I am a huge researcher and planner. I’m the kind of person who will spend weeks (sometimes months) researching purchases. I can be spontaneous if necessary, but when given the option I want to be as informed as possible for anything important. Pregnancy is no exception…in fact, I am even thirstier for information when I’m pregnant.

This is where I remind you I’m kind of a control freak.

When I was on bed rest during my pregnancy with Madeline, the only thing I could concentrate on was reading about my situation. I read all sorts of scenarios and outcomes, read an entire 500-page book on prematurity, and memorized NICU terms. Everyone around me thought I was insane. “Stop stressing yourself out, don’t read those stories about sick babies,” but I had to. I felt compelled to absorb as much information as possible. And it paid off for me – I was an amazingly informed parent when Madeline was in the NICU. I knew the questions to ask and I understood the answers I was given. I was as prepared as I could possibly be, and felt confident in all her medical decisions.

My dad asked me the other day if I’d heard about the new test, MaterniT21, that can detect Down Syndrome with just a sample of the pregnant mother’s blood. The research posted by the company that developed the test shows a 98.6% success rate for diagnosis. As it stands now, tests for Down Syndrome return many false positives, leading women to have unnecessary amniocentesis or chorionic villus sampling, which are very invasive and carry risks. So, this new test should dramatically cut down the number of women who have the invasive tests for no reason (the developers of the test still suggest having an amnio or cvs for official diagnosis).

My dad brought it up because he wanted to know if I would have the test if my doctor offered it during my next pregnancy. I said yes, absolutely. For me, it’s another way I can become a more informed parent. If I found out my child likely  had a Down Syndrome diagnosis, I’d spend the rest of my pregnancy devouring all the information I could so I could be as prepared as possible (I say likely because, as someone with a heightened risk for premature ruptured membranes, I would not have an amnio or cvs).

I’ve been talking to my friends about the new test and I discovered that not everyone is a researcher when it comes to pregnancy. I didn’t expect many, if any, to be as hyper as I am about ingesting information, but I was surprised that some people don’t want to know anything about what is going on. No testing, no reading “my pregnancy this week,” nothing. And while I understand the desire to shield oneself from all the bad, awful stories, I am bewildered by the black out on ALL information. There are so many cool things that happen during pregnancy!

I totally know that on a scale of one to ten, I am obsessive. But is ignorance truly bliss when you’re pregnant?

© COPYRIGHT HEATHER SPOHR 2011 All rights reserved. This content may not be reproduced or transmitted in any form, by any means, without the prior written permission of the author.

For all my joking last week about chewing up my birth control pills, Mike and I DO want another kid. Ideally that would be sometime next year. Being October already, I started looking into making appointments with my medical “team” to make sure everything is up to snuff with the ole’ baby maker.

I have different health insurance since Annabel was born, so I went on my provider’s website to confirm all my doctors were covered. And they are, so yay! I mentioned that to Mike, and he said, “Wait…so Dr. Risky is covered for pre-appointments, but not once you’re pregnant?”

UGH. I had forgotten that I didn’t have maternity coverage.

I called up my insurance provider to find out how to add maternity. After being transferred LITERALLY seven times, I was finally told that the state of California doesn’t require insurance providers to offer maternity coverage…so they don’t.

From a business standpoint, I totally get it. A limited number of the population needs it, and it’s costly and blah blah blah. If I was an insurance company I wouldn’t want to provide maternity if I didn’t have to. It’s just such a bummer that our insurance doesn’t offer it to begin with – I’ve never had health insurance that didn’t include a maternity option.

We’re not sure what our next move should be. Other than switching to a job with a better insurance plan (which isn’t exactly easy these days, either), we don’t really know what our options are. Paying out-of-pocket for a pregnancy would be…expensive. Is another child worth all the money it would cost to bring him or her here? Yes, and no. Yes, for obvious reasons. No because we’re not going to go into debt to the detriment of Annabel.

A lot of people say they aren’t getting pregnant because they can’t afford a baby. We can afford the baby, but without insurance we can’t afford the pregnancy. I’m googling and calling and emailing and trying to leave no stone unturned, but I’m kind of off my game. I was mentally prepared for the long road of pregnancy, but I wasn’t prepared for this detour. Le sigh.

© COPYRIGHT HEATHER SPOHR 2011 All rights reserved. This content may not be reproduced or transmitted in any form, by any means, without the prior written permission of the author.

A lot of people ask me about what it’s like to be on bed rest.  They have a sister/girlfriend/wife who has just been put on it, and they have no idea what to do. I had ten weeks of bed rest during my pregnancy with Madeline. When it started, it was only supposed to be for a few days, as a precaution. I was glad I would only miss a week of work. I was a bit worried about the pregnancy but since everything initially checked out okay I decided to enjoy not having to go out in the hot weather. Then, three days after I was put on temporary precautionary bed rest, I was put on full-time no-holds-barred bed rest. I was only allowed to get up to go to the bathroom. I was allowed a five minute shower but only if I sat down on a seat while I cleaned myself. I needed to lay on my side, preferably my left one, at all times. Never on my back, and I wasn’t ever supposed to sit up because that would stress my abdominal muscles. Gravity was a serious issue since I was constantly leaking amniotic fluid.

So many people told me, “enjoy the rest, because when the baby comes, you won’t get any.” Anyone who says that has never been on bed rest (and is kinda dumb, because you can’t store sleep). While everyone obviously meant well, it did little to cheer me up. I didn’t even know if there would BE a baby at the end of bed rest. I tried to stay positive, but all the doctors told us to expect a miscarriage at any time. Every little ache and pain was feared to be so much more.

Doctors shouldn’t call it bed “rest.” For me, there was nothing restful about it. I was constantly thinking about my condition. I did hours of research on the Internet about babies and mothers in our situation. I wanted to be prepared for anything. It definitely helped once Maddie was in the NICU as I knew what to expect, but there were so many things to prepare for that it totally messed with my mind. Pregnant women are a pretty paranoid bunch these days anyway, what with all the things not to eat, do, etc. Throw in a high risk pregnancy and I can guarantee mental breakdowns. I had a lot of them. Even though I had Mike and my family and friends (when I was allowed to take visitors), I still felt like I was in solitary confinement. I started to wonder what I could have done differently. I shouldn’t have been outside over Labor Day weekend since the weather was so hot. I ran too many errands and I was on my feet too much. When you have nothing to do but think, your mind plays terrible tricks on you.

The one thing I never expected was how totally draining bed rest would be. Because all I could do was lay there, I would sleep in small bursts. Thirty minutes here, 45 minutes there. No long stretches, ever, even at night. I became very knowledgeable on the late night television schedule. I had trouble concentrating on everything. And physically, it destroyed me. I could feel my muscles twitching as they atrophied. My hips and lower back are, I fear, still totally messed up from supporting all my weight in the same position for days on end. I had a pillow top mattress with a memory foam pad, and it still felt like I was laying on rough concrete. The special bed in the hospital wasn’t much better. I’ve had dozens of physical therapy sessions to help.

I had some really low moments. Times I just wanted to give up. I felt like I was going to crack and I couldn’t do it anymore. I didn’t WANT to do it anymore. It was so hard, the enormity so overwhelming, that I just didn’t want to be pregnant and I didn’t CARE. I still feel guilty about that. Thank goodness I had Mike. He never judged me when I was at my most selfish, crying because I was uncomfortable or because I wouldn’t be able to do something. He never threw anything in my face. I never could have made it without him.

Looking back on it all now, it seems like a lifetime ago. When I was on bed rest, I would remind myself, even during my low points, that every day I was on bed rest was a day Madeline didn’t have to be in the hospital. I wish I could have gone longer, that I hadn’t needed that emergency C-Section. My discomfort was merely a paper cut compared to what Maddie went through. That is my biggest advice to moms on bed rest – keep your eye on the prize. Every day you can keep your baby inside and out of the hospital is worth any pain you have to go through to make it happen.

© COPYRIGHT HEATHER SPOHR 2011 All rights reserved. This content may not be reproduced or transmitted in any form, by any means, without the prior written permission of the author.

Living in Los Angeles comes with the prerequisite that you know everything that’s going on with celebrities. I am nothing if not serious about my duties, and I do what I can to stay up to date on my chosen celebrity major: their babies. Victoria Beckham and Kate Hudson had babies this past week. As I did my research, I read an article in the LA Times that spoke less about the celeb offspring and more about how they were born.

To boil it down, Beckham had a repeat C-section, while Hudson had a vaginal birth. Hudson’s first pregnancy was a C-section. The article then goes on to discuss the risks and rewards of VBAC (vaginal birth after C-section), and how many women want at least the chance to deliver naturally but aren’t offered one.

My C-section with Madeline was an emergency surgery that required a “classical” cut on my uterus instead of the common low transverse scar. The doctor that delivered Madeline told me I would never be able to give birth vaginally for subsequent pregnancies. At the time I didn’t give it a second thought, as I was totally wrapped up in Madeline’s NICU stay.

Dr. Risky, my OB for Annabel, was different. At our first appointment, she didn’t tell me a vaginal delivery would be impossible. Instead, she went over my risks for a VBAC, carefully explaining everything to us. She told us she was strongly against it, but in the end the decision was left to Mike and me. After listening carefully and weighing the risks of a VBAC on top of my other risk factors, we chose a repeat C-section. And honestly, after losing Maddie we weren’t willing to take any chances.

That being said, I’m curious why some women do make the choice (when they are allowed) to have a VBAC. I am obviously super-sensitive to anything that will put the baby at risk (and I know C-sections come with risks), so I have a bit of a colored view that I’m trying to rectify. I hate when I hear women say things like, “A C-section isn’t real birth” because I gave birth to two babies that way and I think that’s so insulting. And I hate when other women say that having a C-section is a failure. If the baby is born alive and healthy, isn’t that a success? Isn’t that the POINT?

OK seriously though, I want to understand. Illuminate me, mamas!

© COPYRIGHT HEATHER SPOHR 2011 All rights reserved. This content may not be reproduced or transmitted in any form, by any means, without the prior written permission of the author.

I always wanted two kids, maaaaybe three if the first two were the same gender. They’d be evenly spaced – two years apart, close enough in age that they could play, but wouldn’t have the same classes at school. And we’d all live happily ever after.

After Madeline was born, I was afraid to have another child. Typical parent stuff – I didn’t know how I could possible love another child the way I loved her. Maddie had been through so much, she was so special, there was no way another child could be so special. Not to mention the trauma of her pregnancy. But, just like every other mom, I pushed the hard stuff to the back of my mind, and Mike and I were ready for another (possibly final) child.

And then everything changed.

Now, if my body could handle it (and Dr. Risky wouldn’t kill me) I would try for another child. And another. And another. My desire for lots and lots of children is overwhelming at times. I talk to my therapist about this a lot.

I just feel this…yearning, deep inside me, to be surrounded by my children. It’s almost desperation. And I keep telling my therapist that I think it’s because I am afraid to have another child die, afraid to be alone, and if I have a bunch of kids at least one of them will live an entire life. It’s complicated and messy and irrational.

I am never going to get my Maddie back. I am never going to be without the fear that I’ll lose another child. Somehow I am going to have to figure out how to live through this (that doesn’t involve exploding my uterus).

Luckily for my uterus, this child of mine has the energy of dozens and the attitude of thousands, so she does a good job of keep my reproductive urges to a minimum.

Although, her cuteness kind of makes me wonder what other ones would look like…

© COPYRIGHT HEATHER SPOHR 2011 All rights reserved. This content may not be reproduced or transmitted in any form, by any means, without the prior written permission of the author.

I had my six week check up yesterday with Doctor Risky. Oh, and in case you were wondering, I got this. Again. *Grumble Grumble* Anyway. I brought Annabel with me because I wanted Dr. Risky and her staff to see the little girl we all worked so hard for. And because I like to show her off because I think she’s kind of adorable. It was great to see them all coo over her. I hope Dr. Risky was proud of how healthy and gigantic Annie already is (up almost three pounds since birth, omg).

My exam went fine, Dr. Risky said I have healed well and she cleared me to resume normal activity. I’m actually kind of looking forward to exercising. Of course, ask me again in the morning when it’s time for me to go to the gym. I’ll be singing a verrrrry different tune. But before I go to the gym I am going back to physical therapy to get my hips and back in a bit better shape. I’m hoping my physical therapist can make some good and easy suggestions to help get me back into shape. Emphasis on easy. Hopefully something involving eating cookies.

Speaking of cookies, there is one thing that isn’t quite right. In the last six weeks, I’ve had to check my blood sugar a few times to see how my body is adjusting to no longer being pregnant. The good news is that my blood sugar after I eat is normal. The weird news is that my fasting blood sugar (my blood sugar when I wake up) is way too high. It should be 90 or below, and it has been 111, 110, 135, 100, and 140. Dr. Risky thought that it is a little weird but she was encouraged that my post-meal blood sugar is at a normal level. But, to be sure, I am going to mention it to Dr. Looove when I bring Annabel in for her two month appointment in a few weeks.

Has anyone else experienced this? I’m not snacking overnight or eating gobs of sugar before bed. I’m hoping this isn’t a precursor to type two diabetes.

I told Annie what was going on and she was like, “whaaaaa?”

I’m glad she’s sympathetic.

© COPYRIGHT HEATHER SPOHR 2011 All rights reserved. This content may not be reproduced or transmitted in any form, by any means, without the prior written permission of the author.

Enough time has passed where I feel like I can finally talk about the day Annabel was born. Every time I’ve tried to write about it I haven’t been able to find the words, or the emotions were too overwhelming to work through. But I fear as more time passes I will forget things, and I don’t want that either.

As Mike said, we went in to Labor and Delivery that day because I wasn’t feeling right. It wasn’t anything in particular but a collection of symptoms: a sudden and awful headache, belly tenderness, decreased fetal movement, and just a general unease in my head that I needed to be seen by a doctor. When we arrived at the hospital we were whisked away into a room and tended to immediately. Mike was really certain that we were going to be there for a couple hours and then be sent home. I was less certain but didn’t want to jinx anything either way.

I had a non-stress test that showed Annie was fine, and my urine check didn’t indicate pre-eclampsia. My contractions were minor and irregular, and it was looking like Mike was right, and we’d be heading home. The resident checking on me went to go talk to Dr. Risky, and I sent my parents a text saying everything checked out fine and we’d probably be going home. As soon as I hit send, the resident walked back in with a scrub cap on and said, “So, what do you think about having your c-section this afternoon?”

Everything kicked into high-gear at that point. I called my parents, my cousin, my brother. I tried to send texts to all my friends, but the c-section prep made it impossible. My amazing nurse Helen inserted my IV, did a blood draw, and asked me 1,001 questions while Mike gave me this weird wipe down with sterile wipes. The wipes were FREEZING. Helen checked my blood sugar and it was really low, so she gave me a bag of cold fluid via my new IV. Between the fluids, the wipes, and my nerves, I was shaking badly. And then things got funny.

I started to feel nauseous, so I told Helen as much thinking she could put something in my IV to help with that. She told me to sit back and take some deep breaths. Not hard to do since I was, you know, already laying in bed. This is where things get fuzzy. I THOUGHT I said to Helen that I felt like I was going to pass out, but Mike and my cousin Leah (who had arrived by then) said I didn’t. According to everyone else, I was unresponsive and making guttural noises. The crazier thing is that I don’t remember passing out. I have fainted plenty of times and I remember losing consciousness, but not this time. I have some fuzziness, but as far as I remember, I said I was going to pass out and then I was OK. But, no. Thinking back now, I realize that the room was jammed with people. I remember hearing the doctors and nurses saying my blood pressure (70/40) and that the baby’s heart rate was decreasing. I remember seeing the frightened faces of Mike and Leah, the serious faces of the medical staff, and trying to assure the anesthesiologist that “I’m a fainter, it’s noooooo big deal” while he looking at me like I was a little bit crazy.

The decision was made to move me to the operating room immediately in case I lost consciousness again. In there, the anesthesiologist told me that he wanted to put me under general anesthesia for my c-section. That meant I’d be sleeping and Mike wouldn’t be allowed in the operating room. His reasoning was that he was worried I’d pass out again and he didn’t want to wait to get the results of my blood tests – blood tests that would indicate the safety of being awake for the surgery. Mike and I had always known this was a possibility, but when it was presented to me I looked at Dr. Risky and pleaded with her not to let it happen. If I needed to be put under for the surgery, that was one thing, but if there was a possibility I didn’t, I really wanted to wait and see. She agreed, not only for our sake, but also because general anesthesia complicates things. Luckily, the blood work came back in my favor, and I was allowed to be awake.

I had a lot of time on the operating table while I waited for things to be determined – time where I was alone, since Mike wasn’t brought into the room until moments before the surgery began. I tried to stay calm – Annie’s heart rate was extremely elevated because of the drugs they’d given me when I’d passed out – so I knew I had to keep mine under control to not make things worse. While I laid there, I was greeted with a friendly face. My friend Staci, a nurse and one of my sorority sisters from college, received a text from my cousin telling her I was going into surgery. She hightailed it down to the hospital and made it in time to be there. I was so happy to see her smiling eyes behind her surgical mask. I can’t tell you how much calmer I felt knowing she was there.

The surgery went off without a hitch, and soon the anesthesiologist was telling Mike to stand up and watch our baby be born. I felt all the tugging and pressure, and then a lightness. There was a commotion from all the people in the room, and then I heard a tiny but powerful sound – Annabel’s cry announcing she was here. She sounded exactly like her sister the day she was born. There is nothing – nothing – like hearing your child’s cry, because that means they can breathe. Memories from Madeline’s birth came flooding back, and I realized I was crying. I badly wanted to see my baby, to touch her, and confirm that she was here and she was OK. When Staci brought her over to me, it was magical.

That first touch was so amazing.

Even now, 27 days later, I am having a hard time writing more than the blow by blow of the day. I want Annabel to know how great a day it was. I had been so scared that the emotions would be overwhelming, but they weren’t. I was scared I would be overcome with sadness, but I wasn’t. Not that day. The day of her birth was just joy and love and happiness. The staff at the hospital took such amazing care of all of us. They knew about Madeline, and they wanted to hear about her while they met Annabel. They made an effort to include Maddie in the day and it meant so much to me. At the hospital, we enjoyed the newness of our daughter. We reveled in her birth and specialness.

At home, we continue to do so.

Someday, I’ll find the words to express just how special she is.

© COPYRIGHT HEATHER SPOHR 2011 All rights reserved. This content may not be reproduced or transmitted in any form, by any means, without the prior written permission of the author.

My recovery from Annabel’s birth has been so amazingly easy that I should totally be the poster girl for c-sections. The contrast between how I am doing now versus how I was after Madeline’s birth is amazing. The circumstances were, of course, totally different, but I am really shocked by how good I’m doing. After Maddie’s birth I bled (heavily) for four weeks. After Annie’s I only bled (lightly) for six days. I took major pain medicine for weeks after my first c-section, this time I only take the occasional ibuprofen. Last time I wore maternity clothes for months, this time I’m fitting into pre-pregnancy pants (but don’t worry, the belly is still there). I’m glad I had no idea what  a “normal” recovery should be my first time around, because I definitely would have been freaked out.

But then yesterday morning, I started bleeding out of nowhere. I was surprised and a little worried, since I hadn’t bled for 12 days and this was bright red. Luckily, I was scheduled for my two week appointment with Dr. Risky. As she examined me I told her about the bleeding. She asked a few more questions, and then said, “It’s your period.”

I threw my head back and howled, “nooooooooooo!”

I got my period exactly 28 days after Madeline was born, and now I had it 18 days after Annabel’s birth. My. Body. Hates me.

But still, I was in denial. I asked her how that was possible, since I am breast feeding and it hasn’t even been a month since Annie was born.

“Oh yeah, it’s absolutely possible. You’re just one of the lucky ones.”

And then she said, “Let’s talk about your birth control options.”

So I said, “ABSTINENCE!” because HELLO!

She replied, “Yeah, but not forever, and you’re probably super fertile.”

I said, “all I have to do is tell my husband that and his penis will curl up into his body. Problem solved!”

She laughed and then handed me a prescription for progesterone birth control pills.

Now I have nine months of PMS slamming me. Thank goodness I can now eat chocolate.

I mean, this little thing is so cute I can hardly stand it:

But she doesn’t need an Irish Twin.

© COPYRIGHT HEATHER SPOHR 2011 All rights reserved. This content may not be reproduced or transmitted in any form, by any means, without the prior written permission of the author.

Information is power as they say, and this is rarely ever more true than when pregnant. An expecting mother who is informed about how to be healthy when pregnant greatly improves her chances of having a healthy baby. After everything I’ve been through these last few years, I know just how important that is. So, when I was approached with an amazing opportunity to help AT&T spread the word about text4baby, a new service the White House is launching that could improve the lives of millions of Americans, I immediately pledged to help. It is a cause so near and dear to me.

The text4baby campaign is a nationwide effort to give expectant and new mothers information that promotes healthy pregnancies – and healthy babies – via text messaging. It is totally free, and once registered an expectant mother (“or father!” Mike just yelled across the room) will receive three free text messages a week with health tips specifically tailored to the stage of their baby’s development. So, if you are two months pregnant, you will be texted info about being healthy when two months pregnant, or if you have a two month old, you will be texted info about your two month old. As your pregnancy advances or your child gets older, so will the information texted to you, and it will continue to do so all the way through your baby’s first birthday.

This service is so important because, shockingly, America has one of the highest infant-mortality rates in the industrialized world. Each year more than 500,000 of our babies (one in eight) are born prematurely, and about 28,000 infants die before their first birthday. These statistics don’t have to be so dire…by literally putting health information at the fingertips of expectant and new families, we are empowering them to give their babies the best possible start in life.

As you all know, Madeline was born premature, and one of the reasons she passed away was because of “complications related to prematurity.” So if you are pregnant or a new parent, please sign up for text4baby by texting the word “baby” or “bebe” to 511411. If you’re not pregnant, please help to spread the word. (a press release with more info on text4baby can be read here.) The more parents this information reaches, the more babies will make it to full term, and that is something we can all be proud of.

Everyone deserves a healthy little baby like this:

© COPYRIGHT HEATHER SPOHR 2011 All rights reserved. This content may not be reproduced or transmitted in any form, by any means, without the prior written permission of the author.

While I was laying on the operating table waiting to get the word on whether I’d be awake for my daughter’s birth, Dr. Risky came and sat near my head. She started talking to me about my scar and laid out some options. As I’d mentioned, my former OB left me with a crooked scar from Madeline’s c-section. Dr. Risky wasn’t wild about it being crooked, so she said she could even it out, leaving a bit of the old scar, or try to make the crooked line work. I elected to keep a bit of the old scar. I have the best of both worlds now – an even scar (which, really, I couldn’t care less about) and my two girls’ scars now connect and intertwine on my belly.

After Annabel was born and my surgery was just about over, I was breathing into my oxygen mask when I suddenly heard an unmistakable noise. It was a STAPLE GUN SOUND! I shouted, “That is the creepiest noise I have EVER HEARD!” I don’t recommend shouting on the operating table, by the way. The doctors did not appreciate it. I looked at Mike and said, “I am going to barf OMG,” I also don’t recommend saying that unless you actually mean it, because the anesthesia resident jumped up to adjust my IVs before she realized I wasn’t entirely serious. Just thinking about the noise of the staple gun is making me dry heave.

Now I have to be clear about something – I was never worried about staples actually hurting. I knew that I wouldn’t be able to feel much – if anything – down there. It is all mental. I had a dressing on the incision for the first 36 hours, but when an OB resident came to remove the dressing early Sunday morning I freaked a little. I couldn’t believe they were just going to leave it exposed! And then I had to go home before they were removed. I REFUSED to look at the staples – I had Mike check them to make sure everything looked OK. When I went in to Dr. Risky’s office to have the staples removed, I seriously had to go to my happy place. Unfortunately, I could still hear her drop each staple onto the paper draping…all fourteen of them. GAG.

Something that no one warned me about after my first c-section was the terrible gas pain. I know, you hear gas pain and you’re like, TOO MUCH INFORMATION. But it’s not your typical gas pain from eating a burrito. This is drop me to my knees, make me scream pain that comes on really suddenly as it moves around in my intestines. It. Is. Awful. I am taking medicine for it, which helps a bit, but MAN. I did remember how bad the gas was after my first c-section. The first time it hit I was standing at Madeline’s incubator and I honestly thought I was dying. Luckily there was a nurse nearby that recognized the signs and told me it was normal. Thanks for the warning, Former OB (yet another reason why she is my former OB).

Annabel is doing great. She had the tiniest bit of jaundice when we left the hospital, but it was just about gone when she went for her first check up with Dr. Looove. Unfortunately yesterday it came roaring back, so we had to take her to get some blood work. She needs to repeat it again today so hopefully her bilirubin numbers will be on the way down instead of up. Fingers crossed!

What’s that, you want to see a picture of a naked yellow baby? Well I will give you one.

She is my little Lemon Head.

© COPYRIGHT HEATHER SPOHR 2011 All rights reserved. This content may not be reproduced or transmitted in any form, by any means, without the prior written permission of the author.