Journey of a Homebirth Midwife

H1N1 vaccine recall...

2009-12-16T06:57:00.000-08:00

So there is a voluntary recall by Sanofi Pasteur for vaxes for the h1N1 vaccine. Just wanted to put this out as an alert for anyone who might be considering getting the vax.

And, here is a site that lists all the ingrediants in vaccines. http://www.vaccinesafety.edu/package_inserts.htm

trimming a tree today...

2009-12-13T07:30:00.000-08:00

So today we put up our tree. I'm not one of those uber organized moms who gets her Christmas decorations up the day after Thanksgiving, though I certainly wish I was.

My mother is one of those. She's had her tree up for some time now, and I'm sure that her house is all aglow with Christmas. That's one of the wonderful things about my mother. She always went all out for every season, and it made our house so sweet and homey. I honestly don't know how she did it some years, we had so very little many, many times. But, she did.

Not that I haven't had some Christmas in my house already. I have an amarillis that's about to blossom that I've been nurturing for the past couple weeks, and some pointsettias on either side of the fireplace, as well as Christmas linens on the table. I am one who "needs" a little Christmas. I don't care for Thanksgiving, but Christmas I can get into.

Anyhow, today we put up our tree. My three year old can't wait. She is so excited today, knowing that there is a tree out on top of our jeep, waiting to be brought inside and decorated. She really wanted Daddy and I to get our act together and do it last night, but that was just not going to be happening when we made it home at 9 last night from our weekly errand running.

Merry Christmas this holiday season! I wonder if I'll have a Christmas baby this year. It's entirely possible, I have one lady who is due on Christmas Eve. Should be interesting!

post dates pregnancies...

2009-12-11T08:09:00.000-08:00

I have had the privilege of being with a few beautiful women who trusted their bodies so completely that going "past" their due dates was not of any concern to them. That magical due date puts so much pressure on women. But truthfully, a woman is not "overdue" until she is past 42 weeks. A term pregnancy is 37-42 weeks. That is the norm. For a first time mom, it is most likely that she will carry closer to 42 weeks.

For moms that pass their due dates, I offer the standard obstetrical care, getting BFP's, NST's, etc. but many of my moms decline these services. I have no problem with that as long as baby's heartrate is sounding good at prenatals, there doesn't seem to be a sudden decrease in fluid, and mom is reporting lots of movement from baby. These are excellent indicators clinically of baby's health. For many women, a 10 month pregnancy is normal for her, and inducing her earlier can cause more problems than what it solves.

I wanted to share this article from an e-news issue of Midwifery Today, my favourite Midwifery Periodical. If you don't subscribe and you are a doctor, midwife, doula, or are someone interested in natural birth practices from around the world, I would recommend that you do subscribe.

http://www.midwiferytoday.com/enews/enews0811.asp

Postdates Pregnancies

Postdates, by themselves, are not associated with poor outcomes. A pregnancy that continues long after the due date or in conjunction with poor fetal growth or developmental abnormalities has an increased risk of stillbirth. If growth restriction and birth defects are not present, no statistical increase in risk is seen until a pregnancy reaches 42 weeks and no significant risk exists until past 43 weeks. The primary "evidence" of a sharp rise in stillbirth after 40 weeks—often misquoted as "double at 42 weeks and triple at 43 weeks"—seems to come from one study based on data collected in 1958.(1)

The first question one should ask is whether neonatal mortality statistics from the 1950s should be compared to modern statistics, since labor anesthetics and forceps rates were very different. Early labor monitoring was scanty and prenatal monitoring not yet developed. The McClure-Brown report shows a rise in stillbirth from 10/1000 at 40 weeks to about 18/1000 at 42 weeks. Yes, that is nearly double. But think about those numbers. Even the beginning point is nearly ten times the modern mortality rate. Either modern delivery methods are vastly different or something is wrong with the data collection. This study should be updated by research conducted at least in this century! Modern statistics show an almost flat rate of stillbirth from 40 weeks to 42, with a slight rise at 43 weeks (all numbers being close to 1/1000).(2)

It is true that the stillbirth and fetal distress rates rise more sharply after 43 weeks, but it is also true that in less than 10% of births at 43 weeks do babies suffer from postmaturity syndrome (more than 90% show no signs). We should react to this rise by monitoring postdate pregnancies carefully and inducing if problems arise. But the rise in problems at 43 weeks does not imply a similar risk at 42 and 41 weeks. Postmaturity syndrome is a continuum. It becomes more likely as weeks progress past the due date but does not start on the due date. And the risks must be compared to the risks of interventions. Induction is not risk free. In addition to the risks of prematurity, induced labors have higher rates of cesarean section, uterine rupture, cord prolapse, meconium aspiration, fetal distress, neonatal jaundice, maternal hemorrhage and even the rare but disastrous amniotic fluid embolism.

Large studies have shown that monitoring pregnancy while waiting for spontaneous labor results in fewer cesareans without any rise in the stillbirth rate. One retrospective study of almost 1800 postterm (past 42 weeks) pregnancies with reliable dates compared this group with a matched group delivering "on time" (between 37 and 41 weeks). The perinatal mortality was similar in both groups (0.56/1000 in the postterm and 0.75/1000 in the on-time group). The rates of meconium, shoulder dystocia and cesarean were almost identical. The rates of fetal distress, instrumental delivery and low Apgar were actually lower in the postdate group than in the on-time group.(3)

When a group of researchers conducted a case-matched review of nearly 300 postdate pregnancies, they concluded that the increased rate of obstetric and neonatal interventions "does not appear to be a result of underlying pathology associated with postterm pregnancy." They suggest that "a lower threshold for clinical intervention in pregnancies perceived to be 'at risk' may be a significant contributing factor." In other words, the perceived risk is greater than the actual risk and can become a self-fulfilling prophecy!(4)

— Gail Hart, excerpted from "A Timely Birth," Midwifery Today Issue 72

Breastmilk should be drunk at the same time of day that it was expressed.

2009-12-10T07:27:00.000-08:00

So, another interesting article on breastfeeding. Makes sense actually, as breastmilk is a living organism, adapted to your child, to its needs hour by hour, day by day. Fascinating how we ladies are put together to know just how to provide for our children.

Lotus birthing and homebirth in the news...

2009-12-08T17:35:00.000-08:00

Thought this was a pretty decent article about homebirth and lotus birthing.

Let's clear up a few things that the doc says in the video.

First, Lotus birthers clean the placenta so it is no longer "bloody". It is then very liberally salted and treated with various herbs so that it isn't smelly and won't allow for the breeding of germs. Secondly, whether or not the doc thinks it's "gross" is beside the point. Lastly, it is also not a danger to the baby to let the cord stop pulsating before clamping and cutting it. Honestly, it's common sense to leave the cord alone and let the baby get all of it's blood and its extra oxygen and iron reserves and not rob the baby of that.

Check out http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/ for more current information on this.

So, while Lotus birthing may be a more extreme option of natural birthing, it is never the less the woman's right to do so. I haven't had a client yet choose this, but if she did, I'd support her.

Happy Holidays!

2009-12-04T22:00:00.000-08:00

Merry Christmas, Happy Hanakkuh, etc. etc. etc. I serve such a diverse group of people that I'll have to just wish everyone a happy holiday and that is not to offend anyone, but rather to avoid my having to list every single type of celebration happening this time of year. We celebrate Christmas here at the McFarland household, with an appropriate nod to the festival of lights, which is the celebration that Christ himself would have been partaking of this time of year.

Made it through Thanksgiving, which is not my favourite holiday (I hate Turkey!), and now looking forward to Christmas! I love Christmas. I love the decorating, I love the presents for my children, and this time of year, I don't mind it if it snows so much as other times of the winter. I enjoy the music, and the nostalgic movies, and all the gooshy feelings that it stirs up.

This is also a time for reflection. It has been a very, very busy year here at my practice. I need to take a count but I believe that at year's end I will have attended about forty mamas? Perhaps it was a few more or a few less, I'm not exactly sure, but it has been a fruitful year. It has been a year of growth, and a year of change.

I added a wonderful assistant/apprentice to my practice in the early months of the year, and she is now ready to spread her wings and fly on her own. I think she'll be ready to sit for her exam in the early spring, hopefully NY state will co operate and help her achieve that. NY has a reputation for making their midwife hopefuls wait for months and even years before allowing them to sit for the exam. So here's hoping that Lisa is able to become certified and licensed very soon!

I also started seeing clients at my other assistant's home in Quakertown. My practice has begun to really flourish in the Lehigh Valley area and for that I am also grateful. My assistant in Quakertown is my longtime friend Wendy. We've known each other for twenty years and her father is an amazing chiropractor who has a practice in Perkasie. Wendy works with her Dad a couple days a week and also sells Mary Kay (shameless plug for my friend here :-) ).

And now in December I am adding another apprentice. As Lisa prepares to start her own practice and perhaps take over the Northernmost part of my current practice, I need someone else to accompany me to births. My new apprentice's name is Monica. She's an EMT and is a midwifery student. She's also a doula. She attended a hbac with me in August and was a wonderful assett.

I look forward to the New Year, and to all the New Beginnings and new challenges that it will bring. This past year taught me many lessons and brought me so many opportunities to grow. Every mama and every baby were beautiful, and strong, and amazing in their own special ways.

I am also grateful for the doctors who shall remain nameless for legal reasons, but who know who they are. These two docs see my patients when I need a second opinion, or testing that I can't provide. They take on transfers of women that they barely know and don't ever judge them or me for their decisions. You are both amazing people that I am so humbled to know and work with. There is a special place in heaven for you.

God bless us, everyone.

Day of the midwife BBQ tomorrow and tough week gone by...

2009-05-08T19:37:00.000-07:00

I'll post pictures afterwards, but tomorrow I am having what will become an annual tradition. A barbecue for like minded people in the Lehigh Valley/Pocono Mountain region to gather and celebrate midwives and holistic birthing options. This year nothing special planned, just food and fun and fellowship. If we end up watching a birth movie, I would not be surprised, but it's not "on the agenda".

There have been an additional three babies born safely at home since my last entry, and one mama transferred to the hospital during delivery and the baby born there.

Sadly,the baby of the mama who had to be transferred had a congenital kidney defect that also affected lung development and did not tarry long on this earth. My heart is heavy and full of sorrow for these fine parents who lost their angel. I was blessed to have met them, and to have served them as their midwife for the last few months of her pregancy. I loved hearing this mama's laugh, watching our daughters play together, and making plans for her birth and for her daughter's upcoming birthday party. It never makes sense when a baby passes, and I pray now daily for my clients that they will know peace and joy again.

For more information on congenital birth defects, please contact the March of Dimes for information on testing, options for treatments, and how you can support research efforts. http://www.marchofdimes.com/

If you have lost a child to miscarriage, stillbirth, or in the newborn period, here are some helpful links:
http://www.ivf.com/misc.html
http://www.gentlebirth.org/archives/griefLoss.html
http://www.handonline.org/parents/index.html

Spring is here! I hope. :-)

2009-03-14T14:37:00.001-07:00

I am so glad to see the snow finally melting and the fact that my driveway is all freed up for parking again. My children are back outside more, riding their bikes and trapesing through the woods, making new adventures and discoveries.

With spring, comes new babies. Since December, I think I've been at six births. Each one unique and special. Five girls born on my watch, and only one boy! And so far, my predictions on gender have been correct each time.

I love my work. To me, it is hardly "work". It's so much fun, so invigorating, so uplifting. These women who come to me with their bellies swollen full of baby and new life, they exude a confidence and a life force that is awe inspiring. These are my homebirth mamas, the ones who have come to me to guide them through this journey, and the ones whom I grow to love and respect far more than I think they ever realize.

So often my doula moms do not exude this same confidence, and that is a shame. I can only attribute this to their choices of care providers and lack of educating themselves on just how amazing the woman's body is.

I just finished Jennifer Block's book "Pushed". It is excellent! Best Childbirth book I've read since "Immaculate Deception". I'm always reading. I currently have about seven books going right now, 2 childbirth related, one self help related, and the others are either fiction (like a Monk novel) or devotional in nature.

I recently had a new assistant join my practice. I am loving her. She's studying to be a certified midwife in New York and has a lot of experience and a really genteel spirit about her. We were at a birth with one of my Amish ladies about a week ago and encountered an emergency situation. She was cool as a cucumber though, and did exactly what I asked her to do, and did it well. I really feel God brought me an angel in her. The emergency, by the way, turned out fine, and mama and baby are doing excellent.

HEY FACEBOOK, BREASTFEEDING IS NOT OBSCENE

2008-12-27T08:12:00.001-08:00

So today members of Facebook who support a mother's right to breastfeed in public are encouraged to put this as their status message and change their profile pics to that of a nursing mother. Facebook has taken pictures of breastfeeding women off of people's profiles and albums for being obscene. Ridiculous. So, if you too support women breastfeeding please consider joining us today in this small protest.

Midwives deliver better care...

2008-12-26T22:44:00.001-08:00

Yep, it's been a long time since I've updated, and I've had a couple wonderful homebirths since then. And of course, the holidays have come again and now we await the new year. And I await the birth of two more babies in January.

This year, hopefully, will be the year of the homebirth midwife in PA. I again will be serving the Northeast Region as the Representative to MAP, which is the midwives alliance of Pennsylvania. We are trying to get legislation passed to make homebirth midwifery recognized as being legal by direct entry midwives. Right now the law is confusing and depending on what judge looks at it, DEM's are either abiding by the law or breaking it. The confusion needs to stop and we midwives need to not have to practice under fear of prosecution for helping women to have their babies at home, which is a federally protected right.

Jennifer Block had a nice op ed in a paper in L.A. California. I'll post it below, she makes excellent points.

Midwives deliver
America needs better birth care, and midwives can deliver it.
By Jennifer Block
December 24, 2008

Some healthcare trivia: In the United States, what is the No. 1 reason people are admitted to the hospital? Not diabetes, not heart attack, not stroke. The answer is something that isn't even a disease: childbirth.

Not only is childbirth the most common reason for a hospital stay -- more than 4 million American women give birth each year -- it costs the country far more than any other health condition. Six of the 15 most frequent hospital procedures billed to private insurers and Medicaid are maternity-related. The nation's maternity bill totaled $86 billion in 2006, nearly half of which was picked up by taxpayers.

But cost hasn't translated into quality. We spend more than double per capita on childbirth than other industrialized countries, yet our rates of pre-term birth, newborn death and maternal death rank us dismally in comparison. Last month, the March of Dimes gave the country a "D" on its prematurity report card; California got a "C," but 18 other states and the District of Columbia, where 15.9% of babies are born too early, failed entirely.

The U.S. ranks 41st among industrialized nations in maternal mortality. And there are unconscionable racial disparities: African American mothers are three times more likely to die in childbirth than white mothers.

In short, we are overspending and under-serving women and families. If the United States is serious about health reform, we need to begin, well, at the beginning.

The problem is not access to care; it is the care itself. As a new joint report by the Milbank Memorial Fund, the Reforming States Group and Childbirth Connection makes clear, American maternity wards are not following evidence-based best practices. They are inducing and speeding up far too many labors and reaching too quickly for the scalpel: Nearly one-third of births are now by caesarean section, more than twice what the World Health Organization has documented is a safe rate. In fact, the report found that the most common billable maternity procedures -- continuous electronic fetal monitoring, for instance -- have no clear benefit when used routinely.

The most cost-effective, health-promoting maternity care for normal, healthy women is midwife led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. This model of care is not just cheaper; decades of medical research show that it's better. Mother and baby are more likely to have a normal, vaginal birth; less likely to experience trauma, such as a bad vaginal tear or a surgical delivery; and more likely to breast feed. In other words, less is actually more.

The Obama administration could save the country billions by overhauling the American way of birth.

Consider Washington, where a state review of licensed midwives (just 100 in practice) found that they saved the state an estimated $2.7 million over two years. One reason for the savings is that midwives prevent costly caesarean surgeries: 11.9% of midwifery patients in Wash- ington ended up with C-sections, compared with 24% of low-risk women in traditional obstetric care.

Currently, just 1% of women nationwide get midwife-led care outside a hospital setting. Imagine the savings if that number jumped to 10% or even 30%. Imagine if hospitals started promoting best practices: giving women one-on-one, continuous support, promoting movement and water immersion for pain relief, and reducing the use of labor stimulants and labor induction. The C-section rate would plummet, as would related infections, hemorrhages, neonatal intensive care admissions and deaths. And the country could save some serious cash. The joint Milbank report conservatively estimates savings of $2.5 billion a year if the caesarean rate were brought down to 15%.

To be frank, the U.S. maternity care system needs to be turned upside down. Midwives should be caring for the majority of pregnant women, and physicians should continue to handle high-risk cases, complications and emergencies. This is the division of labor, so to speak, that you find in the countries that spend less but get more.

In those countries, a persistent public health concern is a midwife shortage. In the U.S., we don't have similar regard for midwives or their model of care. Hospitals frequently shut down nurse-midwifery practices because they don't bring in enough revenue. And although certified nurse midwives are eligible providers under federal Medicaid law and mandated for reimbursement, certified professional midwives -- who are trained in out-of-hospital birth care -- are not. In several state legislatures, they are fighting simply to be licensed, legal healthcare providers. (Californians are lucky -- certified professional midwives are licensed, and Medi-Cal covers out-of-hospital birth.)

Barack Obama could be, among so many other firsts, the first birth-friendly president. How about a Midwife Corps to recruit and train the thousands of new midwives we'll need? How about federal funding to create hundreds of new birth centers? How about an ad campaign to educate women about optimal birth?

America needs better birth care, and midwives can deliver it.

Jennifer Block is the author of "Pushed: The Painful Truth About Childbirth and Modern Maternity Care."

Brewer Diet

2008-08-30T13:31:00.000-07:00

http://home.mindspring.com/~djsnjones/index.html is the link to the newest website with all of the Brewer diet information. The Brewer diet is a diet to help prevent many complications of pregnancy, most notably Pre-Eclampsia. Check it out! I found it easy to navigate and very informative.

Home again, so soon?

2008-08-28T07:28:00.000-07:00

Yes, I'm home again, home again. I left the Philippines earlier than I thought I would, but it was still an excellent experience. No, I did not get all of my "numbers" as I had hoped, but that is ok. There is no shame in being a Direct Entry Midwife and not a CPM. I still have the goal of being a CPM in mind, but it will simply take me a bit longer.

While in the Philippines, I witnessed/attended the births of 16 babies. I got some more hands on experience in difficult situations like shoulder dystocias and hemorrhages, which helped to affirm to me that my skills are excellent. I also got some more clinical experience with prenatals, postpartum moms, and newborn well baby checks and newborn exams. Overall, a good experience.

The downside to my trip was my illness. The second week that I was there, I got what everyone told me was Dengue fever. Sounded horribly scary but it was basically an awful fever, flu like symptoms, diarrhea, and awful body aches. I was sick with a fever of up to 104.6 for four days before insisting on going to the hospital. By that time, I was vomitting, and having diarrhea every 15-20 minutes. I was so weak and drinking hurt. Turned out that I had amoebas, and a bad case of them. The doctor said from the tap water, which I had initially been assured was perfectly safe to drink. I stayed the night in the hospital and was put on flagyl, an anti amoeba/parasite med for the next 6 days. The flagyl killed the amoebas, but made all my food taste like metal. It was not a happy recovery.

Anyhow, I am home now, fully recovered from amoebas, but promptly came down with a doozy of a head cold when I returned. That is now subsiding and I am slowly getting my house unpacked.

Moved in, now unpacking, and repacking!

2008-07-19T14:47:00.000-07:00

What a week! We've just moved out of our way too small house into a house that is the perfect size for our family and my small practice. It has all the space we need and more!!! I am so grateful. This move was truly providential.

Now that we're out of our old house though, the unpacking begins. I confess I am overwhelmed and exhausted. My sweet hubby has told me to take the day off and I am heeding his advice, even though the boxes and clutter from said boxes is driving me insane!

None the less, there are a few rooms I want to have done before I leave Thursday. You see, Thursday I leave for the Philippines. I don't know that I'll be able to keep my blog up while I'm there, but I will surely try to do so. So, I will be unpacking my boxes, and then packing up my suitcase for a long trip away from home. I'm going to miss my family terribly.

Midwives Alliance of Pennsylvania...

2008-06-13T23:02:00.000-07:00

I just wanted to alert all of you out there in the land of blogs about the Midwives Alliance of Pennsylvania. I am the Northeastern Region's representative to this group, and we are trying to get legislation passed similar to what Massachusetts is putting through their congress. We are hoping to get a midwifery board in place for Pennsylvania, and make licensure available to CPM's who work here in PA.

http://www.pamidwivesalliance.org/

A few myths that keep being passed around by the folks at ACOG about CPM's need to be addressed also. A CPM is not "just" a lay midwife. Lay implies untrained and unskilled. This could not be further from the truth (and quite frankly, I know some amazingly talented and great "lay" midwives who are not CPMs, but I digress).

ACOG has erroneously misinformed the public by stating that CPM's only have to attend 20 births to be a midwife. Again, not true.

To become a CPM it is is long process. 20 births as an active participant (not just observing), 20 births as a primary under supervision, 20 postpartum exams as primary, 20 newborn exams as primary, 75 prenatal exams as primary, a total of 1350 clinical hours, a 45 page checklist of hands on skills that must be signed off on by a senior midwife, three letters of recomendation, informed consent, practice guidelines, and handouts developed by the student midwife have to be done, and all of this has to be submitted to the North American Registry of midwives before you proceed to part two of the PEP (portfolio evaluation process). Part two is where you then have to have your hands on skills checked again by a different midwife than one that you have already worked with, either in a QE exam, or by completing a seven page checklist with an approved CPM. After you have done this and passed, you send that in to NARM along with a letter with an intent to take the CPM exam. Then you get to take your exam a few months later, an exam which takes 8 hours to complete and is exhaustive about prenatal, birth, postpartum, and well woman and well newborn care.

IF, and only IF you complete all of this, are you then a CPM. Does this sound like an untrained, unskilled person to attend a low risk homebirth? Certainly not. Also, many CPM's acquire much more birth experience than what is required by NARM, but do not submit all of the births that they have attended, just what is asked of them to submit. Also, for one reason or another some of those births may not "count" according to NARM guidelines.

It just makes my blood boil when I see these lies posted by ACOG, which by the way, is not a college at all, but a trade organization.

updating my website...

2008-06-07T00:21:00.000-07:00

Well, I haven't changed the look of my website in about four years, and it needed a facelift. So, tonight I started that daunting task. I really like what I've done so far. http://www.mybirthbydesign.com/ I only have the front page done so far, but since the text is already on the other pages, I just mostly have to copy and paste from here on out. Hopefully I'll be done with this by the end of the week, if not sooner. Once I get going on something like this, its hard for me to stop until it's done.

I didn't do anymore packing or cleaning today. Just didn't feel like it. It was a good day to just enjoy my children, kick back, run a couple errands, and be me.

Bobby called with some good news on our financial situation, so I am praising the Lord for that and praising Him for my husband. He's an amazing man, I am so blessed to have him.

Summer's a comin'...

2008-06-05T13:45:00.000-07:00

Today it's a muggy day in the Pocono Mountains. Not quite rainy, not quite hot, just kind of ... blech. I'm trying to get myself motivated to do some cleaning, but it's not happening. I know me, I'll come alive about 11 o'clock tonight and be up until 2 again cleaning and packing.

Yep, we're packing again. We're moving locally, and have found the perfect house. We are trusting the Lord to give it to us. We first must have our current house rented out or we won't be able to move until December 1st, when our lease is up. We figured moving during the summer was a better idea than later in the winter though, as most people don't move to the frigid cold of the mountains at that time.

Along with the packing, I'm spending a lot of time praying that the IRS comes through with our refund check(s). You see, I've been accepted in the internship program at Davao, Philippines and plan on being there for six weeks at the end of summer. http://www.midwifeschool.org/mercy/ Six weeks and I should be done with all my clinical requirements to be a midwife. After 7 + years, I'll be able to turn in my NARM paperwork and hopefully take my exam to be a CPM next February.

This will be the second time that I have been abroad for a midwifery internship. The last time was in 2004, when I went to Senegal, Africa. An amazing experience that God used to help me to bless others, and I was blessed by the experience. I have a heart for international service, that is for sure. I hope to go abroad many more times, and to also have the means to take my family with me.

To me, this trip is both a missions trip and a trip to focus entirely on midwifery. Here at home, my focus is on husband, children, home, and midwifery, in varying order depending on the day. I know I'll miss my husband and children, who wouldn't? But, I feel that the Lord is in this. He will provide.

Please keep me in your prayers that our money will become available soon for my trip and for our move. The sooner I can purchase my tickets, the cheaper they will be, not to mention the fact that I'd like to have all the details finalized as soon as possible.