran’s rights as well as allay the concerns of the international community. | https://www.euronews.com/2014/11/18/iran-final-nuclear-talks-deadline-likely-to-be-extended | isPartOf: CC-MAIN-2019-35
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} | 461 | Home Breaking News Iran nuclear deal: Deadline extended until June 2015
Iran nuclear deal: Deadline extended until June 2015
The deadline for Iran nuclear deal has been extended until June 30, 2015, after talks in Vienna failed to reach a comprehensive agreement.
Six world powers want Iran to curb its nuclear program in return for the lifting of sanctions.
Tehran says it is not seeking nuclear weapons, but wants atomic energy.
The six countries – the US, UK, Russia, China, France and Germany – have been in negotiations with Iran to finalize a preliminary deal reached last year in Geneva.
Iran would be allowed to continue accessing $700 million per month in frozen assets during that period.
Diplomats expect to reach a political agreement by March 1, 2015, with the full technical details of the agreement confirmed by July 1, 2015.
Iranian President Hassan Rouhani is to give a national address this evening, Iranian news agencies reported.
There are thought to have been three key sticking points in the negotiations:
• Western states want to reduce Iran’s capacity for uranium enrichment in order to prevent it acquiring weapons-grade material but Tehran is set on expanding it nearly twentyfold in the coming years
• Iran wants sanctions lifted immediately but Western states want to stagger their removal to ensure Tehran abides by its commitments
• Iran has failed to explain explosives tests and other activity that could be linked to a nuclear weapons program and has denied international nuclear inspectors access to its Parchin military site
Highly enriched uranium can be used to make a nuclear bomb, but uranium enriched to lower levels can be used for energy purposes.
Under the terms of international treaties, countries have the right to develop nuclear energy, which Iran insists is its only aim.
However, the International Atomic Energy Agency (IAEA) says it has been unable to confirm Tehran’s assertions that its nuclear activities are exclusively for peaceful purposes.
The UN Security Council has adopted six resolutions since 2006 requiring Iran to stop enriching uranium, with sanctions to persuade Iran to comply.
Both Saudi Arabia and Israel are also vehemently opposed to Iran acquiring nuclear weapons. Saudi Foreign Minister Prince Saud al-Faisal visited Vienna at the weekend for talks with US Secretary of State John Kerry, though his country is not formally involved in the discussions.
[youtube n1aqmGBff1E 650]
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} | 567 | Proposed Deal: U.S. to Allow Iran to Continue Enriching, Keep Centrifuges Intact
The United States has proposed a short-term nuclear agreement with Iran at a meeting in Geneva which would allow Tehran to continue enriching uranium at low levels, an aide briefed on the talks told the British Telegraph newspaper on Thursday.
The goal is to freeze Iran’s nuclear program for perhaps six months in order to create a breathing space for a comprehensive agreement to be negotiated, according to the Telegraph.
Western diplomats and U.S. officials have refused to disclose any details of a “first step agreement” with Iran at Thursday’s talks in Geneva. But a Senate aide, citing briefings from the White House, the State Department and sources in Geneva, said he understood that it would include four key points:
1) Iran would stop enriching uranium to the 20 percent level that is close to weapons-grade and turn its existing stockpile of this material into harmless oxide, according to the Telegraph report.
2) Iran would continue enrichment to the 3.5 percent purity needed for nuclear power stations but agree to limit the number of centrifuges being used for this purpose. There would, however, be no requirement to remove or disable any other centrifuges.
In return, according to the Telegraph, America would ease economic sanctions, possibly by releasing some Iranian foreign exchange reserves currently held in frozen accounts. In addition, some restrictions affecting Iran’s petrochemical, motor and precious metals industries could be relaxed.
However, a senior administration official made clear that only “reversible” sanctions would be eased – and they could be re-imposed if Iran were to break any deal.
The report comes as a senior Iranian official claimed that a breakthrough had been made at nuclear talks in Geneva, and that Tehran’s proposed plan for resolving the impasse over its atomic program has been accepted by the six world powers.
Responding to the reports, Prime Minister Binyamin Netanyahu warned that signing an interim deal with Iran would be a mistake of “historic proportions,” but that appears to be precisely the deal being hammered out.
Speaking at a conference on joint strategic dialogue between the government of Israel and the Jewish world, Netanyahu said the proposals being offered at the meeting would ease pressure on Iran for empty concessions that would “allow Iran to retain the capabilities to make nuclear weapons.”
David Albright, the director of the Institute for Science and International Security (ISIS), a think tank which monitors Iran’s nuclear ambitions, cautioned in a conversation with the Telegraph against an agreement that would not genuinely freeze the program.
If Iran stopped enrichment to 20 per cent purity and converted its existing stockpile, this would be “nowhere near enough”, he said. Any interim agreement would be also undermined if Iran was still able to manufacture centrifuges, including the old IR-1s and the more advanced IR-2Ms.
ISIS recently released a new report which found that Iran could produce enough weapons-grade uranium to build a nuclear bomb in as little as a month.
Source material can be found at this site.
Posted in Terrorism and tagged , , , , , , . | https://conservativepapers.com/news/2013/11/08/proposed-deal-u-s-to-allow-iran-to-continue-enriching-keep-centrifuges-intact/ | isPartOf: CC-MAIN-2021-25
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} | 484 | The United States and Iran have said that progress has been made in the latest round of talks on Tehran's nuclear programme, but warned there was still a long way to go to seal a final deal.
Negotiators for Iran and six world powers had been meeting in Geneva since Friday and plan further talks in Switzerland next week, a senior US administration official said on Monday.
"These were serious, useful and constructive discussions," the official told the AFP news agency after US Secretary of State John Kerry and Iranian Foreign Minister Mohammad Javad Zarif wrapped up two days of meetings in the lakeside city.
Zarif agreed. "Some progress was made on certain subjects, but there is still a long road ahead to reach a final agreement," he told Iranian media.
As a March 31 deadline looms for reaching a political framework for a deal, State Department spokeswoman Jen Psaki told reporters in Washington that Kerry "could certainly participate at some point" in next week's negotiations, but she had nothing concrete to announce.
"These talks have been productive, there's still more work to do," Psaki said.
The so-called P5+1 group of Britain, China, France, Russia, the United States and Germany are trying to strike an accord that would prevent Tehran from developing a nuclear bomb.
In return, the West would ease punishing sanctions imposed on Tehran over its nuclear programme, which Iran insists is purely civilian in nature.
European oil embargo squeezes Iran
The idea would be to reward Iran for good behaviour over the last years of any agreement, gradually lifting constraints on its uranium enrichment programme and slowly easing economic sanctions.
Iran said it does not want nuclear arms and needs enrichment only for energy, medical and scientific purposes, but the US fears Tehran could re-engineer the programme to produce a nuclear weapon.
10-year restrictions
The US initially sought restrictions lasting for up to 20 years; Iran had pushed for less than a decade. The prospective deal appears to be somewhere in the middle.
One variation being discussed would place at least a 10-year regime of strict controls on Iran's uranium enrichment programme.
Iran could also be allowed to operate significantly more centrifuges than the US administration first demanded, though at lower capacity than they currently run.
Several officials spoke of 6,500 centrifuges as a potential point of compromise, with the US trying to restrict them to Iran's mainstay IR-1 model instead of more advanced machines.
It would also be forced to ship out most of the enriched uranium it produces, or change it to a form that is difficult to reconvert for weapons use.
It takes about 1 tonne of low-enriched uranium to process into a nuclear weapon, and officials said that Tehran could be restricted to an enriched stockpile of no more than 300 kilogrammes.
Source: Agencies | http://www.aljazeera.com/news/2015/02/iran-geneva-nuclear-talks-150223141419466.html | robots: classic
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Iran's potential movement on enrichment reflected the intense pressure to close a deal. But substantial differences between the sides may prove too difficult to bridge before Tuesday's deadline for a preliminary agreement, which is meant to set the stage for a further round of negotiations toward a comprehensive deal in June.
The goal is a long-term curb on Iran's nuclear activities. In return, Tehran would gain relief from the burden of global economic penalties.
Foreign ministers and other representatives of Iran and the six powers in the talks have said there is a chance of succeeding by the deadline despite significant obstacles.
White House spokesman Josh Earnest said it was up to Iran to make that happen.
By accepting the restrictions, the Iranians would "live up to their rhetoric that they are not trying to acquire a nuclear weapon," he said in Washington on ABC's "This Week."
From Israel, Prime Minister Benjamin Netanyahu renewed strong criticism of what he brands a bad deal. He is at the forefront of accusations that Iran helped the recent Shiite rebel advance in Yemen, and Netanyahu linked Iran's alleged proxy grab for influence in the Middle East with what he sees as victory by Tehran at the negotiations in the Swiss city of Lausanne.
"The Iran-Lausanne-Yemen axis is very dangerous for humanity and must be stopped," he said.
U.S. Senate Majority Leader Mitch McConnell, heading a delegation of American senators visiting Israel, said the lawmakers supported legislation to require Congress to approve any agreement on Iran's nuclear program, or to increase penalties against Iran if no deal is reached.
The officials in Lausanne said the sides were advancing on limits to aspects of Iran's uranium enrichment program, which can be used to make the core of a nuclear warhead.
The officials, who spoke on condition of anonymity because they were not authorized to publicly discuss the talks, said Tehran now may be ready to accept even fewer.
Tehran is ready to ship to Russia all the enriched uranium it produces, the officials said, describing a change from previous demands that Iran be permitted to keep a small amount in stock.
One official cautioned that Iran previously had agreed to this, only to change its mind. Also, Iran's official IRNA news agency on Sunday cited an unidentified Iranian negotiator as denying such an agreement had been reached.
The United States and its allies want a deal that extends the time Iran would need to make a nuclear weapon from the present two months to three months to at least a year.
The officials said a main dispute involves the length of an agreement. Iran, they said, wants a total lifting of all caps on its activities after 10 years, while the U.S. and others at the talks - Russia, China, Britain, France and Germany - insist on progressive removal after a decade.
A senior U.S. official characterized the issue as lack of agreement on what happens in years 11 to 15. The official spoke on condition of anonymity in line with State Department rules on briefing about the closed-door talks.
Limits on Iran's research and development of centrifuges also were unresolved, the Western officials said.
Tehran has created a prototype centrifuge that it says enriches uranium 16 times faster than its present mainstay model. The U.S. and its partners want to constrain research that would increase greatly the speed of making enough weapons-grade uranium for a bomb, once limits on Iran's programs are lifted.
One official said Russia opposed the U.S. position that any U.N. penalties lifted in the course of a deal should be reimposed quickly if Tehran reneged on any commitments.
Both Western officials Iran was resisting attempts to make inspections and other ways of verification as intrusive as possible.
There was tentative agreement on turning a nearly-finished reactor into a model that gives off less plutonium waste than originally envisaged. Plutonium, like enriched uranium, is a path to nuclear weapons.
Iran and the U.S. were discussing letting Iran run centrifuges at an underground bunker that has been used to enrich uranium. The machines would produce isotopes for peaceful applications, the officials said.
With the Tuesday deadline approaching and problems remaining, U.S. Secretary of State John Kerry canceled plans Sunday to return to the United States for an event honoring the late U.S. Sen. Edward Kennedy. French Foreign Minister Laurent Fabius and Frank-Walter Steinmeier, his German counterpart, scratched planned trips to Kazakhstan.
Kerry has been in discussions with Iranian Foreign Minister Mohammad Javad Zarif since Thursday. | https://www.savannahnow.com/article/20150329/NEWS/303299885 | isPartOf: CC-MAIN-2019-30
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'Time is short,' Rouhani urges faster progress at nuclear talks
Speaking shortly before the latest round of negotiations between Iran and the world powers ended Friday, Iranian President Hassan Rouhani said faster progress needed to be made in order to seal a deal by the Nov. 24 deadline.
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Without mentioning the US by name, Hassan Rouhani suggested agreement could end the more than three-decade deep-freeze in relations between Washington and Tehran and mark "the beginning of a path toward collaboration and cooperation."
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"There have been steps forward, but they haven't been significant," Rouhani said, arguing that his country had shown the necessary flexibility and that it now was up to the U.S. and five other nations to advance the talks.
"Time is short," he told reporters.
Russian Foreign Minister Sergey Lavrov struck a more optimistic note on the talks, saying separately that both sides were interested in resolving "the remaining small but extremely important issues." But eight days into the current session, he seemed alone in that relatively upbeat assessment.
The officials spoke shortly before the latest round between Iran and six world powers ended late Friday. The session was held on the sidelines of the U.N. General Assembly's ministerial meeting and foreign ministers attending had been expected to join the talks.
But that never happened. French Foreign Minister Laurent Fabius said a lack of "significant advances" obviated the need, while U.S. officials cited scheduling conflicts. Iranian media quoted Iranian Deputy Foreign Minister Abbas Araghchi as saying the sides had "not yet arrived at a mutual understanding that can serve as the basis of an agreement."
Without judging progress, U.S. Secretary of State John Kerry said his "fervent hope" was that a deal would be struck. A senior U.S. official said an enormous amount of details still needed to be worked through before the November deadline. She demanded anonymity in line with State Department rules.
The talks remain stuck over uranium enrichment. Iran says it needs a robust enrichment program to make reactor fuel and for other peaceful purposes, but the U.S. and its allies fear the program's other application — making the fissile core of a nuclear weapon.
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While eager to reach an agreement in return for an end to crippling nuclear-related sanctions, Iranian officials insist they will never agree to gutting their enrichment capabilities. Insisting that the sanctions must "be melted away," Rouhani nonetheless said Iran will not accept any agreement that requires it to stop enriching uranium.
The U.S. came to the current round demanding that Tehran limit its enrichment output at what roughly 1,500 of its mainstay centrifuge machines would produce. Iran insists the output should remain at the level produced at the approximately 10,000 centrifuges it now operates — and be allowed to expand more than ten-fold over the next decade.
With the clock ticking down on the deadline, diplomats have told The Associated Press that the U.S. is considering a new approach. They said the tentative proposal would allow Tehran to keep nearly half of the centrifuges already spinning but reduce the stock of uranium gas fed into the machines to the point where it would take more than a year of enriching to create enough material for a nuclear warhead.
The diplomats emphasized that the proposal is only one of several being discussed by the six powers — the U.S., Russia, China, Britain, France and Germany — and has not yet been formally submitted to the Iranians.
Other ideas also include letting Iran have more than 1,500 machines but removing or destroying much of the infrastructure needed to make them run — connecting circuits, pipes used to feed uranium gas and other auxiliary equipment.
Both would allow the Iranians to claim that they did not compromise on vows that they would never destroy existing enrichment capabilities, while keeping intact American demands that the program be downgraded to a point where it could not be quickly turned to making bombs.
But even if a solution is found, the sides still differ on how long Iran's nuclear program should be constrained, with Tehran seeking less than a decade and the demanding Americans substantially more.
Reflecting Iran's opposition to deep cuts, Rouhani said the main issue was not decreasing enrichment but how long "Iran is willing to limit its capability, and after what period they can expand upon those activities."
The fates of a reactor under construction near the city of Arak and of an underground enrichment facility at Fordo are also up in the air. The U.S. and its Western allies want the reactor converted to reduce to a minimum of its production of plutonium, an alternate pathway to nuclear arms. And they insist that the Fordo plant be shuttered or used for something other than enrichment because it is fortified and thought to be impervious to air attacks.
Associated Press writers Gregory Katz and Matthew Lee contributed. | https://m.csmonitor.com/World/Latest-News-Wires/2014/0927/Time-is-short-Rouhani-urges-faster-progress-at-nuclear-talks | robots: classic
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} | 844 | 'Time is short,' Rouhani urges faster progress at nuclear talks
Speaking shortly before the latest round of negotiations between Iran and the world powers ended Friday, Iranian President Hassan Rouhani said faster progress needed to be made in order to seal a deal by the Nov. 24 deadline.
Without mentioning the US by name, Hassan Rouhani suggested agreement could end the more than three-decade deep-freeze in relations between Washington and Tehran and mark "the beginning of a path toward collaboration and cooperation."
"There have been steps forward, but they haven't been significant," Rouhani said, arguing that his country had shown the necessary flexibility and that it now was up to the U.S. and five other nations to advance the talks.
"Time is short," he told reporters.
Russian Foreign Minister Sergey Lavrov struck a more optimistic note on the talks, saying separately that both sides were interested in resolving "the remaining small but extremely important issues." But eight days into the current session, he seemed alone in that relatively upbeat assessment.
The officials spoke shortly before the latest round between Iran and six world powers ended late Friday. The session was held on the sidelines of the U.N. General Assembly's ministerial meeting and foreign ministers attending had been expected to join the talks.
But that never happened. French Foreign Minister Laurent Fabius said a lack of "significant advances" obviated the need, while U.S. officials cited scheduling conflicts. Iranian media quoted Iranian Deputy Foreign Minister Abbas Araghchi as saying the sides had "not yet arrived at a mutual understanding that can serve as the basis of an agreement."
Without judging progress, U.S. Secretary of State John Kerry said his "fervent hope" was that a deal would be struck. A senior U.S. official said an enormous amount of details still needed to be worked through before the November deadline. She demanded anonymity in line with State Department rules.
The talks remain stuck over uranium enrichment. Iran says it needs a robust enrichment program to make reactor fuel and for other peaceful purposes, but the U.S. and its allies fear the program's other application — making the fissile core of a nuclear weapon.
While eager to reach an agreement in return for an end to crippling nuclear-related sanctions, Iranian officials insist they will never agree to gutting their enrichment capabilities. Insisting that the sanctions must "be melted away," Rouhani nonetheless said Iran will not accept any agreement that requires it to stop enriching uranium.
The U.S. came to the current round demanding that Tehran limit its enrichment output at what roughly 1,500 of its mainstay centrifuge machines would produce. Iran insists the output should remain at the level produced at the approximately 10,000 centrifuges it now operates — and be allowed to expand more than ten-fold over the next decade.
With the clock ticking down on the deadline, diplomats have told The Associated Press that the U.S. is considering a new approach. They said the tentative proposal would allow Tehran to keep nearly half of the centrifuges already spinning but reduce the stock of uranium gas fed into the machines to the point where it would take more than a year of enriching to create enough material for a nuclear warhead.
The diplomats emphasized that the proposal is only one of several being discussed by the six powers — the U.S., Russia, China, Britain, France and Germany — and has not yet been formally submitted to the Iranians.
Other ideas also include letting Iran have more than 1,500 machines but removing or destroying much of the infrastructure needed to make them run — connecting circuits, pipes used to feed uranium gas and other auxiliary equipment.
Both would allow the Iranians to claim that they did not compromise on vows that they would never destroy existing enrichment capabilities, while keeping intact American demands that the program be downgraded to a point where it could not be quickly turned to making bombs.
But even if a solution is found, the sides still differ on how long Iran's nuclear program should be constrained, with Tehran seeking less than a decade and the demanding Americans substantially more.
Reflecting Iran's opposition to deep cuts, Rouhani said the main issue was not decreasing enrichment but how long "Iran is willing to limit its capability, and after what period they can expand upon those activities."
The fates of a reactor under construction near the city of Arak and of an underground enrichment facility at Fordo are also up in the air. The U.S. and its Western allies want the reactor converted to reduce to a minimum of its production of plutonium, an alternate pathway to nuclear arms. And they insist that the Fordo plant be shuttered or used for something other than enrichment because it is fortified and thought to be impervious to air attacks.
Associated Press writers Gregory Katz and Matthew Lee contributed.
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} | 306 | With barely a month left until a self-imposed deadline to hammer out a nuclear agreement with Iran, the United States is now considering an alternative proposal that significantly softens its previous position on the number of active centrifuges Tehran should be allowed to operate, the Associated Press, or AP, reported, citing unnamed U.S. officials.
The report comes after months of talks between Iran and six world powers failed to yield a comprehensive agreement.
Under the purported new deal, Iran will be allowed to keep up to 4,500 centrifuges -- a significant climbdown by the U.S., which had previously insisted that no more than 1,500 centrifuges should be left operating -- but will have to reduce the stock of uranium gas fed into the machines to a point where it would take more than a year of enrichment to fuel a nuclear warhead, the U.S. officials told AP.
The officials reportedly emphasized that the proposal is just one of many being discussed by the P5+1 group, which includes the U.S., Russia, China, Britain, France and Germany, and has not yet been formally submitted to the Iranians.
Iran, has, so far, insisted that it be allowed to run at least 9,400 centrifuges under its current nuclear program, stating that it wants to use the technology for peaceful purposes and not to build a nuclear warhead.
Toward this end, Iranian negotiators had, earlier in September, urged the Western powers to drop their “illogical demands” over its nuclear program and reiterated the need to reach a conclusive deal by the Nov. 24 deadline.
Iran is already subject to U.S. sanctions which target several companies and individuals, over its nuclear program. Iranian President Hassan Rouhani, addressing the United Nations General Assembly on Thursday, said that he “can’t place trust”, in countries that impose such sanctions, highlighting the lack of a substantial progress in the negotiations so far. | http://www.ibtimes.com/us-ready-soften-stance-iran-nuclear-deal-report-1695410 | robots: classic
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UNITED NATIONS (AP) — Seven months and more than a half dozen rounds into talks on a substantive nuclear deal, Iran and six world powers gathering for another session appear no closer to an agreement.
Iran claims its nuclear program has only peaceful purposes, but Western nations have long suspected Iran wants to have the capacity to make nuclear weapons.
The talks once again bring Iran to the negotiating table with the United States, Russia, China, Britain, France and Germany. But this time they are taking place on the sidelines of the U.N. General Assembly. That means U.S. Secretary of State John Kerry and his counterparts will likely join in, adding their diplomatic muscle to the meeting.
Some facts about enrichment and other issues related to the nuclear negotiations:
There is agreement that Iran should have an "enrichment program with practical limits and transparency measures" to ensure it's peaceful. That has led to haggling over how many — and what kind — of centrifuges Iran should be allowed to have. The machines can enrich uranium from low, reactor-fuel level, all the way to grades used to build the core of a nuclear weapon, and their output grows according to how modern they are.
Iran has not publicly backed away from its plan to expand enrichment over the next eight years to a level that would require about 190,000 centrifuges. It now has about 20,000 centrifuges, half of them operational. Iranian officials have signaled they are ready to freeze that number for now. The United States wants Iran to have fewer than 1,000 centrifuges.
The U.S. and its allies consider the underground enrichment plant near the Iranian village of Fordo a threat because it is heavily fortified against aerial attacks. They want it shut down or converted to non-enrichment functions. Among the Iranian offers rejected by the West is turning Fordo into an enrichment research facility.
The reactor under construction near the city of Arak is also a concern for the West because it is a heavy-water unit that would produce substantial amounts of plutonium that can be used as the fissile core of a missile. The Iranians have offered to re-engineer it to produce less plutonium — but that process is reversible. The U.S. seeks a completely new kind of reactor that produces only minuscule amounts of plutonium.
An interim agreement says that if Iran honors a final agreement, it will eventually be treated as any other non-nuclear weapons member of the Nuclear Non-Proliferation Treaty. This means Iran would have the right to expand enrichment without having to worry about strict monitoring.
Senior U.S. officials define the number of years of restrictions as "in the double digits," while Iran wants it to be less than 10 years.
Iran denies wanting — or ever working on — nuclear weapons and has pledged to cooperate with the latest U.N. atomic agency effort to probe such allegations. But months into the inquiry, it has yet to provide information sought by the agency. While the investigation is separate from the talks, the U.S. says a deal can be struck only if the U.N. agency is satisfied with the probe and its final results.
Associated Press diplomatic writer Matthew Lee contributed from Washington and AP U.N. chief correspondent Edith Lederer from the United Nations.
New round of Iran nuclear talks faces old hurdles
Sorry we are not currently accepting comments on this article. | https://www.dailymail.co.uk/wires/ap/article-2761849/New-round-Iran-nuclear-talks-faces-old-hurdles.html | isPartOf: CC-MAIN-2019-13
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Iran, 6 powers wrestle over text of nuke deal
Wednesday - 5/14/2014, 12:04pm ET
European foreign policy chief Catherine Ashton, left, and Iranian Foreign Minister Mohamad Javad Zarif, right, wait for the start of closed-door nuclear talks in Vienna, Austria, Wednesday, May 14, 2014. The talks between Iran and six world powers have entered an ambitious new stage with the two sides sitting down to start drafting the text of a final deal. (AP Photo/Ronald Zak)
Associated Press
VIENNA (AP) -- Nuclear talks between Iran and six world powers moved to an ambitious new stage on Wednesday, with the two sides sitting down to start writing the text of a final deal. But with major issues still unresolved, any initial draft is likely to be a patchwork affair -- and agreement remains uncertain.
The talks are being coordinated by EU foreign policy chief Catherine Ashton, and her spokesman, Michael Mann, said the two sides are "getting down to the nitty-gritty" in discussions scheduled to adjourn Friday, about two months before the July 20 target date for a deal.
The United States and its allies hope to reduce Iran's potential nuclear weapons-making capacity by negotiating substantial cuts in its atomic program. Tehran says it has no interest in such weapons but is ready for some concessions if all sanctions on its economy are lifted.
Two diplomats involved with international efforts to trace and curb Iran's atomic activities said the two sides were coming to the table with some differences narrowed but others remaining.
The diplomats demanded anonymity because they are not authorized to discuss the confidential talks. But they gave a partial picture of where things stand.
Areas of progress include:
The partially built reactor at Arak was meant to be a heavy-water facility that would produce substantial amounts of waste plutonium -- material that can be used as the core of a nuclear weapon. There is tentative agreement on re-engineering the reactor to a light-water installation or cutting back on its output.
Iran is ready in principle to sign an agreement with the U.N. atomic agency that would allow its experts to visit any declared nuclear site at very short notice; investigate suspicions of undeclared nuclear activity, and push for deeper insight into all atomic work.
Major differences remain on:
Iran now has nearly 20,000 centrifuges set up, with about half of them producing uranium enriched to reactor fuel-grade levels. Iran says it is enriching only for peaceful purposes but if reconfigured, the centrifuges could produce weapons-grade uranium for nuclear bombs.
The United States, Britain, France and Germany say no more than a few thousand of the machines should be left standing. Tehran wants to expand the program -- or at least keep the status quo.
Russia is ambivalent about numbers, as long as Iran agrees to allow the U.N. nuclear agency greater monitoring and investigating authority, while China normally supports Russia's position.
The United States and its allies say Iranian missiles capable of delivering a nuclear weapon must be dealt with in any deal. But Iranian Supreme Leader Ayatollah Ali Khamenei said earlier this week that hopes of including the missiles are "a stupid, idiotic expectation." One of the diplomats said possible compromises could focus on nuclear missile payloads, or limiting further test launches.
The United States and its allies allege that Iran worked on nuclear weapons in the past and say Tehran must admit it to secure a nuclear deal. Tehran says such accusations are baseless.
A U.N. probe into the accusations relaunched three months ago has so far not narrowed differences.
The U.S. and its allies want to limit the scope of Iran's nuclear program for more than a decade. Tehran wants any constraints lifted after only a few years.
| http://www.wtop.com/220/3621329/Iran-6-powers-work-on-text-of-nuke-deal | robots: classic
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} | 888 | US: Iran's answer inadequate
Diplomats say counteroffer rejects demand that Teheran export most of potential warhead material.
Qom nuclear facility iran 248 88 ap (photo credit: AP)
Qom nuclear facility iran 248 88 ap
(photo credit: AP)
US State Department spokesman P.J. Crowley responded unfavorably Monday night to the Iranian rebuttal of the international proposal which would have committed it to quickly exporting most of the material it would need to make a nuclear warhead.
"I'm not sure that they've delivered a formal response, but it is clearly an inadequate response," Crowley told reporters in Washington.
Iran told the head of the UN nuclear agency that it did not accept the proposal.
For months, Iranian officials have used the media to criticize the plan backed by most of the world's major powers and to offer alternatives to one of its main conditions - that the Islamic republic ship out most of its stock of enriched uranium and then wait for up to a year for its return in the form of fuel rods for its Teheran research reactor.
While critical of such statements, the United States and its allies noted that Iran had yet to respond to the International Atomic Agency regarding the plan, first drawn up in early October in a landmark meeting in Geneva between Iran and the six world powers, and then refined later that month in Vienna talks among Iran, the US, Russia and France.
But Iran now also has told the IAEA - which chaired the Vienna talks - that it wants an alternative to the plan. Its version effectively rejects the key demand that it agree to a tight timetable in shipping out most of its enriched uranium supply, said the diplomats.
The talks in Vienna came up with a draft proposal that would take 70 percent of Iran's low-enriched uranium to reduce its stockpile of material that could be enriched to a higher level, and possibly be used to make nuclear weapons.
That uranium would be returned about a year later as refined fuel rods, which can power reactors but cannot be readily turned into weapons-grade material. Iran maintains its nuclear program is only for the peaceful purpose of generating energy.
The Geneva talks grouped the US, Russia, China, Britain, France and Germany around the negotiating table with Iran. Diplomats from three of those big powers said Tuesday that Iran's counterproposal to the IAEA was essentially a rehash of an already publicly floated offer that fell far short of the six nations' expectations.
In a January 6 meeting with IAEA chief Yukiya Amano, Ali Asghar Soltanieh, the chief Iranian delegate to the agency, said his country would exchange enriched uranium only on domestic soil and only simultaneously for research reactor fuel, said the diplomats, who asked for anonymity because their information was confidential.
That would delay any exchange for at least a year or so - the time needed to make the rods for the Teheran reactor. And that, in turn would give Iran time to increase its enriched uranium stockpile to a level where it would still have enough to make a nuclear weapon even if it exported the 1.2 tons (1,100 kilograms) specified in the original draft agreement.
In addition, the Iranian counterproposal calls for exchanges in several tranches, said the diplomats. That, too, runs counter to the Western wish that Iran ship out most of its present accumulation of enriched uranium in one batch and thereby leave it with not enough to make a weapon.
Repeated calls to the cell-phone number of Soltanieh, the Iranian chief IAEA delegate, were not answered Tuesday.
Around 2,200 pounds of low-enriched uranium are needed to produce enough weapons-grade uranium for a single nuclear warhead, according to experts. Iran is believed to have well over that amount in its stockpiles and its thousands of centrifuges churn out new material by the day.
Iran points to nuclear deals with Western companies and governments that were put on ice after the Islamic Revolution overthrew the previous regime three decades ago in arguing it cannot trust that its interlocutors will deliver the fuel rods if it agrees to export most of its enriched uranium on good faith.
It argues that its nuclear program is aimed at creating a peaceful nuclear energy network to serve its growing population. The US and other nations believe Iran's nuclear program has the goal of creating atomic weapons.
The United States and its Western allies have been pushing for a fourth round of UN sanctions.
But with Russia, and especially China, skeptical of any new UN penalties, they have to tread carefully to maintain six power unity on how to deal with the Islamic Republic.
A meeting Saturday of senior diplomats from the six powers focused on possible new sanctions but participants said it reached no agreement.
"I don't think that we bridged the different views that the United States and others and China have about the - about the issue of sanctions," Crowley said. "These are long-standing concerns, and we'll continue to talk to China about them." | https://www.jpost.com/iranian-threat/news/us-irans-answer-inadequate | isPartOf: CC-MAIN-2021-31
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} | 827 | APNewsBreak: Officials say Iran responds to fuel exchange offer, its terms unsatisfactory
The Associated Press ~ staff The News
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VIENNA, Austria - Iran has formally responded to a nuclear fuel swap proposal backed by the world's major powers with a counteroffer effectively rejecting their demand that Tehran quickly export most of the material it would need to make a warhead, diplomats said Tuesday.
For months, Iranian officials have used the media to criticize the plan and offer alternatives to one of its main conditions - that the Islamic republic ship out most of its stock of enriched uranium and then wait for up to a year for its return in the form of fuel rods for its Tehran research reactor.
While critical of such statements, the United States and its allies said they did not constitute a formal response to the plan, first drawn up in early October in a landmark meeting in Geneva between Iran and the six world powers, and then refined later that month in Vienna talks among Iran, the U.S., Russia and France.
The diplomats told The Associated Press that Iran first submitted such a formal response to the International Atomic Energy Agency earlier this month in a Jan. 6 meeting between Ali Asghar Soltanieh, Iran's chief representative to the IAEA, and agency chief Yukiya Amano. They disagreed on whether the response was oral or written.
That uranium would be returned about a year later as refined fuel rods, which can power reactors but cannot be readily turned into weapons-grade material. Iran maintains its nuclear program is only for the peaceful purpose of generating energy.
The Geneva talks grouped the U.S., Russia, China, Britain, France and Germany around the negotiating table with Iran. Diplomats from two of those big powers said Tuesday Iran's formal counterproposal was essentially a rehash of an already publicly floated offer that fell far short of the six nations' expectations.
In its submission, Iran was offering to exchange enriched uranium only on domestic soil and only simultaneously for research reactor fuel, said the diplomats, who asked for anonymity because their information was confidential.
That would delay any exchange for at least a year or so - the time needed to make the rods for the Tehran reactor. And that, in turn would give Iran time to increase its enriched uranium stockpile to a level where it would still have enough to make a nuclear weapon even if it exported the 1.2 tons (1,100 kilograms) specified in the original draft agreement.
In addition, the Iranian counterproposal calls for exchanges in several tranches, said the diplomats. That, too, runs counter to the Western wish that Iran ship out most of its present accumulation of enriched uranium in one batch and thereby leave it with not enough to make a weapon.
Repeated calls to the cell-phone number of Soltanieh, the Iranian chief IAEA delegate, were not answered Tuesday.
Around 2,200 pounds of low-enriched uranium are needed to produce enough weapons-grade uranium for a single nuclear warhead, according to experts. Iran is believed to have well over that amount in its stockpiles and its thousands of centrifuges churn out new material by the day.
Iran points to nuclear deals with Western companies and governments that were put on ice after the Islamic Revolution overthrew the previous regime three decades ago in arguing it cannot trust that its interlocutors will deliver the fuel rods if it agrees to export most of its enriched uranium on good faith.
It argues that its nuclear program is aimed at creating a peaceful nuclear energy network to serve its growing population. The U.S. and other nations believe Iran's nuclear program has the goal of creating atomic weapons.
The United States and its Western allies have been pushing for a fourth round of U.N. sanctions. But with Russia, and especially China, skeptical of any new U.N. penalties, they have to tread carefully to maintain six power unity on how to deal with the Islamic Republic.
A meeting Saturday of senior diplomats from the six powers focused on possible new sanctions but participants said it reached no agreement.
Concerns include Iran's refusal to heed U.N. Security Council demands that it freeze its enrichment program; fears that it may be hiding more nuclear facilities after its belated revelations that it was building a secret fortified enrichment plant, and its stonewalling of an IAEA probe of alleged programs geared to developing nuclear arms.
Organizations: International Atomic Energy Agency, The Associated Press, U.N. U.N. Security Council
Geographic location: Iran, United States, VIENNA Tehran Russia Geneva Austria France China Britain Germany Islamic Republic
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} | 780 | YOU ARE HERE: LAT HomeCollections
Western nations support Iran nuclear deal, but Tehran's stance is still unknown
U.S., Russia and France announce they back the plan, which would divert most of Iran's nuclear fuel toward medical research. Iran had seemed willing to go along but lately has signaled reluctance.
October 24, 2009|Borzou Daragahi
BEIRUT — Iran said Friday that it would respond next week to a proposal to ship the bulk of its enriched uranium abroad to be turned into fuel for a medical research reactor. The delay plunged into doubt a deal aimed at easing the standoff over Iran's nuclear program.
Earlier in the day, the United States, Russia and France formally signed off on the plan, devised by representatives of the world powers, Iranian negotiators and International Atomic Energy Agency chief Mohamed ElBaradei during talks in Vienna this week. But Iran, which faced the same Friday deadline for a response, told the agency that it needed more time.
Iran's envoy to the IAEA, Ali Asghar Soltanieh, told state television that his government was "reviewing the text of the proposals that were drawn up by Mr. ElBaradei. . . . We are examining their various legal and technical dimensions before presenting a report."
In Washington, a State Department spokesman expressed hope that Iran would still back the proposal. The United States "would have preferred to have a response today," said Ian Kelly. "We approach this with a sense of urgency."
Under the proposal, lran would send as much as 80% of its enriched uranium to Russia and France to be further refined and fitted for a Tehran reactor used for cancer diagnosis and treatment, all under the authority of the IAEA, the United Nations' nuclear watchdog.
Tehran signaled a willingness to go along with the arrangement during talks in Vienna this week and Geneva last month, but has given pessimistic signals about the deal since.
Iran's indecisiveness could be a negotiating strategy or a sign that Tehran's political factions could not come to an agreement.
State television Friday cited an unnamed member of the Iranian nuclear negotiating team rejecting the proposal. Instead, the unnamed official reportedly said, Iran would rather buy fuel for the reactor from international suppliers.
"The Islamic Republic of Iran is prepared to purchase the fuel needed for the Tehran research reactor within the framework of a clear proposal," said the official, according to an article on the website of the state broadcasting network. "It is waiting for a constructive and confidence-building response."
But it was not immediately clear whether the statement represented Iran's response, and the spokesman for Iran's nuclear energy program could not be reached for comment on the issue.
On Thursday, Iran's deputy speaker of parliament also complained about the deal, saying the nation could itself further refine its 3.5% enriched reactor-grade fuel to the 20% enrichment necessary for a medical reactor.
Any attempt by Tehran to modify or spurn the proposal is likely to complicate the Obama administration's efforts to resolve the nuclear standoff through diplomacy. Such a move could revive a drive to impose harsh new economic sanctions on Iran, and add to suspicions that its nuclear program is aimed at developing weapons.
Natural uranium requires enrichment to a low grade for use in civilian power plants, to a slightly higher level of purity for use in medical research and to a high degree for use in weapons, though crude bombs can be made with lower-grade material.
Under the proposal, Iran would send 2,600 pounds of its reactor-grade fuel abroad by year's end, a Western diplomat said, speaking on condition of anonymity.
Although the plan wouldn't end international concern about Iran's nuclear program, it would reduce Tehran's stockpile of fissile material below the threshold for building an atomic weapon while serving as a template for possible future compromises, experts say. Physicists say about 2,500 pounds of low-enriched uranium is needed to churn out the 80 pounds of weapons-grade uranium needed for one nuclear bomb.
The head of Iran's Atomic Energy Organization also announced that inspectors would arrive in Iran today to examine a recently disclosed enrichment facility near the city of Qom.
The facility's existence, previously discovered by Western intelligence agencies, has fueled worries that Iran may be building a clandestine nuclear program parallel to the one at known sites near the cities of Natanz, Esfahan and Arak.
Iran insists it is not legally obliged to declare nuclear facilities until six months before it introduces nuclear material into them, an argument disputed by the International Atomic Energy Agency and the West.
Times staff writer Christi Parsons in Washington and special correspondents Julia Damianova in Vienna and Ramin Mostaghim in Tehran contributed to this report.
Los Angeles Times Articles | http://articles.latimes.com/2009/oct/24/world/fg-iran-nuclear24 | isPartOf: CC-MAIN-2018-43
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} | 893 | Iran hints it could ship some uranium abroad
Iran hinted Monday it could agree to ship some low-enriched uranium abroad for processing as reactor fuel as the world awaited its reply on a U.N.-drafted nuclear plan aimed at easing tensions with the West.
But the step might not be enough to defuse the tensions, and Foreign Minister Manouchehr Mottaki also left open the possibility Iran may snub the proposal and instead seek to buy the nuclear fuel it needs for a research reactor that makes medical isotopes.
The two-sided scenario presented by Mottaki appeared part of Iran's strategy to drag out negotiations over its nuclear program and leave the West guessing about its decision expected later this week.
But Iran has not closed the door on the U.N.-backed concessions and has suggested there is room for some agreement on ways to keep tabs on its nuclear fuel and uranium enrichment. The latest message came as U.N. nuclear inspectors completed their second full day examining a still-unfinished enrichment lab that was top secret until just a month ago.
Mottaki said Iran could send part of its stockpile of partially enriched uranium abroad for later processing into fuel rods for reactors. It marked the first official indication that Iran could partly sign onto the U.N.-drafted plan that called for Russia to complete the enrichment process.
But Mottaki did not specify how much uranium Iran would consider allowing leave the country, and the amount could be far below the 70 percent of the country's stockpile envisioned by the U.N. plan, which is backed by Washington and Iran's key ally Russia.
Since the plan's goal is to delay Iran's ability to build a nuclear weapon by getting a large part of its enriched uranium stock out of the country, a willingness by Tehran to ship a small amount abroad would do little good. Iran claims it seeks only a peaceful nuclear program for research and energy.
Mottaki said Tehran's decision to buy nuclear fuel or ship uranium abroad "will be made in the next few days."
In either case, Mottaki said Iran will continue to enrich its own uranium as well – a step opposed by the U.S. and its allies over fears they could produce weapons-grade material.
"Iran's legal peaceful nuclear activities will continue and this issue (Iran's enrichment program) has nothing to do with supplying fuel for the Tehran reactor," he said.
Fears about the nature of Iran's nuclear program were heightened in September with the disclosure of a once-secret uranium enrichment facility near the holy city of Qom. U.N. inspectors made their first visit to the site on Sunday as they began a three-day mission that will include taking soil samples from the site. No results on their findings were expected until they leave Iran later this week.
Iran agreed to the inspections during a landmark meeting with the U.S. and other world powers at the beginning of October in Geneva, where the idea of Tehran shipping uranium to Russia for further enrichment was first raised.
The draft U.N. plan was formalized last week after Iran held talks in Vienna with the United States, Russia and France.
So far, Tehran's response to the plan has been unclear. Iran's parliament speaker Ali Larijani earlier accused the West of trying to cheat his country with the proposal, raising doubts Tehran will approve the deal.
Russia nudged Iran to accept the plan. Moscow's role is critical for Iran since Russia is a major trade partner and is finishing work on Iran's first energy-producing reactor in Bushehr in southern Iran. Under the agreement, Russia would supply the reactor fuel.
Deputy Foreign Minister Sergei Ryabkov said implementation of the proposal "would allow for a cooling of emotions and a realistic assessment of the situation."
Ryabkov, who has led Russian negotiators in talks on Iran's program, made his comments in an interview published Monday in the Russian daily Vremya Novostei.
The U.N. plan envisions Iran sending up to 70 percent of its low-enriched uranium to Russia, where it would be enriched to a higher degree needed for use in the Tehran research reactor.
The deal is attractive to the U.S. and its allies because it would mean Iran – for a period of time, anyway – would not have enough uranium stocks to build a bomb.
Uranium enriched to a low level is used to fuel a nuclear reactor for electricity, and a somewhat higher level is used in research reactors. When enriched to levels above 90 percent, the uranium can be used to build a bomb.
The Vienna plan would require Iran to send 2,420 pounds (1,100 kilograms) of low-enriched uranium to Russia in one batch by the end of the year.
French Foreign Minister Bernard Kouchner said time was running out to reach agreement over Iran's nuclear program since Israel might launch a pre-emptive strike.
"They (the Israelis) will not tolerate an Iranian bomb. We know that, all of us. So that is an additional risk and that is why we must decrease the tension and solve the problem," Kouchner told the Daily Telegraph in an interview published Monday.
Mottaki on Monday replied that "the Zionist regime doesn't dare to attack Iran because it is currently in its weakest position."
Copyright © 2016, The San Diego Union-Tribune | http://www.sandiegouniontribune.com/sdut-ml-iran-nuclear-102609-2009oct26-story.html | robots: classic
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} | 547 | Iran brushes aside UN nuclear deal
— Iran's foreign minister on Wednesday said his country would not export its enriched uranium for further processing, brushing aside the latest U.N. plan aimed at preventing Tehran from potentially building nuclear weapons.
Instead Manochehr Mottaki said Iran would consider a nuclear swap inside Iran as an alternative plan.
The United Nations last month offered a deal to take 70 percent of Iran's low-enriched uranium to reduce its stockpile of material that could be enriched to a higher level, and possibly be used to make nuclear weapons.
That uranium would be returned about a year later as refined fuel rods, which would solve the impasse over its nuclear program. Fuel rods cannot be readily turned into weapons-grade material.
"We will definitely not send our 3.5-percent enriched uranium out of the country," Mottaki told the semiofficial ISNA news agency. "That means a simultaneous fuel swap could be considered inside Iran."
The counterproposal was an indication of Iran's unwillingness to trust the West with its fuel for the time needed to transform it into the more harmless fuel rods.
Mottaki said that Iranian experts were looking at the modified proposal to determine what amounts of uranium should be exchanged for fuel rods.
However it remained unclear what would happen with Iran's uranium, if it would be shipped out of the country as part of the trade or remain inside Iran.
In Washington, State Department spokesman Ian C. Kelly said the U.S. was waiting for Iran to submit its formal response to the International Atomic Energy Agency, or IAEA.
"What was said today doesn't inspire our confidence" that Iran will accept the proposal that was tentatively agreed to in Geneva.
The idea of Tehran shipping uranium for further enrichment was first raised during a landmark meeting with the U.S. and other world powers at the beginning of October in Geneva. At the time, Iran also agreed to inspections after the disclosure of a uranium enrichment facility plant known as Fordo, near the holy city of Qom.
Kelly said the U.S. was still consulting with its negotiating partners on a way forward. At some point, he said, the focus would turn to ways of increasing sanctions pressure on Iran, adding, "We're not quite at that point now. But time is short."
Under the U.N. proposal, Iran would export its uranium which is enriched at less than 5 percent – enough to produce fuel to burn in plants. Enriching uranium to much higher levels can produce weapons-grade material.
In exchange, the Iranian uranium would be further enriched in Russia and then be sent to France. Once there, it would be converted into fuel rods, which would be returned to Iran.
The amount of uranium that would be exported by Iran under the U.N. plan, about 1.2 tons (1,100 kilograms) of low-enriched uranium, represents about 70 percent of its stockpile. It would have been sent to Russia in one batch by the end of the year, easing concerns the material would be used for a bomb.
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What might have saved these veterans?
Iran rejects UN-proposed nuclear deal
— Iran's foreign minister on Wednesday said his country would not export its enriched uranium for further processing, effectively rejecting the latest U.N. plan aimed at preventing Tehran from building nuclear weapons.
Instead Manochehr Mottaki said Iran would consider a nuclear swap inside Iran as an alternative plan.
The United Nations last month offered a deal to take 70 percent of Iran's low-enriched uranium to reduce its stockpile of material that could be enriched to a higher level, and possibly be used to make nuclear weapons.
That uranium would be returned about a year later as refined fuel rods, which would solve the impasse over its nuclear program. Fuel rods cannot be readily turned into weapons-grade material.
"We will definitely not send our 3.5-percent enriched uranium out of the country," Foreign Minister Manochehr Mottaki told the semiofficial ISNA news agency. "That means a simultaneous fuel swap could be considered inside Iran."
The counterproposal was an indication of Iran's unwillingness to trust the West with its fuel for the time needed to transform it into the more harmless fuel rods.
Mottaki said that Iranian experts were looking at the modified proposal to determine what amounts of uranium should be exchanged for fuel rods.
Under the U.N. proposal, Iran exports its uranium which is enriched at less than 5 percent – enough to produce fuel to burn in plants. Enriching uranium to much higher levels can produce weapons-grade material.
In exchange, the Iranian uranium would be further enriched in Russia and then be sent to France. Once there, it would be converted into fuel rods, which would be returned to Iran.
Mottaki dismissed a comment by U.S. Secretary of State Hillary Clinton that it only had the most recent U.N. plan as its choice.
"Diplomacy is not all or nothing. Mrs. Clinton's comments that Iran must accept only this proposal is not diplomatic."
The U.S. and its allies see the process as buying time to reach a compromise with Iran by depriving it of the amount of uranium needed to potentially make a nuclear bomb. Western powers believe Iran is seeking nuclear weapons, or at least the ability to produce them on short notice. Tehran says its uranium activities are aimed only at generating electricity.
The amount of uranium that would be exported by Iran under the U.N. plan, about 1.2 tons (1,100 kilograms) of low-enriched uranium, represents about 70 percent of its stockpile. It would have been sent to Russia in one batch by the end of the year, easing concerns the material would be used for a bomb.
Around 2,200 pounds (1,000 kilograms) of low-enriched uranium is needed to produce enough weapons-grade uranium for a single nuclear warhead, according to experts. Iran is believed to have well over that amount of low-enriched uranium in its stockpiles.
(This version CORRECTS Mottaki quote to include reference to simultaneous, expands quote.)
The Associated Press | http://www.sandiegouniontribune.com/news/2009/nov/18/iran-rejects-un-proposed-nuclear-deal/ | robots: classic
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Photo: AFP
Iran willing to swap nuclear material in Turkey
Foreign Minister Mottaki says Tehran 'does not have a problem with Turkish soil' as location for exchange of enriched uranium for nuclear fuel, adding 'West has to do the trust-building, then it is pursuable'
Iran would be willing to swap nuclear material with the West in Turkey, the foreign minister said in the country's latest counteroffer to a UN-drafted deal aimed at thwarting Tehran's ability to produce atomic weapons.
The UN proposal aims to ease concerns that Iran could build a nuclear weapon by reducing its stockpile of low-enriched uranium. Under the proposal, the uranium would be shipped to France and Russia in exchange for more highly enriched fuel rods that are not suitable for use in weapons.
Speaking on Iran's state TV, Foreign Minister Manouchehr Mottaki suggested Turkey, which neighbors Iran and has good relations with the West, as a venue for exchanging nuclear material.
Iran "does not have a problem with Turkish soil" as the location for an exchange of enriched uranium for nuclear fuel, he said late Thursday.
In Turkey, Foreign Minister Ahmet Davutoglu welcomed the Iranian announcement and said his government is ready to do its best to help reach a diplomatic solution to the standoff over Iran's nuclear program.
While Iran's remarks signaled a slight change in stance — the country has said before it would only accept such an exchange on its own territory — they represent no significant shift in Iran's policy.
'Ball in their own court'
Iran says it has no intention of building a bomb, maintaining its program is for generating electricity.
At various times, Iran has proposed swapping material in batches — which would not necessarily reduce its ability to build a bomb. At other times it has insisted on a simultaneous swap inside Iran, or threatened to just produce the fuel rods on its own.
The West needs to prove its goodwill intentions toward Tehran first, Mottaki said in the interview.
"Exchange is acceptable," he said. "They (West) have to do the trust-building, then it is pursuable."
Iran is able to produce the fuel on its own, Mottaki said, calling this a "preferable" option while adding that Iran is still ready for talks with the West.
"The ball in their own court, they should answer us," said Mottaki. "Threat and sanctions are useless."
Enrichment is at the core of the nuclear controversy. Low-enriched uranium is used to fuel a nuclear energy reactor, but highly enriched uranium can be turned into a nuclear warhead. Once converted into rods, the uranium cannot be enriched further.
The UN has demanded that Iran suspend all enrichment, a demand Tehran has refused, saying it has a right to develop the technology under the Nonproliferation Treaty. Iran has also defiantly announced it intends to build the 10 new uranium enrichment sites, drawing a forceful rebuke from the UN nuclear watchdog agency.
The US and its allies are threatening to impose more sanctions on Iran if it does not cooperate.
Earlier this week, President Mahmoud Ahmadinejad dismissed a year-end deadline set by the Obama administration and the West for Tehran to accept the UN-drafted deal and also shrugged off the threat of more sanctions.
פרסום ראשון: 12.26.09, 08:53
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