Is it possible to look at childbirth in a "balanced," unbiased manner? I just thought it worth asking that question. I am inside myself as I've posted on this blog, and so I cannot completely view my writing with total objectivity. Do I come off as a die-hard? Do I sound judgmental? Am I sane? (Actually, I already know the answer to that third question, so let's focus on the first questions.)
The fact is, I DON'T think that it's possible to be completely unbiased about childbirth. At least, it's impossible to be completely unemotional. Childbirth is a life-changing experience. It's the time when you meet one of the most important people in your life. It's a complete transformation physically, spiritually, and emotionally. However positive or negative your experience is will unavoidably affect your feelings about the care providers, the birthing location, and the method you chose (or had to accept).
I can't speak for other women, but each childbirth experience has left me altered forever. Beside the obvious physical changes (like a profoundly widened pelvis and ribcage and some seriously droopy breasts), there are so many emotional changes that have come with childbirth. Humility, feelings of inadequacy, frustration, humility, elation, and humility. Childbirth is the beginning of motherhood, and motherhood is one CRAZY roller-coaster ride. Really, I'd mention the importance of humility, but most who stumble upon this are mothers or mothers-to-be. And if you haven't already discovered the need for humility as a key component in motherhood, then you will before long. :)
Motherhood is also fun, and I think that childbirth can also be kind of fun too. Like, how often can you be stark naked in front of a bunch of people and yet know that you're doing something completely wholesome? How often does such an impossible task become a reality? It's just kind of neat.
Okay, I'm rambling. I guess I just wanted to say that, while I might come off a little die-hard on this blog, I do not believe that there is only one right way to have a baby. I speak passionately about the benefits of natural childbirth, because it was a wonderful way for me to have my last three children. But I love to hear birth stories of all kinds, especially ones where the mother and father could look back and know that they were in good hands and were blessed.
Most labors will come with surprises, even the smoothest of labors. Some go faster than expected. Others drag on forever. Some are very frightening, while others are surprisingly very peaceful. There are complications that can bring great risk to mom and baby while a room away some lucky lady is having the perfect hypno-birth or the perfect epidural. (Sheesh!)
While all labors may not be equally satisfying, all mothers are created equal and deserve to be respected for their experiences and their decisions. I've often looked back at my first labor and judged myself very harshly for not having pursued a Bradley method childbirth sooner. And yet, I still went through all of the sickness, carried the baby for 9 months, gained lots and lots of weight, did the best I could with that labor and with that lovely little person. And though I've learned some powerful things about myself and about childbirth, I loved my first daughter as much I've loved each other child I've given birth to.
So, for the record, if you stumble upon this and love epidurals, please don't think I'm judging you. I'm glad you could have a positive experience. If you have had one or more cesareans, please don't think that I pity you, look down on you, or think that your OB is a monster of some sort. If anything, I just hope that you had a terrific recovery, and I'm slightly jealous that your pelvic floor is in better shape than mine. And if you were unable to give birth to your own children and were only able to adopt, I have deep respect for the journey you have been on and I rejoice in your family. (I'm also touched that you would even read this.)
I will always be an advocate of education about childbirth, though. I don't think that is in conflict with having respect for varying viewpoints and experiences with childbirth. The couple who does their best to learn about pregnancy and childbirth may not have an easier birth each time, but they will understand better what's happening. And hopefully that understanding will help them find peace sooner.
I have a good friend who recently had a gorgeous, healthy little baby. She had hoped and prepared for a natural labor, but she was instead faced with a very complicated delivery. I know very little detail except that she went through a difficult, painful, and somewhat frightening ordeal. And yet her serenity about the experience is such a beautiful gift and example. She has deep gratitude for her little love, and she has seen the blessings surrounding the trials. Above all, she is filled with one great emotion - love.
And that, my friends, is what motherhood and childbearing and rearing is about. It's about loving someone else in a way that is beyond comprehension. It is about loving to sacrifice for another, and (eventually, at least) seeing the sacrifice as really a gift to the mother even more than to the child.
I don't know what kind of woman I will be in the end. I can only hope that through these years of fun, frustration, excitement, elation, anguish, anxiety, and affection that somehow the gift of being able to give of myself to these amazing human beings will mold me into something more than I currently am. Somehow, I hope that on this imperfect journey, love will see my children and me through to building some meaningful, loving relationships that will last forever.
Today I am humbled to bear the title of mother. I honor all who share the name.
Friday, June 25, 2010
Tuesday, March 9, 2010
The Woman Who Weans Early
If a woman has enough difficulties with breastfeeding, sometimes it makes sense (depending on her and her situation) to consider bottle-feeding a baby instead. I realize that in saying that, I'm totally defying many authorities. Breastmilk is definitely best for babies, and if you have breastmilk to give, the thought of actually choosing another feeding method floods you instantly with tremendous guilt. But having milk (whether or not it is enough can be debatable) is not the only issue at hand. Sometimes other things need to be taken into consideration.
Anyway, if you are considering weaning, maybe you shouldn't read this. I would recommend that you call a lactation consultant or a La Leche Leader. Call a friend who has been successful with breastfeeding. Pray. Keep nursing until you know that you could not take it anymore. That's the only advice I could ever give on the subject, because anyone can tell that I'm no expert on breast-feeding.
But I am an expert on struggling with breastfeeding. I'm an expert at calling lactation consultants, reading websites, pouring through The Womanly Art of Breastfeeding, watching videos of the right way to latch your baby, buying herbs to naturally but gently battle intraductal yeast, weighing your baby way too much before, after, and between feedings, looking at dairy with fear after a tough night of frequent wakings and green mucousy poopy diapers the next day, stepping on the scale and weighing 1/2 pound less than the day before (day after day) because you couldn't get enough to eat for another day, spending 40+ minutes per feeding stripping, changing, switch feeding, and working to wake your baby to make sure they feed better and get enough. I'm an expert at crying. Oh, I'm a bonafide guru at turning on the waterworks.
I could write a book about laying in bed in the morning after an exhausting night of feedings with your sweet baby tucked in next to you and thinking about the day ahead of trying to be a mother to four children in a house that's piling higher and higher with dishes and laundry. And while you have images of 40 minute feedings with your seemingly perpetually exposed breasts hanging out while your toddler is coming at you and the baby with large toys, you just think, "Please, let my heart stop beating right now."
But that's pretty unhealthy, isn't it? If you're like me, you might know what post-partum depression sounds like, and when you're wishing for a cardiac arrest it can be pretty alarming to you let alone to your husband and others. So, you might find yourself searching for something that can make the load you're carrying a little more managable.
And let's talk about breasts. Actually, let's not. I'm not a fan of mine. They've let me down way too many times with their lopsidedness and slow letdown and watery milk and sore, tender nipples and shooting pains during yeast infections that feel like a string is tied from your nipple to a place in your left shoulder blade and the baby is tugging on that string as they nurse. I've had enough of my breasts, and if I thought for a second that they'd do some good for someone else I would definitely post them on e-bay or something. Alas, this is only disturbing and is completely impossible.
A woman who weans earlier than she originally expected is on a horrible roller-coaster for at least a while. Hopefully, if she can have a healthy outlook on it, it can be a short while. But the mourning is there, because when the milk is gone, it's pretty much gone (unless you have the time, energy, and resources to invest in relactation - something I would have seriously considered with my first baby, but could not possibly now that I have four kids).
I would like to respectfully point out that most women I know who wean early (and earlier than planned) have really tried to explore all of their options. To say, "Exhaustion won over" is an oversimplification. Indeed, most have exhausted certain options, or at least, as we've accessed all of the solutions necessary (when there is more than one problem), we've concluded that the battle was more than we could manage with the other factors in our life. For some of us, weaning was the more sane option for us and our families.
I would like to humbly request that no one offer me advice on how to fix my breastfeeding challenges. If a woman says, "Breastfeeding didn't work out," please don't recommend that she rent a hospital grade pump. The use of past tense will likely indicate that the milk is gone already. Now if she says, "I don't think breastfeeding is working out," that's another story. If I were still nursing and reaching out (as I was last week when I blogged, called a ton of people, read a ton of literature, bought of ton of herbs, did a ton of nursing, etc), advice would be welcomed and appreciated. But now that I've decided to bottle feed and made that transition, it doesn't help me to look back and question my decision again and again.
The truth is, I don't even need help to question my decision. That's the toughest part of premature weaning - you question your decision for awhile. I've often found myself looking back for at least a few weeks thinking, "Maybe I could've pumped my milk? Why didn't I just do that? What a selfish person I am!" But then my mind plays through the scenario and I remember that part of the problem was the yeast, the fatigue brought on by continued lactation and food sensitivities, and I already had too many things on my plate as it was. So where was the time to pump?
Maybe just a few more weeks of switch-nursing, I've wondered? Maybe I just needed to wait it out, and then she'd wake up and start nursing better. But the baby had become such a weak nurser by the end, and again there were the other children to care for.
"Sooner or later it would've gotten better. She would've nursed better. My milk would've come back better. We could've beat the yeast. Or I could've breast and bottle fed." Unless the doctor declared the weight-gain was too slow, and do I think I could've handled several more weeks (or 60 minute feedings instead of 40 minute feedings)? (My 3rd baby was a very sleepy, slow nurser all the way through 2 months when I fell apart for all of the same reasons).
I don't even ask how will I bond with my baby, because the fact is, I didn't enjoy the nursing experience very much. I love holding and snuggling my baby, but I don't have to be topless to do that. And I'm such a stress case that every time my baby fussed for any reason, I was flooded with guilt and anxiety that she wasn't getting enough, it was something I ate, or a fear of, "Do I have to nurse again now?"
Please believe me, this is not meant persuade other women to wean or even to defend my choice to others. On the contrary, it's a heads-up that any woman who chooses too wean early (unless your own health issues make that decision for you or something) will be facing some more big emotions. So hang in there and give it your all.
If you end up where I've found myself, though, I pray you can forgive yourself quicker than I am. I hope you can quickly find a formula that your baby loves and thrives on. (Thank goodness, we've had some good, healthy, regular stools since we switched!) I hope that you can enjoy the benefits of bottle-feeding without guilt while rejoicing that you genuinely gave it your best effort and gave them the best start you could. Hold your baby close and snuggle them a lot while feeding them. Look into their eyes, and be sure to burp them well. :)
A good friend of mine (who loves nursing and does with little or no struggle at all) asked why I was afraid to quit nursing. She repeatedly said, "Enjoy your baby. If that means you can fix the nursing problems and enjoy it, do that. If it means bottle-feed, do that. Enjoy your baby."
It seems too simple, but since my breasts are mostly back to normal and the baby is content with the bottle, it's the advice I have to take now.
I can cheekily say this - if she follows suit like her siblings and is sleeping 12 hours straight at 4 months (or is down to one feeding that her wonderful father does), I will not be mourning anymore. ;)
Anyway, if you are considering weaning, maybe you shouldn't read this. I would recommend that you call a lactation consultant or a La Leche Leader. Call a friend who has been successful with breastfeeding. Pray. Keep nursing until you know that you could not take it anymore. That's the only advice I could ever give on the subject, because anyone can tell that I'm no expert on breast-feeding.
But I am an expert on struggling with breastfeeding. I'm an expert at calling lactation consultants, reading websites, pouring through The Womanly Art of Breastfeeding, watching videos of the right way to latch your baby, buying herbs to naturally but gently battle intraductal yeast, weighing your baby way too much before, after, and between feedings, looking at dairy with fear after a tough night of frequent wakings and green mucousy poopy diapers the next day, stepping on the scale and weighing 1/2 pound less than the day before (day after day) because you couldn't get enough to eat for another day, spending 40+ minutes per feeding stripping, changing, switch feeding, and working to wake your baby to make sure they feed better and get enough. I'm an expert at crying. Oh, I'm a bonafide guru at turning on the waterworks.
I could write a book about laying in bed in the morning after an exhausting night of feedings with your sweet baby tucked in next to you and thinking about the day ahead of trying to be a mother to four children in a house that's piling higher and higher with dishes and laundry. And while you have images of 40 minute feedings with your seemingly perpetually exposed breasts hanging out while your toddler is coming at you and the baby with large toys, you just think, "Please, let my heart stop beating right now."
But that's pretty unhealthy, isn't it? If you're like me, you might know what post-partum depression sounds like, and when you're wishing for a cardiac arrest it can be pretty alarming to you let alone to your husband and others. So, you might find yourself searching for something that can make the load you're carrying a little more managable.
And let's talk about breasts. Actually, let's not. I'm not a fan of mine. They've let me down way too many times with their lopsidedness and slow letdown and watery milk and sore, tender nipples and shooting pains during yeast infections that feel like a string is tied from your nipple to a place in your left shoulder blade and the baby is tugging on that string as they nurse. I've had enough of my breasts, and if I thought for a second that they'd do some good for someone else I would definitely post them on e-bay or something. Alas, this is only disturbing and is completely impossible.
A woman who weans earlier than she originally expected is on a horrible roller-coaster for at least a while. Hopefully, if she can have a healthy outlook on it, it can be a short while. But the mourning is there, because when the milk is gone, it's pretty much gone (unless you have the time, energy, and resources to invest in relactation - something I would have seriously considered with my first baby, but could not possibly now that I have four kids).
I would like to respectfully point out that most women I know who wean early (and earlier than planned) have really tried to explore all of their options. To say, "Exhaustion won over" is an oversimplification. Indeed, most have exhausted certain options, or at least, as we've accessed all of the solutions necessary (when there is more than one problem), we've concluded that the battle was more than we could manage with the other factors in our life. For some of us, weaning was the more sane option for us and our families.
I would like to humbly request that no one offer me advice on how to fix my breastfeeding challenges. If a woman says, "Breastfeeding didn't work out," please don't recommend that she rent a hospital grade pump. The use of past tense will likely indicate that the milk is gone already. Now if she says, "I don't think breastfeeding is working out," that's another story. If I were still nursing and reaching out (as I was last week when I blogged, called a ton of people, read a ton of literature, bought of ton of herbs, did a ton of nursing, etc), advice would be welcomed and appreciated. But now that I've decided to bottle feed and made that transition, it doesn't help me to look back and question my decision again and again.
The truth is, I don't even need help to question my decision. That's the toughest part of premature weaning - you question your decision for awhile. I've often found myself looking back for at least a few weeks thinking, "Maybe I could've pumped my milk? Why didn't I just do that? What a selfish person I am!" But then my mind plays through the scenario and I remember that part of the problem was the yeast, the fatigue brought on by continued lactation and food sensitivities, and I already had too many things on my plate as it was. So where was the time to pump?
Maybe just a few more weeks of switch-nursing, I've wondered? Maybe I just needed to wait it out, and then she'd wake up and start nursing better. But the baby had become such a weak nurser by the end, and again there were the other children to care for.
"Sooner or later it would've gotten better. She would've nursed better. My milk would've come back better. We could've beat the yeast. Or I could've breast and bottle fed." Unless the doctor declared the weight-gain was too slow, and do I think I could've handled several more weeks (or 60 minute feedings instead of 40 minute feedings)? (My 3rd baby was a very sleepy, slow nurser all the way through 2 months when I fell apart for all of the same reasons).
I don't even ask how will I bond with my baby, because the fact is, I didn't enjoy the nursing experience very much. I love holding and snuggling my baby, but I don't have to be topless to do that. And I'm such a stress case that every time my baby fussed for any reason, I was flooded with guilt and anxiety that she wasn't getting enough, it was something I ate, or a fear of, "Do I have to nurse again now?"
Please believe me, this is not meant persuade other women to wean or even to defend my choice to others. On the contrary, it's a heads-up that any woman who chooses too wean early (unless your own health issues make that decision for you or something) will be facing some more big emotions. So hang in there and give it your all.
If you end up where I've found myself, though, I pray you can forgive yourself quicker than I am. I hope you can quickly find a formula that your baby loves and thrives on. (Thank goodness, we've had some good, healthy, regular stools since we switched!) I hope that you can enjoy the benefits of bottle-feeding without guilt while rejoicing that you genuinely gave it your best effort and gave them the best start you could. Hold your baby close and snuggle them a lot while feeding them. Look into their eyes, and be sure to burp them well. :)
A good friend of mine (who loves nursing and does with little or no struggle at all) asked why I was afraid to quit nursing. She repeatedly said, "Enjoy your baby. If that means you can fix the nursing problems and enjoy it, do that. If it means bottle-feed, do that. Enjoy your baby."
It seems too simple, but since my breasts are mostly back to normal and the baby is content with the bottle, it's the advice I have to take now.
I can cheekily say this - if she follows suit like her siblings and is sleeping 12 hours straight at 4 months (or is down to one feeding that her wonderful father does), I will not be mourning anymore. ;)
Friday, March 5, 2010
The Last Great Marathon
I guess now is as good a time as any to describe my labor with this last baby, my 4th child and 2nd daughter.
First of all, I think that I should share my birth plan with you. Well, I won't share it word for word, but here are some of the requests I made in my plan (which I respectfully entitled my "Birth Requests" just to show I was level-headed):
-No IV or heplock unless medically necessary
-A quiet, peaceful atmosphere in which to labor with my husband
-Please don't offer medication. I will request it if I need it
-Only intermittent fetal monitoring unless continuous monitoring proves necessary
-No episiotomy unless there are signs of fetal distress during stage 2, and please allow me to try pushing harder if needed
Well, you get the picture. I wanted the most natural, lowest intervention birth necessary. I was convinced that the less intervention I had, the more I could relax and enjoy my labor.
The funny thing is, I'm not a very relaxed person. :) But seriously, I had never labored before without an IV and continuous fetal monitoring, and I was surprised at how much I'd come to depend on having a machine count my contractions and track my baby's heartbeat for me. It was so strange to have all of that freedom.
I guess I should backtrack and just describe what happened. As I stated a few posts ago, I was scheduled for induction on Wednesday, February 17. I was not excited about this. I knew that an induction would be a final farewell forever to my "dream birth." (Well, actually, my dream birth is a home tub birth, but oh well...) Anyway, I called the midwife on call on Tuesday the 16th and asked her what would really be the safest option for me. Should I a) just keep waiting to see if I start naturally soon and potentially go over a week past the due date, b) see if getting my cervix stripped could start me into labor so I wouldn't need a Pitocin induction, or c) just face the induction. Both she, the midwife on call (I'll call her Midwife C, my favorite in the practice) and the midwife scheduled for Wednesday were absolutely wonderful. I knew that with either one of them I could trust that I'd have their full support to labor as I wanted to. I knew that I wouldn't need to feel like I was auditioning - they wouldn't panic, even if I did. I was straight-forward with Midwife C about this, that I wanted either her or Midwife R (scheduled for Wednesday) to deliver my baby. I let her know that my comfort level dropped on Thursday with JB was back on call.
And frankly I was in pain. During those final weeks of pregnancy, my daughter's stretches and kicks weren't just uncomfortable - they were frighteningly painful. Her head was so low and hitting a nerve, and at times I would completely lose my footing and almost fall to the floor. It was sudden, sharp, and frustrating. I swore a lot in those weeks. Also, I felt a deep burning pain just behind my pubic bone (sorry to be graphic, but hey, it's pregnancy). I could tell that her head was right behind it, and walking was terribly comfortable.
I was ready to be done with my pregnancy, and I was willing to be induced on Wednesday if it meant a sooner birth and a better provider. Still, I wanted one last shot at a natural, low-intervention birth. So we agreed to have my cervix stripped. I hurried to the office, underwent the very uncomfortable procedure, and found out that I was dilated to about 5 centimeters. Midwife C was pretty hopeful that she'd see me later to have a baby. I was pretty hopeful too, but I had waited so long and had started losing faith in my body. So it was hard to relax or get excited (which I wanted to avoid anyway, because I feared that adrenaline would undermine any contractions that might start).
During the hours that followed, I experienced occasional, mild to moderate contractions. I'm not very good at timing contractions, though, so I couldn't tell you how far about they were. Besides, I was too busy doing other things. My sweet husband, hoping that we were set for a labor and feeling antsy about being at work when I might start quickly, opted to work from home that day. He helped out with the boys while I nested lightly and tried to stay mildly active without wearing myself out.
By dinner-time the contractions were stronger and a bit steadier, but I still hadn't gotten around to really timing them. They seemed inconsistent. I did start to feel, however, that I wanted to rest and relax through them instead of being on my feet. My husband cleared the table, called his parents to let them know that we thought we were probably starting, and worked on putting the children down for the night. At around 8ish, the contractions reached a new level, and I needed to use the bathroom. As I sat on the toilet, I noticed the faint smell of blood and looked down see a bloody show. It wasn't scary, but it was something new. I decided to step into the shower. This was probably it. Now I needed to focus on relaxing.
My husband checked on me in the shower, and I said that it was a good time to call his parents. He picked up the phone and found a voice message from his mother saying that his dad was on the way in case he was needed. He called her and let her know that the timing was perfect.
Now we packed the car and waited for my father in law, and suddenly the contractions started to slow down, though they didn't weaken at all. As I feared, excitement (even my mild, apprehensive excitement) was slowing the labor down. I shared with my husband that felt silly and wondered if we were moving too quickly. He said that he felt that it was the right time. We had prayed that we'd know when to go to the hospital, and he felt confident that now was the time. So we moved on.
In the car, I tried timing contractions (I'd done a little bit while resting - they were somewhere around 4-5 minutes apart). This time the contractions were stronger, but the position I was sitting in made them seem more mild. I can't explain, but I can tell you that I like to labor sitting up. :) I called the midwife, and the next contraction came about 3 minutes after the previous one had. She said that was timing she could work with and said that she looked forward to seeing us. (As I turned out, she delivered at least 3 or 4 babies that day!)
We arrived at the hospital and rode the elevator up to the labor and delivery unit. I was brought in to triage for 10 minutes of monitoring and a cervical check. I was hoping for 7 centimeters, but I was only at 6. Still, that was something. They don't usually send you home at 6 centimeters. While I was trying to find a comfortable position during the monitoring, the probe kept getting off track. (This should be a good reminder of why continuous monitoring can be such a pain. Too much movement makes for messy readings, and that can make people anxious). My husband and I were joyfully marveling at the steady chug of our daughter's heartbeat, which sounded like horses' hooves on a race-track. My husband made a joke and asked whether I was ready to deliver the race-horse that was with the baby, and I couldn't stop laughing. The monitor contractions showed some pretty spiky readings for the next few minutes from my belly shaking. Finally I was released from the monitor and brought to my room. I quickly used the bathroom, changed clothing, and started moving around. Then I decided to fill up the tub while my husband got our stuff from the car. I enjoyed sitting in the tub for awhile, where I noticed that the backpain which came with each strong contraction seemed to be muted somewhat.
It might have been wise for me to stay in the tub, but when my midwife visited and checked on me, I realized that I had no idea how far apart my contractions were and it was hard to tell how strong they were in the tub too. She suggested that I turn on the jets and see if the bubbles could stimulate the nipples and make my contractions get stronger. It worked like a charm. In fact, the contractions that came with the jets on were intense and almost scarily close. I went from what I am sure was 3-4 minutes apart to maybe 90 seconds to 2 minutes apart. It was erratic. I started to think that it would be wiser to get out soon.
I toweled off and proposed that we go for a walk. I was given a second robe to cover my backside, but after taking about 4 steps into the hallway, I realized that I was in no condition to walk. My contractions required rest.
I came back in and sat on the bed. I admitted that I was frustrated about keeping track of my contractions. The uncertainty was getting to me - I was so used to a machine doing the work and letting me know how far along I was. My midwife offered to check me and I accepted. I was now at an 8. The contractions, though somewhat inconsistent, were very strong. In fact, right after the tub, I had a couple of contractions that literally came immediately one after the other.
As I expected, the deep back pain which came with my previous labors was there again. This time it seemed stronger and more intense, and the fact was I was finding it very hard to really relax. I mean, ideally I should be on my side or slightly reclined and letting my whole body go. But the backpain seemed to intensify beyond anything I could handle when I was on my side. The only thing that I felt that I could handle was being upright. I was focusing on relaxing my lower body while I was propping myself up with my arms. It was crazy, I could tell. But at this point the contractions were too strong and too frequent to request a birthing ball or something.
Midwife C was so awesome. She just supported me through it and told me what a great job I was doing. I didn't feel judged for not being more relaxed or better prepared. I just worked through each contraction sitting up with her directly in front of me encouraging me. My husband gently massaged my back between contractions and pushed hard on my lower back during contractions. The burning was so intense. I focused on deep breathing and visualizing my uterus and my cervix. I could feel and see the muscles doing their work.
It was very painful. So painful. Painfully humbling, and yet I knew that I was in transition and that I was a matter of minutes before I'd be pushing out my daughter. I started to feel pressure and an urge to push even though my water hadn't yet broken. The midwife said that I could grunt a bit with the next contraction, so I did, and I was convinced that my water broke when liquid started gushing out. She looked and said that it was just urine, but then she reached in to check the bag of waters, and it burst immediately. I just started pushing at that point.
Now, for some reason I remember that when I was pushing my boys, I didn't feel a whole lot of pain between contractions. Something about the way my daughter was positioned made this much more painful, and I didn't really feel like I could or should rest and only push with contractions. There was intense pressure and that continued burning pain in my abdomen. Unfortunately, I was sitting so far forward that the baby wasn't going to progress in that position. She they got me slightly reclined back at a 45 degree angle, and I pulled me legs back and pushed with all that I had. I wasn't screaming, but I was moaning and wailing the whole time. It was a whole new experience.
The baby had really worked herself up into an interesting place. As I had suspected, her head was right behind my pubic bone, and the midwife was literally reaching up and pulling her head down (almost digging her out) to where she could be birthed. I just kept pushing, and thank goodness people reminded me to take some breaths and pace myself. As the baby started to crown, I felt that familiar sting and pull. But I had not opted for a mirror this time, and I'm glad I didn't. They announced that the baby was crowning, and I continued to push hard. Then my midwife yelled at me to slow down a bit. :) She want to save me from crowning. She told me to gently grunt the baby out, and I could hear here announce that the head was born.
Then I did something naughty. I pushed again. I could feel the rest of the baby's body still inside me, and the pressure was so strong and the burning so intense that I didn't wait for coaching. I just pushed, and her body slid out. I immediately felt a stinging sensation, though, that was too familiar - the feeling of a perineal tear. I knew it, but it was okay. The midwife had tried, and I was the one who didn't wait for coaching. Happily it was just a 1st degree tear again.
And there was this lovely little person on belly at that point. The fluid had actually been a bit yellow, showing slight signs of her having passed mechonium. But they examined her on my chest and suctioned her out a bit, and she was fine. She had ingested a bit, but not much. And she was pink.
And then she pooped on me. What a funny thing to have happen to you! Though, after having pushed a baby out, you really don't care that someone has pooped on you, especially when they are small and beautiful.
I was so amazed that she was there, and I tried to cuddle her. I was humbled by my pain, though. It wasn't in a way that made me feel cold toward the baby. It was just a deep, humbling ache in my body. And it was such a relief to have her outside of me for a change.
My husband and I were overjoyed. We were also tired. After the placenta was delivered (again, I was a little hasty and pushed it out before the cord even stopped pulsing - I just wanted to get everything out of my body!) and my tear was stitched up, the room started clearing out. My midwife had another labor to attend in the same hospital. My husband and I were left with our little one, and I offered her the breast. She latched on well (though I didn't do an amazing job making it a painless latch for her). She nursed both sides for awhile, and I immediately met a new pain - nipple soreness.
We really enjoyed our bonding time with her, but I have to admit that my husband and I hadn't realized until then how tired we were. I nursed her again, and eventually they took the baby down to the nursery where my husband assisted in and recorded the baby's first bath.
I was a bloody mess, though I did enjoy using the bathroom. It really is a great feeling to relieve your own bladder after a birth. I was transferred to our room, and soon my husband arrived with our cute little one with the round head and the slightly large ears. She's beautiful and sweet, and she's has a sensitive little soul. I can tell. I don't know if she'll eventually become as rowdy as her siblings are.
About the hospital stay: The staff was great, but hospital stays are so not restful. It seemed that every time I dozed off after awhile, someone came in for a blood-pressure check or to change the garbage. Some nurses were nice enough to turn off the computer monitor, but most forgot. I was glad to have three pillows from home to stack up around my head and block out the light.
So that was it. No painless birth for me, but that's okay. I didn't expect it. In fact, I think there was a part of me that wasn't willing to trust and give in to the labor until I felt that the contractions were truly painful. Then I could work at relaxing against them to minimize the pain. It might not be the smartest way to have a baby, but it worked for me.
And I'm so grateful to be done. No, I haven't had surgery. We don't yet know that it would prove necessary. Hopefully other reliable forms of birth control will be...well, reliable (and not detrimental to my physical or emotional health). Still, we feel that our family is complete.
And now we are in the throws of chaotic life with a newborn. She's lovely, but someday I want my bed back. And my breasts, and some sleep. :)
(Again, I think I'll post this unedited for now in case a curious friend is anxious to get the scoop. Thanks for reading!)
First of all, I think that I should share my birth plan with you. Well, I won't share it word for word, but here are some of the requests I made in my plan (which I respectfully entitled my "Birth Requests" just to show I was level-headed):
-No IV or heplock unless medically necessary
-A quiet, peaceful atmosphere in which to labor with my husband
-Please don't offer medication. I will request it if I need it
-Only intermittent fetal monitoring unless continuous monitoring proves necessary
-No episiotomy unless there are signs of fetal distress during stage 2, and please allow me to try pushing harder if needed
Well, you get the picture. I wanted the most natural, lowest intervention birth necessary. I was convinced that the less intervention I had, the more I could relax and enjoy my labor.
The funny thing is, I'm not a very relaxed person. :) But seriously, I had never labored before without an IV and continuous fetal monitoring, and I was surprised at how much I'd come to depend on having a machine count my contractions and track my baby's heartbeat for me. It was so strange to have all of that freedom.
I guess I should backtrack and just describe what happened. As I stated a few posts ago, I was scheduled for induction on Wednesday, February 17. I was not excited about this. I knew that an induction would be a final farewell forever to my "dream birth." (Well, actually, my dream birth is a home tub birth, but oh well...) Anyway, I called the midwife on call on Tuesday the 16th and asked her what would really be the safest option for me. Should I a) just keep waiting to see if I start naturally soon and potentially go over a week past the due date, b) see if getting my cervix stripped could start me into labor so I wouldn't need a Pitocin induction, or c) just face the induction. Both she, the midwife on call (I'll call her Midwife C, my favorite in the practice) and the midwife scheduled for Wednesday were absolutely wonderful. I knew that with either one of them I could trust that I'd have their full support to labor as I wanted to. I knew that I wouldn't need to feel like I was auditioning - they wouldn't panic, even if I did. I was straight-forward with Midwife C about this, that I wanted either her or Midwife R (scheduled for Wednesday) to deliver my baby. I let her know that my comfort level dropped on Thursday with JB was back on call.
And frankly I was in pain. During those final weeks of pregnancy, my daughter's stretches and kicks weren't just uncomfortable - they were frighteningly painful. Her head was so low and hitting a nerve, and at times I would completely lose my footing and almost fall to the floor. It was sudden, sharp, and frustrating. I swore a lot in those weeks. Also, I felt a deep burning pain just behind my pubic bone (sorry to be graphic, but hey, it's pregnancy). I could tell that her head was right behind it, and walking was terribly comfortable.
I was ready to be done with my pregnancy, and I was willing to be induced on Wednesday if it meant a sooner birth and a better provider. Still, I wanted one last shot at a natural, low-intervention birth. So we agreed to have my cervix stripped. I hurried to the office, underwent the very uncomfortable procedure, and found out that I was dilated to about 5 centimeters. Midwife C was pretty hopeful that she'd see me later to have a baby. I was pretty hopeful too, but I had waited so long and had started losing faith in my body. So it was hard to relax or get excited (which I wanted to avoid anyway, because I feared that adrenaline would undermine any contractions that might start).
During the hours that followed, I experienced occasional, mild to moderate contractions. I'm not very good at timing contractions, though, so I couldn't tell you how far about they were. Besides, I was too busy doing other things. My sweet husband, hoping that we were set for a labor and feeling antsy about being at work when I might start quickly, opted to work from home that day. He helped out with the boys while I nested lightly and tried to stay mildly active without wearing myself out.
By dinner-time the contractions were stronger and a bit steadier, but I still hadn't gotten around to really timing them. They seemed inconsistent. I did start to feel, however, that I wanted to rest and relax through them instead of being on my feet. My husband cleared the table, called his parents to let them know that we thought we were probably starting, and worked on putting the children down for the night. At around 8ish, the contractions reached a new level, and I needed to use the bathroom. As I sat on the toilet, I noticed the faint smell of blood and looked down see a bloody show. It wasn't scary, but it was something new. I decided to step into the shower. This was probably it. Now I needed to focus on relaxing.
My husband checked on me in the shower, and I said that it was a good time to call his parents. He picked up the phone and found a voice message from his mother saying that his dad was on the way in case he was needed. He called her and let her know that the timing was perfect.
Now we packed the car and waited for my father in law, and suddenly the contractions started to slow down, though they didn't weaken at all. As I feared, excitement (even my mild, apprehensive excitement) was slowing the labor down. I shared with my husband that felt silly and wondered if we were moving too quickly. He said that he felt that it was the right time. We had prayed that we'd know when to go to the hospital, and he felt confident that now was the time. So we moved on.
In the car, I tried timing contractions (I'd done a little bit while resting - they were somewhere around 4-5 minutes apart). This time the contractions were stronger, but the position I was sitting in made them seem more mild. I can't explain, but I can tell you that I like to labor sitting up. :) I called the midwife, and the next contraction came about 3 minutes after the previous one had. She said that was timing she could work with and said that she looked forward to seeing us. (As I turned out, she delivered at least 3 or 4 babies that day!)
We arrived at the hospital and rode the elevator up to the labor and delivery unit. I was brought in to triage for 10 minutes of monitoring and a cervical check. I was hoping for 7 centimeters, but I was only at 6. Still, that was something. They don't usually send you home at 6 centimeters. While I was trying to find a comfortable position during the monitoring, the probe kept getting off track. (This should be a good reminder of why continuous monitoring can be such a pain. Too much movement makes for messy readings, and that can make people anxious). My husband and I were joyfully marveling at the steady chug of our daughter's heartbeat, which sounded like horses' hooves on a race-track. My husband made a joke and asked whether I was ready to deliver the race-horse that was with the baby, and I couldn't stop laughing. The monitor contractions showed some pretty spiky readings for the next few minutes from my belly shaking. Finally I was released from the monitor and brought to my room. I quickly used the bathroom, changed clothing, and started moving around. Then I decided to fill up the tub while my husband got our stuff from the car. I enjoyed sitting in the tub for awhile, where I noticed that the backpain which came with each strong contraction seemed to be muted somewhat.
It might have been wise for me to stay in the tub, but when my midwife visited and checked on me, I realized that I had no idea how far apart my contractions were and it was hard to tell how strong they were in the tub too. She suggested that I turn on the jets and see if the bubbles could stimulate the nipples and make my contractions get stronger. It worked like a charm. In fact, the contractions that came with the jets on were intense and almost scarily close. I went from what I am sure was 3-4 minutes apart to maybe 90 seconds to 2 minutes apart. It was erratic. I started to think that it would be wiser to get out soon.
I toweled off and proposed that we go for a walk. I was given a second robe to cover my backside, but after taking about 4 steps into the hallway, I realized that I was in no condition to walk. My contractions required rest.
I came back in and sat on the bed. I admitted that I was frustrated about keeping track of my contractions. The uncertainty was getting to me - I was so used to a machine doing the work and letting me know how far along I was. My midwife offered to check me and I accepted. I was now at an 8. The contractions, though somewhat inconsistent, were very strong. In fact, right after the tub, I had a couple of contractions that literally came immediately one after the other.
As I expected, the deep back pain which came with my previous labors was there again. This time it seemed stronger and more intense, and the fact was I was finding it very hard to really relax. I mean, ideally I should be on my side or slightly reclined and letting my whole body go. But the backpain seemed to intensify beyond anything I could handle when I was on my side. The only thing that I felt that I could handle was being upright. I was focusing on relaxing my lower body while I was propping myself up with my arms. It was crazy, I could tell. But at this point the contractions were too strong and too frequent to request a birthing ball or something.
Midwife C was so awesome. She just supported me through it and told me what a great job I was doing. I didn't feel judged for not being more relaxed or better prepared. I just worked through each contraction sitting up with her directly in front of me encouraging me. My husband gently massaged my back between contractions and pushed hard on my lower back during contractions. The burning was so intense. I focused on deep breathing and visualizing my uterus and my cervix. I could feel and see the muscles doing their work.
It was very painful. So painful. Painfully humbling, and yet I knew that I was in transition and that I was a matter of minutes before I'd be pushing out my daughter. I started to feel pressure and an urge to push even though my water hadn't yet broken. The midwife said that I could grunt a bit with the next contraction, so I did, and I was convinced that my water broke when liquid started gushing out. She looked and said that it was just urine, but then she reached in to check the bag of waters, and it burst immediately. I just started pushing at that point.
Now, for some reason I remember that when I was pushing my boys, I didn't feel a whole lot of pain between contractions. Something about the way my daughter was positioned made this much more painful, and I didn't really feel like I could or should rest and only push with contractions. There was intense pressure and that continued burning pain in my abdomen. Unfortunately, I was sitting so far forward that the baby wasn't going to progress in that position. She they got me slightly reclined back at a 45 degree angle, and I pulled me legs back and pushed with all that I had. I wasn't screaming, but I was moaning and wailing the whole time. It was a whole new experience.
The baby had really worked herself up into an interesting place. As I had suspected, her head was right behind my pubic bone, and the midwife was literally reaching up and pulling her head down (almost digging her out) to where she could be birthed. I just kept pushing, and thank goodness people reminded me to take some breaths and pace myself. As the baby started to crown, I felt that familiar sting and pull. But I had not opted for a mirror this time, and I'm glad I didn't. They announced that the baby was crowning, and I continued to push hard. Then my midwife yelled at me to slow down a bit. :) She want to save me from crowning. She told me to gently grunt the baby out, and I could hear here announce that the head was born.
Then I did something naughty. I pushed again. I could feel the rest of the baby's body still inside me, and the pressure was so strong and the burning so intense that I didn't wait for coaching. I just pushed, and her body slid out. I immediately felt a stinging sensation, though, that was too familiar - the feeling of a perineal tear. I knew it, but it was okay. The midwife had tried, and I was the one who didn't wait for coaching. Happily it was just a 1st degree tear again.
And there was this lovely little person on belly at that point. The fluid had actually been a bit yellow, showing slight signs of her having passed mechonium. But they examined her on my chest and suctioned her out a bit, and she was fine. She had ingested a bit, but not much. And she was pink.
And then she pooped on me. What a funny thing to have happen to you! Though, after having pushed a baby out, you really don't care that someone has pooped on you, especially when they are small and beautiful.
I was so amazed that she was there, and I tried to cuddle her. I was humbled by my pain, though. It wasn't in a way that made me feel cold toward the baby. It was just a deep, humbling ache in my body. And it was such a relief to have her outside of me for a change.
My husband and I were overjoyed. We were also tired. After the placenta was delivered (again, I was a little hasty and pushed it out before the cord even stopped pulsing - I just wanted to get everything out of my body!) and my tear was stitched up, the room started clearing out. My midwife had another labor to attend in the same hospital. My husband and I were left with our little one, and I offered her the breast. She latched on well (though I didn't do an amazing job making it a painless latch for her). She nursed both sides for awhile, and I immediately met a new pain - nipple soreness.
We really enjoyed our bonding time with her, but I have to admit that my husband and I hadn't realized until then how tired we were. I nursed her again, and eventually they took the baby down to the nursery where my husband assisted in and recorded the baby's first bath.
I was a bloody mess, though I did enjoy using the bathroom. It really is a great feeling to relieve your own bladder after a birth. I was transferred to our room, and soon my husband arrived with our cute little one with the round head and the slightly large ears. She's beautiful and sweet, and she's has a sensitive little soul. I can tell. I don't know if she'll eventually become as rowdy as her siblings are.
About the hospital stay: The staff was great, but hospital stays are so not restful. It seemed that every time I dozed off after awhile, someone came in for a blood-pressure check or to change the garbage. Some nurses were nice enough to turn off the computer monitor, but most forgot. I was glad to have three pillows from home to stack up around my head and block out the light.
So that was it. No painless birth for me, but that's okay. I didn't expect it. In fact, I think there was a part of me that wasn't willing to trust and give in to the labor until I felt that the contractions were truly painful. Then I could work at relaxing against them to minimize the pain. It might not be the smartest way to have a baby, but it worked for me.
And I'm so grateful to be done. No, I haven't had surgery. We don't yet know that it would prove necessary. Hopefully other reliable forms of birth control will be...well, reliable (and not detrimental to my physical or emotional health). Still, we feel that our family is complete.
And now we are in the throws of chaotic life with a newborn. She's lovely, but someday I want my bed back. And my breasts, and some sleep. :)
(Again, I think I'll post this unedited for now in case a curious friend is anxious to get the scoop. Thanks for reading!)
Wednesday, March 3, 2010
Breastfeeding Blues
Breastfeeding is so hard for me. It just is.
This might sound surprising, since I'm such an advocate for natural childbirth. It would usually follow that I have a very optimistic outlook on breastfeeding. Indeed, I think that breastfeeding is a wonderful thing and something that every mom should give a concerted effort toward (or at least consider trying). That doesn't mean that I think it's easy.
When my daughter was born, I had two big challenges that arose in connection to my birth experience and breastfeeding: placental remains and having received antibiotics during labor. Actually, a third challenge that I attributed for years to the epidural was a sleep baby. Alas, I've had three unmedicated births now (yes, my 4th birth, which I promise to describe soon, was also a natural birth), and all of my babies have been somewhat sleepy eaters (though one was less than the others).
Anyway, after the baby came, I was very stressed, had inadequate (and pretty starchy and sugary) nutrition, and I quickly started to experience symptoms of yeast, though I was undiagnosed until the baby was 4 weeks old.
Wait. There is one more challenge which I've not admitted yet - I was extremely uneducated about breastfeeding. Even after having 4 children, I still feel like a novice. But I digress...
Anyway, I came down with yeast in my milk, and that made my already sore nipples even more painful. My daughter didn't actually latch on until day 2, and I didn't realize that it would have been wise to pump a lot in the first day. So I only pumped a few times. Then I didn't bring a pump home, which would have been wise as well, as my sleepy eater of a daughter wasn't so hot at stimulating my breasts to produce milk.
So the milk came in - not a ton, I'm sure, but a start. I nursed my daughter until she fell asleep, called it a feeding, and when she would quickly fuss for more, I would hesitate to feed her again. It was hurting.
Oh, I could go on and on, but it's a really depressing story, and I don't need depressing right now. Suffice it to say, I knew little, made a lot of mistakes, learned more, made fewer mistakes, and by the time I really understood what it would take to get my milk supply where it needed to be and to get my daughter nursing well enough to be nourished by me, it was too late. Having tried a supplemental nursing system for several days and ending up with my daughter and me in tears each time, I finally began to offer my daughter supplemental bottles to keep her gaining well. When she was six weeks old, she realized that she could be nourished by a bottle and no longer needed to latch on. At 8 weeks postpartum, my bleeding had continued, and it was discovered that, in delivering my placenta for me, the doctor had left some placental remains in my uterus. My body had never fully figured out that it wasn't pregnant anymore, and the prolactin levels had been insufficient for me to produce an adequate supply. Ironically, I still got a little bit of satisfaction in pumping what milk I until my daughter was 3 months old and adding it to her formula bottles. At 3 months, we had a family gathering that threw off my pumping schedule, and my milk never came out again. I had about a half a day of engorgement.
That first experience was painful, so when my second baby came and needed a quick transfer to the NICU, I immediately requested a pump. Until I was allowed to put my son on the breast, I pumped at least every two hours with one 4 hour stretch at night, and I gave myself an incredible start with a milk supply. Happily, my son was less sleepy than his siblings have all turned out to be, and he nursed pretty well. I still had soreness, but I passed quicker. We did have yeast, but it was quickly taken care of.
The hardest challenges I faced with my handsome son was that 1) he was very sensitive to any dairy I ate - so much so that his stools literally had blood in them, and 2) he was not a great sleeper. I was so determined to nurse him that I kept him in a swing for months to make his sleep schedule "bareable" for me, and by 4 months had never exceeded a 5 or 6 hour stretch of sleep in a night. He also usually followed a good night with two or three rough nights of nursing every two hours. It seemed that my body was so time sensitive that getting extra sleep and going too long was poison to my supply. But I could be wrong. It might just have been that his sleep quality in the swing was very poor, and he was accustomed to frequent night-time nursings.
Anyway, at 4 months I reluctantly weaned my boy, and my emotional and physical health changed literally overnight. It was a sad choice, but it was a blessing to my family.
With our third child, I had a sleepy eater on my hands. And though I had nursed frequently in the beginning, I had forgotten to do breast compressions and work hard to wake my son to feed well enough. My right breast immediately shrunk to half-sized as soon as engorement ended - the letdown was too slow for my little guy, so he hadn't drained the breast well. We eventually showed strong signs of yeast again, and this time I found it more difficult to erradicate (having 3 kids is really hard, by the way). Happily, or unhappily, he was a great sleeper, and I was so anxious at all times about my milk just going away, that I was wearing myself out with nighttime feedings (I would literally go in and feed my son in his sleep just to keep my milk up).
At about 8 weeks, my husband had a three day business trip. Right around that time, my son stopped napping well during the day and was demanding feedings every 90 minutes during the day. By the second day, I started offering him supplemental bottles. He loved it. Then I panicked and wanted to go back to just the breast again. So I tried to pump after each feeding to stimulate my supply back up. After less than a day of pumping, I was exhausted. My husband came home, and after some prayer and consideration (I was still fighting yeast, by the way), we decided to fully wean him to a bottle. He was happy, slept like a dream, and fussed very little. It took a few tries of formula (we didn't just start with the normal stuff, which turned out to be the best for him) to keep him regular. But - viola - he was a happy formula fed baby.
Here we are now with our 4th and final baby. I have milk for her, and I think she's doing alright. But I'm a little discouraged. Well, a lot discouraged, actually. I have cried me a river already. Her output has been great - at least 8 or more wets and 4-6 messy diapers a day. She lost at least 9 or 10 ounces (so many poopy diapers) in the hospital, and her weight gain quota was pretty big - at least 9 or 10 ounces in 12 days. Well, she hasn't hit her birth-weight yet, and she's 2 weeks old today. Sometimes I weigh her, and it looks like she's almost there, but then she'll have a wet diaper or a big bowel movement, or it'll be a couple of hours after a feeding, and she'll be a few ounces behind again. (I have a scale - I don't know that it's amazing, but it seems to work).
So, my point to all of this is, even if you've had a successful nursing experience before (I consider my handsome son's experience to be the most successful, and I attribute it largely to the great milk supply and his active nursing from the beginning), there is a lot to know.
So here's a link I found to a very helpful website. The information is so much better than that idiotic little booklet they give you at the hospital. I would encourage all to not make the mistake I made this time - which was to wait until after the baby came - to educate or reeducate myself on the breastfeeding. Read up on things now and learn how to get the best start you can so that you don't have to "fix" problems later on. If you can get your baby gaining and nursing well in those first few weeks, you have such a great start.
I haven't given up. She's gaining - more slowly than I'd like, but still gaining I think. We'll have to see what her doctor says. I believe we can do it (if I can just get enough calories and not DIE of stress!!). I wish you the best!!
P.S. I'll have to skip editing and let this be it's grammatically messy self. Must rest (or pick up a crying toddler).
This might sound surprising, since I'm such an advocate for natural childbirth. It would usually follow that I have a very optimistic outlook on breastfeeding. Indeed, I think that breastfeeding is a wonderful thing and something that every mom should give a concerted effort toward (or at least consider trying). That doesn't mean that I think it's easy.
When my daughter was born, I had two big challenges that arose in connection to my birth experience and breastfeeding: placental remains and having received antibiotics during labor. Actually, a third challenge that I attributed for years to the epidural was a sleep baby. Alas, I've had three unmedicated births now (yes, my 4th birth, which I promise to describe soon, was also a natural birth), and all of my babies have been somewhat sleepy eaters (though one was less than the others).
Anyway, after the baby came, I was very stressed, had inadequate (and pretty starchy and sugary) nutrition, and I quickly started to experience symptoms of yeast, though I was undiagnosed until the baby was 4 weeks old.
Wait. There is one more challenge which I've not admitted yet - I was extremely uneducated about breastfeeding. Even after having 4 children, I still feel like a novice. But I digress...
Anyway, I came down with yeast in my milk, and that made my already sore nipples even more painful. My daughter didn't actually latch on until day 2, and I didn't realize that it would have been wise to pump a lot in the first day. So I only pumped a few times. Then I didn't bring a pump home, which would have been wise as well, as my sleepy eater of a daughter wasn't so hot at stimulating my breasts to produce milk.
So the milk came in - not a ton, I'm sure, but a start. I nursed my daughter until she fell asleep, called it a feeding, and when she would quickly fuss for more, I would hesitate to feed her again. It was hurting.
Oh, I could go on and on, but it's a really depressing story, and I don't need depressing right now. Suffice it to say, I knew little, made a lot of mistakes, learned more, made fewer mistakes, and by the time I really understood what it would take to get my milk supply where it needed to be and to get my daughter nursing well enough to be nourished by me, it was too late. Having tried a supplemental nursing system for several days and ending up with my daughter and me in tears each time, I finally began to offer my daughter supplemental bottles to keep her gaining well. When she was six weeks old, she realized that she could be nourished by a bottle and no longer needed to latch on. At 8 weeks postpartum, my bleeding had continued, and it was discovered that, in delivering my placenta for me, the doctor had left some placental remains in my uterus. My body had never fully figured out that it wasn't pregnant anymore, and the prolactin levels had been insufficient for me to produce an adequate supply. Ironically, I still got a little bit of satisfaction in pumping what milk I until my daughter was 3 months old and adding it to her formula bottles. At 3 months, we had a family gathering that threw off my pumping schedule, and my milk never came out again. I had about a half a day of engorgement.
That first experience was painful, so when my second baby came and needed a quick transfer to the NICU, I immediately requested a pump. Until I was allowed to put my son on the breast, I pumped at least every two hours with one 4 hour stretch at night, and I gave myself an incredible start with a milk supply. Happily, my son was less sleepy than his siblings have all turned out to be, and he nursed pretty well. I still had soreness, but I passed quicker. We did have yeast, but it was quickly taken care of.
The hardest challenges I faced with my handsome son was that 1) he was very sensitive to any dairy I ate - so much so that his stools literally had blood in them, and 2) he was not a great sleeper. I was so determined to nurse him that I kept him in a swing for months to make his sleep schedule "bareable" for me, and by 4 months had never exceeded a 5 or 6 hour stretch of sleep in a night. He also usually followed a good night with two or three rough nights of nursing every two hours. It seemed that my body was so time sensitive that getting extra sleep and going too long was poison to my supply. But I could be wrong. It might just have been that his sleep quality in the swing was very poor, and he was accustomed to frequent night-time nursings.
Anyway, at 4 months I reluctantly weaned my boy, and my emotional and physical health changed literally overnight. It was a sad choice, but it was a blessing to my family.
With our third child, I had a sleepy eater on my hands. And though I had nursed frequently in the beginning, I had forgotten to do breast compressions and work hard to wake my son to feed well enough. My right breast immediately shrunk to half-sized as soon as engorement ended - the letdown was too slow for my little guy, so he hadn't drained the breast well. We eventually showed strong signs of yeast again, and this time I found it more difficult to erradicate (having 3 kids is really hard, by the way). Happily, or unhappily, he was a great sleeper, and I was so anxious at all times about my milk just going away, that I was wearing myself out with nighttime feedings (I would literally go in and feed my son in his sleep just to keep my milk up).
At about 8 weeks, my husband had a three day business trip. Right around that time, my son stopped napping well during the day and was demanding feedings every 90 minutes during the day. By the second day, I started offering him supplemental bottles. He loved it. Then I panicked and wanted to go back to just the breast again. So I tried to pump after each feeding to stimulate my supply back up. After less than a day of pumping, I was exhausted. My husband came home, and after some prayer and consideration (I was still fighting yeast, by the way), we decided to fully wean him to a bottle. He was happy, slept like a dream, and fussed very little. It took a few tries of formula (we didn't just start with the normal stuff, which turned out to be the best for him) to keep him regular. But - viola - he was a happy formula fed baby.
Here we are now with our 4th and final baby. I have milk for her, and I think she's doing alright. But I'm a little discouraged. Well, a lot discouraged, actually. I have cried me a river already. Her output has been great - at least 8 or more wets and 4-6 messy diapers a day. She lost at least 9 or 10 ounces (so many poopy diapers) in the hospital, and her weight gain quota was pretty big - at least 9 or 10 ounces in 12 days. Well, she hasn't hit her birth-weight yet, and she's 2 weeks old today. Sometimes I weigh her, and it looks like she's almost there, but then she'll have a wet diaper or a big bowel movement, or it'll be a couple of hours after a feeding, and she'll be a few ounces behind again. (I have a scale - I don't know that it's amazing, but it seems to work).
So, my point to all of this is, even if you've had a successful nursing experience before (I consider my handsome son's experience to be the most successful, and I attribute it largely to the great milk supply and his active nursing from the beginning), there is a lot to know.
So here's a link I found to a very helpful website. The information is so much better than that idiotic little booklet they give you at the hospital. I would encourage all to not make the mistake I made this time - which was to wait until after the baby came - to educate or reeducate myself on the breastfeeding. Read up on things now and learn how to get the best start you can so that you don't have to "fix" problems later on. If you can get your baby gaining and nursing well in those first few weeks, you have such a great start.
I haven't given up. She's gaining - more slowly than I'd like, but still gaining I think. We'll have to see what her doctor says. I believe we can do it (if I can just get enough calories and not DIE of stress!!). I wish you the best!!
P.S. I'll have to skip editing and let this be it's grammatically messy self. Must rest (or pick up a crying toddler).
Sunday, February 14, 2010
On Inductions
It's time for another rant as I am now 40 weeks and 3 days along, and there is very little action from my uterus. Well, there's still a great deal of action in my uterus (thank goodness), but not much from said bag of muscles.
I am scheduled to be induced on the 17th if this baby doesn't come spontaneously before then, and the closer that date comes the more I'm slightly wishing I could run and hide in a desert or something. I do not want to have to be induced again (though my previous inductions were for medical, not "due date" reasons).
I hate obstetrics in America. Despite the fact that the average gestational age is just short of 42 weeks, and I've known moms expecting their 8th child who've carried them that long, my uniquely natural-oriented practice of midwives still has pressure to induce me just before I hit 41 weeks. It's just ridiculous! Why do they have to rush our babies out with Pitocin when our bodies could literally be a day or two from naturally delivering?
Yes, I know I've delivered naturally with Pitocin, but it was no walk in the park. Also, I've sometime analyzed the decision the midwives made to blast me through the labor the way they did. I mean, when we decided to induce, the plan was to start me on Pitocin, and then once my contractions really got underway (remember, I was starting at 5 centimeters) the Pitocin was to be shut off to allow my body to labor naturally. Unfortunately, once the Pit started, my son's heart-rate seemed to get a little messier. I have a sister-in-law whose baby didn't love the Pitocin in her induction, and so they shut off the Pit and used a different induction method (some kind of balloon thing against the cervix).
In my case, however, they just decided to up the Pitocin levels until it was full blast for most of the labor. It made for a short but very difficult labor. I guess the big difference between my induction and my sister-in-law's induction was that my baby started with variables in the heart-rate, and her baby was simply "overdue." Oh well! All's well that ends well, I guess.
That doesn't make me more excited about the prospect of another induction or about the practice of doctors and midwives to set expiration dates on pregnancies. In my opinion, as long as the baby is doing well, Mom should be allowed to ride out the pregnancy unless she doesn't want to.
Since I love stories, here are three stories that illustrate why I'm afraid of Pitocin and would prefer not to have another induction with it - one happy story and two... not so happy stories. I have a friend who recently had a VBAC, and what a blessing it was that she could have a VBAC! It was her third pregnancy, and in her second pregnancy she had placenta previa, which makes a cesarean medically necessary for the safety of Mom and Baby. In her third pregnancy, she was informed that if she wanted to deliver vaginally, she would have to spontaneously begin labor before the "expiration date" (probably set at 41 weeks minus a day), because she was required to birth her baby by that date, and they could not induce her with Pitocin.
Now let's examine that last statement: They could not induce her with Pitocin. Why was that? Now, considering a VBAC is a perfectly reasonable possibility for most women, and yet a Pitocin induction is not, could this be an indicator that Pitocin is not a perfect replica of the body's natural oxytocin? Is it an indication that a constant drip of contraction inducing hormone might be tough on someone's body? Is it possible that Pitocin could overdue it on the uterus and is not a completely safe option at all times? I think so. Well, these risks are completely known (and they stand for non-VBAC contenders as well), and yet Pitocin is used all of the time to induce and augment labor.
The good news is this mom did go into spontaneous labor just before the set expiration date, and she was able to deliver vaginally. What a blessing it was for her! (Though she ended up having some other health problems soon after, but that's another story and one that I don't think was actually related to the VBAC. I'll have to look it up though...)
Here's story #2: I have a friend who has three children but was never able to deliver vaginally? Well, I have a few friends like this, but this one had this experience for the most interesting reason - her babies "never dropped." In other words, her doctors set an expiration date on her pregnancy, and she never delivered spontaneously before the expiration date. So they attempted to induce her with Pitocin, and because the the cervix was not ripe and there was not sufficient dilation, they had to deliver her babies via cesarean - all three pregnancies!! Yikes!!! Can you hear me screaming at the top of my lungs at this?
What I am totally convinced about this situation is that my friend's babies wanted to gestate a little longer than the average baby. They were probably good solid 42-weekers, but their mom was never given the chance to carry them to their full gestational age. They were not facing distress requiring induction, either, nor were they particularly huge babies. They just weren't allowed the come when they wanted to come.
Here's story #3. Are you ready? A friend of mine has a sister overseas whose bag of waters leaked with her second baby. She went to the hospital after some time, and the law required that she be allowed to wait awhile longer before they induced with Pitocin. (I think having a waiting period is smart, by the way. Waiting usually works for labor to start, though I guess that sitting in a hospital bed might make it a little useless, but I digress...) The labor didn't start spontaneously, so they induced her with Pitocin. Shortly after the delivery of the baby, who was fine, they became concerned about Mom's bleeding. They checked out the condition of the uterus, and it was practically in shreds. After having just two children (when the couple had planned on more), Mom was given a hysterectomy.
I haven't done the research on this last one, but here's my only slightly educated theory. I think they inadvertently overdid it on her uterus with the Pitocin.
What are the potential dangers of Pitocin? Babycenter gives a pretty bland explanation that Pitocin sometimes overdoes it on the uterus and on the baby. Birthing naturally has a decent breakdown on some of the risks, which include uterine rupture and fetal distress as well. And finally, this article from Associated Content actually mentions potential links between the increase in cases of autism in recent decades in congruence with the increased use of Pitocin to induce or augment labor. I'm not saying they're linked, but it's an interesting thought.
I think that the fact that, once a woman is given Pitocin, she automatically has to receive continuous (not intermittent) fetal monitoring is an obvious indication that the drug is not without risks. And yet, tons of my friends are induced with most of their labors, and they look forward to it.
I'm not saying that Pitocin should go away. It helped me get my last son here safely, and it gave me a fantastically tight tummy afterward with minimal post-partum bleeding. :) It's just a shame that medical providers aren't more cautious about their use of Pitocin, and women would do well to educate themselves about the drug before embracing it whole-heartedly.
So I need to get going with the walks, pineapple, accupressure, or whatever else it takes to have this baby soon. I have just three days if I'm to avoid another encounter with Mr. Pit. Please pray for me and my little one!
I am scheduled to be induced on the 17th if this baby doesn't come spontaneously before then, and the closer that date comes the more I'm slightly wishing I could run and hide in a desert or something. I do not want to have to be induced again (though my previous inductions were for medical, not "due date" reasons).
I hate obstetrics in America. Despite the fact that the average gestational age is just short of 42 weeks, and I've known moms expecting their 8th child who've carried them that long, my uniquely natural-oriented practice of midwives still has pressure to induce me just before I hit 41 weeks. It's just ridiculous! Why do they have to rush our babies out with Pitocin when our bodies could literally be a day or two from naturally delivering?
Yes, I know I've delivered naturally with Pitocin, but it was no walk in the park. Also, I've sometime analyzed the decision the midwives made to blast me through the labor the way they did. I mean, when we decided to induce, the plan was to start me on Pitocin, and then once my contractions really got underway (remember, I was starting at 5 centimeters) the Pitocin was to be shut off to allow my body to labor naturally. Unfortunately, once the Pit started, my son's heart-rate seemed to get a little messier. I have a sister-in-law whose baby didn't love the Pitocin in her induction, and so they shut off the Pit and used a different induction method (some kind of balloon thing against the cervix).
In my case, however, they just decided to up the Pitocin levels until it was full blast for most of the labor. It made for a short but very difficult labor. I guess the big difference between my induction and my sister-in-law's induction was that my baby started with variables in the heart-rate, and her baby was simply "overdue." Oh well! All's well that ends well, I guess.
That doesn't make me more excited about the prospect of another induction or about the practice of doctors and midwives to set expiration dates on pregnancies. In my opinion, as long as the baby is doing well, Mom should be allowed to ride out the pregnancy unless she doesn't want to.
Since I love stories, here are three stories that illustrate why I'm afraid of Pitocin and would prefer not to have another induction with it - one happy story and two... not so happy stories. I have a friend who recently had a VBAC, and what a blessing it was that she could have a VBAC! It was her third pregnancy, and in her second pregnancy she had placenta previa, which makes a cesarean medically necessary for the safety of Mom and Baby. In her third pregnancy, she was informed that if she wanted to deliver vaginally, she would have to spontaneously begin labor before the "expiration date" (probably set at 41 weeks minus a day), because she was required to birth her baby by that date, and they could not induce her with Pitocin.
Now let's examine that last statement: They could not induce her with Pitocin. Why was that? Now, considering a VBAC is a perfectly reasonable possibility for most women, and yet a Pitocin induction is not, could this be an indicator that Pitocin is not a perfect replica of the body's natural oxytocin? Is it an indication that a constant drip of contraction inducing hormone might be tough on someone's body? Is it possible that Pitocin could overdue it on the uterus and is not a completely safe option at all times? I think so. Well, these risks are completely known (and they stand for non-VBAC contenders as well), and yet Pitocin is used all of the time to induce and augment labor.
The good news is this mom did go into spontaneous labor just before the set expiration date, and she was able to deliver vaginally. What a blessing it was for her! (Though she ended up having some other health problems soon after, but that's another story and one that I don't think was actually related to the VBAC. I'll have to look it up though...)
Here's story #2: I have a friend who has three children but was never able to deliver vaginally? Well, I have a few friends like this, but this one had this experience for the most interesting reason - her babies "never dropped." In other words, her doctors set an expiration date on her pregnancy, and she never delivered spontaneously before the expiration date. So they attempted to induce her with Pitocin, and because the the cervix was not ripe and there was not sufficient dilation, they had to deliver her babies via cesarean - all three pregnancies!! Yikes!!! Can you hear me screaming at the top of my lungs at this?
What I am totally convinced about this situation is that my friend's babies wanted to gestate a little longer than the average baby. They were probably good solid 42-weekers, but their mom was never given the chance to carry them to their full gestational age. They were not facing distress requiring induction, either, nor were they particularly huge babies. They just weren't allowed the come when they wanted to come.
Here's story #3. Are you ready? A friend of mine has a sister overseas whose bag of waters leaked with her second baby. She went to the hospital after some time, and the law required that she be allowed to wait awhile longer before they induced with Pitocin. (I think having a waiting period is smart, by the way. Waiting usually works for labor to start, though I guess that sitting in a hospital bed might make it a little useless, but I digress...) The labor didn't start spontaneously, so they induced her with Pitocin. Shortly after the delivery of the baby, who was fine, they became concerned about Mom's bleeding. They checked out the condition of the uterus, and it was practically in shreds. After having just two children (when the couple had planned on more), Mom was given a hysterectomy.
I haven't done the research on this last one, but here's my only slightly educated theory. I think they inadvertently overdid it on her uterus with the Pitocin.
What are the potential dangers of Pitocin? Babycenter gives a pretty bland explanation that Pitocin sometimes overdoes it on the uterus and on the baby. Birthing naturally has a decent breakdown on some of the risks, which include uterine rupture and fetal distress as well. And finally, this article from Associated Content actually mentions potential links between the increase in cases of autism in recent decades in congruence with the increased use of Pitocin to induce or augment labor. I'm not saying they're linked, but it's an interesting thought.
I think that the fact that, once a woman is given Pitocin, she automatically has to receive continuous (not intermittent) fetal monitoring is an obvious indication that the drug is not without risks. And yet, tons of my friends are induced with most of their labors, and they look forward to it.
I'm not saying that Pitocin should go away. It helped me get my last son here safely, and it gave me a fantastically tight tummy afterward with minimal post-partum bleeding. :) It's just a shame that medical providers aren't more cautious about their use of Pitocin, and women would do well to educate themselves about the drug before embracing it whole-heartedly.
So I need to get going with the walks, pineapple, accupressure, or whatever else it takes to have this baby soon. I have just three days if I'm to avoid another encounter with Mr. Pit. Please pray for me and my little one!
Sunday, February 7, 2010
The Power of Suggestion
So I am now 39 1/2 weeks along, dilated to 4 centimeters, and 90% effaced. Though I consistently wake every night many times and have at least one stretch of 90 minutes plus of wakefulness (this is really getting to me, by the way), I had two nights last week where I woke to a good 1 1/2 - 2 hours of steady, real contractions. These weren't killer contractions by any means, but they were definitely more than "Braxton Hicks." I felt that familiar tug in my lower back that has come with each labor. (By the way, this tug is often due to a ligament in the lower back which attaches the uterus to the back muscles. When the uterus contracts, the ligament gets pulled on, and voila! - back pain. Just a little FYI.)
Considering I've had 3 babies already, I thought it might help for me to know where my starting point is when I begin to labor actively so we can be sure to get to the hospital on time. A car birth sounds like an adventure, but it's probably not the safest option.
While I would have been very happy to have had my baby by now, however, I had a couple of reasons for wanting the pregnancy to last a little longer. First of all, my oldest daughter was scheduled for baptism on Saturday, and I was concerned that if the baby came too close to the baptismal date then we would have to reschedule the baptism. That probably sounds silly, but between the fact that where we live rescheduling would mean having to wait an entire month to be baptized and the concern that it might put a small damper on the two sisters' starting relationship, I wanted the baptism to go through as scheduled. Also my oldest son has been coughing like crazy, and I wanted to see his cough settle down a little before we brought a baby into the house.
But really, these are kind of silly excuses to want to talk your baby out of coming at an inconvenient time. What was really concerning me on the first night was this - I didn't like the midwife on call. I know, it sounds very neurotic, but it's just a fact.
You see, I live in a relatively small town that is located at least 20-30 minutes drive to my midwives' practice. Between here and the practice, there are probably dozens of OBs and at least one other practice of midwives. The reason I travel so far is because these midwives have a reputation for being very supportive of natural childbirth. In fact, I birthed my 3rd child (Mr. Rambo who ties knots into his cord) with this group of midwives. The fact that I was able to labor unmedicated though I was induced with Pitocin is owing largely to the fact that the midwives who attended my labor were very supportive of a natural birth. I even knew a woman whose husband was allowed by one of these midwives to assist in the delivery of their 5th baby. These are rare midwives.
The thing is, even in a practice like this, not all midwives are created equal. Midwife M, who oversaw Mr. Rambo's birth, left a year or so ago, and the midwife who they hired is - shall we say - an interesting fit. Or maybe she just doesn't fit with the practice at all.
I'll call her midwife JB. She's a very pretty lady, apparently a mother herself, and fairly nice. Alas, it sounds like she has a few issues with the whole natural thing. For one thing, I understand (from another midwife) that she tends to cut more episiotomies than all of the other midwives. This bothers me. She is apparently fairly uncomfortable with tears. That's sad and frankly outdated. If someone like that is delivering my baby, I'll have a hard time trusting them to just let me tear (as I'm likely to do with my large babies and considerable scar tissue from birth #1). I don't mind tearing. Now I don't know if she tends to cut without permission (as do so many OBs), but just knowing that she has the "Oh no, she's tearing!" issue makes me a little uncomfortable.
There is something I consider worse, however - much, much worse. Apparently she has a habit of suggesting epidurals to patients. (sigh) (deep breathe)
I have such issues with care providers suggesting epidurals to women. First of all, from everything I've read and heard in classes, there are very few situations where an epidural might make a birth safer. Unless mom has skyrocketing blood pressure and is about to go into cardiac arrest from the pain, there aren't many other medical indications for epidurals. I will concede that, should there be a good likelihood of emergency cesarean, it might make providers more comfortable knowing that mom is hooked up to the anesthesia in advance. If, however, a quick vaginal delivery is feasible, it's more likely with an unmedicated birth. The epidural might inadvertently make a cesarean more necessary if stage 2 of labor is too prolonged.
My second issue with the "suggesting" epidurals thing is that even the most prepared couples usually get to a point where mom is feeling unsure that she can handle much more. If she's only dilated to 2 centimeters, she might understandably say, "Forget this!" and get the meds (and I can understand why she'd choose that). But if mom is at a 7 or more, she is likely looking at another 30 minutes or less of dilation. Most women who are deeply committed to the idea of natural birth would consider it worth it to refocus their energy and finish out stage one so that they can push unhindered by an epidural.
Actually, just as another FYI, there are some women who can literally dilate from 2 to 10 centimeters in less than an hour. It sounds pretty darn tough, but it happens. One case sighted in my favorite natural birth book Childbirth the Bradley Way is a labor just like that. Mom hit a point where the labor started to get pretty strong. She and her husband arrived at the hospital, but in triage she was turned away because she was only dilated to two centimeters. On the way home, she announced that she didn't think that she could keep going. Her husband recognized the "self-doubt" signpost and turned back around. Alas, the baby came before they could reach the hospital. Yikes!! All was well in the end, but the triage nurse might have done well to pay more attention to the woman than to the dilation.
So, when mom hits this milestone, typically at transition, the last thing she needs to hear is "There's nothing wrong with an epidural." There is nothing wrong with an epidural, but it's not necessarily the right choice for every woman in labor who starts to get discouraged. Yet most women are very susceptible to suggestion at a time like that, and as I've said in the past, such a suggestion would not only be tempting but might feel like an indication that she's not "doing well enough" with her contractions.
Here are two stories, both of which infuriate me: First, a friend of mine was delivering with the more local midwives in the area (notorious among natural birthers for being intervention minded). After several hours of my friend laboring unmedicated with a Pitocin induction, her midwife announced to her that she wasn't dealing well enough with the contractions, and she should get an epidural. Now I don't know if my friend's blood pressure was spiking, but from what I understand, the midwife just wasn't satisfied with how well my friend was doing. She had an epidural, and her labor went fine. But my friend really wanted a natural birth and was disappointed with how things went. She still says that she wants "another go" at it. I would feel the same.
My second story makes me think that castration might not be an unreasonable punishment for some people. A friend of a friend had had a terrible experience with her first epidural labor. I don't know how prepared or trained she was, but she was determined to birth naturally the second time around. During her second labor, however, the nurse was dissatisfied with how well she was coping with her labor. The nurse repeatedly suggested an epidural, but the woman refused. Finally the nurse brought the anesthesiologist in with her. He stood there offering the patient the procedure, but she refused explaining that her previous epidural was awful. He explained that it often depended on the anesthesiologist. She replied that he had been the anesthesiologist, and she didn't want an epidural. So he stood there and argued with her (through her contractions) until she consented. She hated her second birth experience as much as the first.
Am I the only person who is disgusted by that story? Just wondering. Also, I've always wondered where the heck her husband was. My husband might've knocked the man off of his feet!
The biggest qualm I have with this issue is that the birth does not belong to the provider. It's not their baby or their body. They don't know what mom is feeling. They don't know exactly how she's interpreting the physical sensations in her body. She might just be starting to think that it's getting tough. It's HER decision, and SHE should be the one to request the meds if she wants them.
No woman should ever feel bad for getting epidural. It's her right to decide, but it's no one else's right to suggest one.
Back to this midwife who I was afraid of: I was discussing her today with another woman in the practice. I shared that I didn't trust JB and explained my concern about her suggesting epidurals to patients. She (my friend) explained that JB told her that with one of her own births, she was unable to get an epidural and it was so painful that she had difficulty bonding with her baby.
I don't mean to sound insensitive, but I would suggest that JB should consider talking to someone and working through this experience she had with her labor. There is a huge difference between the birth of a woman who plans on meds but can't get them and another who plans for and has a natural birth expecting to face pain. It's a night and day experience, in fact. Again, it brings me to my previous rant on the "painless childbirth" expectation.
A woman who prepares (or even just plans) to birth naturally and expects some (or lots of) pain will perceive the labor very differently. She may even experience tremendous pain in her labor, but she is less likely to be traumatized by it because SHE CHOSE IT. It's amazing what some "crazies" will choose, but when we get what we choose, we often feel good about it. We might feel a sense of accomplishment, of peace. And we might be so glad that we stuck out that hard part so that we could enjoy the satisfaction of more capable, controlled pushing, less tearing, a better recovery, etc. Labor is a hugely difficult task, but the difficulty (and, yes, usually pain) of that task should not nullify every pre-labor decision a woman makes. And if a woman has decided in advance that she wants to go unmedicated, whatever choice she makes should be honored.
Finally, women who labor naturally should not have to feel like they are being auditioned going into labor. There shouldn't be this criteria of "Well, if you want to go natural, you'd better not complain during it." Yet I see that as being the case when nurses, OBs, and midwives suggest epidurals when they think a woman isn't doing well enough. Women should be allowed to complain as much as they want. I don't know that it helps with the pain (it probably doesn't), but it's their right to moan, cry, or even scream if they'd like. Again it is their birth and their choice. If we are so determined to respect a woman's right to request an epidural (which we should), then we ought to show the same respect for a woman who chooses not to request an epidural.
So as I sit here ignoring my mild, thankfully occasional contractions, I'm hoping to give birth to this little girl sometime in the next 4-5 days. Only I don't want her to come before 8:00 AM tomorrow morning and the next midwife is in. You see, right now JB is on call. :)
Update on 2/10/10 - I had my 40 week check-up with JB today. She's a lovely person, and I think that we'll be fine if she's the provider on call. I'd still prefer another provider, though. I have a feeling that she is more relaxed in clinic (duh!) and might still have an intervention trigger finger during labor. In the meantime, I'm sending vibes to this little one to come and join our family soon...
Considering I've had 3 babies already, I thought it might help for me to know where my starting point is when I begin to labor actively so we can be sure to get to the hospital on time. A car birth sounds like an adventure, but it's probably not the safest option.
While I would have been very happy to have had my baby by now, however, I had a couple of reasons for wanting the pregnancy to last a little longer. First of all, my oldest daughter was scheduled for baptism on Saturday, and I was concerned that if the baby came too close to the baptismal date then we would have to reschedule the baptism. That probably sounds silly, but between the fact that where we live rescheduling would mean having to wait an entire month to be baptized and the concern that it might put a small damper on the two sisters' starting relationship, I wanted the baptism to go through as scheduled. Also my oldest son has been coughing like crazy, and I wanted to see his cough settle down a little before we brought a baby into the house.
But really, these are kind of silly excuses to want to talk your baby out of coming at an inconvenient time. What was really concerning me on the first night was this - I didn't like the midwife on call. I know, it sounds very neurotic, but it's just a fact.
You see, I live in a relatively small town that is located at least 20-30 minutes drive to my midwives' practice. Between here and the practice, there are probably dozens of OBs and at least one other practice of midwives. The reason I travel so far is because these midwives have a reputation for being very supportive of natural childbirth. In fact, I birthed my 3rd child (Mr. Rambo who ties knots into his cord) with this group of midwives. The fact that I was able to labor unmedicated though I was induced with Pitocin is owing largely to the fact that the midwives who attended my labor were very supportive of a natural birth. I even knew a woman whose husband was allowed by one of these midwives to assist in the delivery of their 5th baby. These are rare midwives.
The thing is, even in a practice like this, not all midwives are created equal. Midwife M, who oversaw Mr. Rambo's birth, left a year or so ago, and the midwife who they hired is - shall we say - an interesting fit. Or maybe she just doesn't fit with the practice at all.
I'll call her midwife JB. She's a very pretty lady, apparently a mother herself, and fairly nice. Alas, it sounds like she has a few issues with the whole natural thing. For one thing, I understand (from another midwife) that she tends to cut more episiotomies than all of the other midwives. This bothers me. She is apparently fairly uncomfortable with tears. That's sad and frankly outdated. If someone like that is delivering my baby, I'll have a hard time trusting them to just let me tear (as I'm likely to do with my large babies and considerable scar tissue from birth #1). I don't mind tearing. Now I don't know if she tends to cut without permission (as do so many OBs), but just knowing that she has the "Oh no, she's tearing!" issue makes me a little uncomfortable.
There is something I consider worse, however - much, much worse. Apparently she has a habit of suggesting epidurals to patients. (sigh) (deep breathe)
I have such issues with care providers suggesting epidurals to women. First of all, from everything I've read and heard in classes, there are very few situations where an epidural might make a birth safer. Unless mom has skyrocketing blood pressure and is about to go into cardiac arrest from the pain, there aren't many other medical indications for epidurals. I will concede that, should there be a good likelihood of emergency cesarean, it might make providers more comfortable knowing that mom is hooked up to the anesthesia in advance. If, however, a quick vaginal delivery is feasible, it's more likely with an unmedicated birth. The epidural might inadvertently make a cesarean more necessary if stage 2 of labor is too prolonged.
My second issue with the "suggesting" epidurals thing is that even the most prepared couples usually get to a point where mom is feeling unsure that she can handle much more. If she's only dilated to 2 centimeters, she might understandably say, "Forget this!" and get the meds (and I can understand why she'd choose that). But if mom is at a 7 or more, she is likely looking at another 30 minutes or less of dilation. Most women who are deeply committed to the idea of natural birth would consider it worth it to refocus their energy and finish out stage one so that they can push unhindered by an epidural.
Actually, just as another FYI, there are some women who can literally dilate from 2 to 10 centimeters in less than an hour. It sounds pretty darn tough, but it happens. One case sighted in my favorite natural birth book Childbirth the Bradley Way is a labor just like that. Mom hit a point where the labor started to get pretty strong. She and her husband arrived at the hospital, but in triage she was turned away because she was only dilated to two centimeters. On the way home, she announced that she didn't think that she could keep going. Her husband recognized the "self-doubt" signpost and turned back around. Alas, the baby came before they could reach the hospital. Yikes!! All was well in the end, but the triage nurse might have done well to pay more attention to the woman than to the dilation.
So, when mom hits this milestone, typically at transition, the last thing she needs to hear is "There's nothing wrong with an epidural." There is nothing wrong with an epidural, but it's not necessarily the right choice for every woman in labor who starts to get discouraged. Yet most women are very susceptible to suggestion at a time like that, and as I've said in the past, such a suggestion would not only be tempting but might feel like an indication that she's not "doing well enough" with her contractions.
Here are two stories, both of which infuriate me: First, a friend of mine was delivering with the more local midwives in the area (notorious among natural birthers for being intervention minded). After several hours of my friend laboring unmedicated with a Pitocin induction, her midwife announced to her that she wasn't dealing well enough with the contractions, and she should get an epidural. Now I don't know if my friend's blood pressure was spiking, but from what I understand, the midwife just wasn't satisfied with how well my friend was doing. She had an epidural, and her labor went fine. But my friend really wanted a natural birth and was disappointed with how things went. She still says that she wants "another go" at it. I would feel the same.
My second story makes me think that castration might not be an unreasonable punishment for some people. A friend of a friend had had a terrible experience with her first epidural labor. I don't know how prepared or trained she was, but she was determined to birth naturally the second time around. During her second labor, however, the nurse was dissatisfied with how well she was coping with her labor. The nurse repeatedly suggested an epidural, but the woman refused. Finally the nurse brought the anesthesiologist in with her. He stood there offering the patient the procedure, but she refused explaining that her previous epidural was awful. He explained that it often depended on the anesthesiologist. She replied that he had been the anesthesiologist, and she didn't want an epidural. So he stood there and argued with her (through her contractions) until she consented. She hated her second birth experience as much as the first.
Am I the only person who is disgusted by that story? Just wondering. Also, I've always wondered where the heck her husband was. My husband might've knocked the man off of his feet!
The biggest qualm I have with this issue is that the birth does not belong to the provider. It's not their baby or their body. They don't know what mom is feeling. They don't know exactly how she's interpreting the physical sensations in her body. She might just be starting to think that it's getting tough. It's HER decision, and SHE should be the one to request the meds if she wants them.
No woman should ever feel bad for getting epidural. It's her right to decide, but it's no one else's right to suggest one.
Back to this midwife who I was afraid of: I was discussing her today with another woman in the practice. I shared that I didn't trust JB and explained my concern about her suggesting epidurals to patients. She (my friend) explained that JB told her that with one of her own births, she was unable to get an epidural and it was so painful that she had difficulty bonding with her baby.
I don't mean to sound insensitive, but I would suggest that JB should consider talking to someone and working through this experience she had with her labor. There is a huge difference between the birth of a woman who plans on meds but can't get them and another who plans for and has a natural birth expecting to face pain. It's a night and day experience, in fact. Again, it brings me to my previous rant on the "painless childbirth" expectation.
A woman who prepares (or even just plans) to birth naturally and expects some (or lots of) pain will perceive the labor very differently. She may even experience tremendous pain in her labor, but she is less likely to be traumatized by it because SHE CHOSE IT. It's amazing what some "crazies" will choose, but when we get what we choose, we often feel good about it. We might feel a sense of accomplishment, of peace. And we might be so glad that we stuck out that hard part so that we could enjoy the satisfaction of more capable, controlled pushing, less tearing, a better recovery, etc. Labor is a hugely difficult task, but the difficulty (and, yes, usually pain) of that task should not nullify every pre-labor decision a woman makes. And if a woman has decided in advance that she wants to go unmedicated, whatever choice she makes should be honored.
Finally, women who labor naturally should not have to feel like they are being auditioned going into labor. There shouldn't be this criteria of "Well, if you want to go natural, you'd better not complain during it." Yet I see that as being the case when nurses, OBs, and midwives suggest epidurals when they think a woman isn't doing well enough. Women should be allowed to complain as much as they want. I don't know that it helps with the pain (it probably doesn't), but it's their right to moan, cry, or even scream if they'd like. Again it is their birth and their choice. If we are so determined to respect a woman's right to request an epidural (which we should), then we ought to show the same respect for a woman who chooses not to request an epidural.
So as I sit here ignoring my mild, thankfully occasional contractions, I'm hoping to give birth to this little girl sometime in the next 4-5 days. Only I don't want her to come before 8:00 AM tomorrow morning and the next midwife is in. You see, right now JB is on call. :)
Update on 2/10/10 - I had my 40 week check-up with JB today. She's a lovely person, and I think that we'll be fine if she's the provider on call. I'd still prefer another provider, though. I have a feeling that she is more relaxed in clinic (duh!) and might still have an intervention trigger finger during labor. In the meantime, I'm sending vibes to this little one to come and join our family soon...
Monday, February 1, 2010
Painless Childbirth, An Emotional Rant
So, I bet when you read "An Emotional Rant" you thought to yourself, "What else is new?" :) But I want to go off on a topic that I find intriguing and confusing.
What is "painless childbirth?" If you are at your midwife's office, you might see an advertisement for a class that can help you achieve "painless childbirth." In other childbirth camps, an epidural can supposedly give you "painless childbirth." When my husband and I first discussed the possibility of me birthing unmedicated, he questioned why I would want to deal with the pain if it wasn't necessary. In other words, why would I choose pain when I could have "painless childbirth?"
Where did we all get this idea that childbirth was supposed to be painless? Please please please don't get me wrong, I am not saying this in frustration toward laboring women. Who I'm really ticked at right now are the medical care providers and the childbirth educators who are setting this unrealistic standard by which we are supposed to measure our birth experiences.
"Painless childbirth" is a possibility with some women. But it takes a lot of factors to make it possible. Your baby needs to be positioned well. Your labor cannot be flying along at lightening speed. You have to reach an extremely deep level of relaxation and not have something disrupt it. You need to be well rested. It's not very likely with an extremely prolonged labor. It's more likely in a birthing center or in a home birth. You would need the right coaching or support from your birth partner and/or care provider. You need an absolute minimal amount of intervention. In fact, all of the "painless" births I've watched on youtube were tub births.
Another possibility is that you go to a hospital to be induced (before labor has started), and you are allowed to receive your epidural before the Pitocin kicks in. You have no negative reactions to the epidural, and you pop in a movie and wait out your dilation stage. When your nurse has determined that you've hit 10 centimeters, your baby just happens to be in the perfect position and is a lovely 7 pounds even. You have good strong arms or good helpers, somehow your legs get into the perfect position, and you push 3 times before your baby gently slides out with no tearing and no episiotomy. You hold your little one for nursing and a snuggle. And when your epidural wears off, you feel fabulous. There's another "painless childbirth" scenario!
Do either of these sound like one of your births? If so, you are one lucky lady!!
I'm not trying to be negative. Both of these pictures sound great, but there are so many variables in these two equations which can go wrong and make your would-be painless childbirth a real disaster (or at least, a painful childbirth).
Let's take the first unmedicated birth. Most women have their babies in hospitals, because they feel it is safer for them and for their baby. This automatically means a few things will take away from their comfort level. Either they will arrive early, but they'll be poked, prodded, checked, and disturbed enough that they can't stay relaxed enough for a painless birth. Or they will arrive late enough in their labors that they're headed right into or coming right out of transition, and being triaged and checked in at that stage is bound to make things painful.
What if there are some complications in your delivery? Got a posterior baby? A bigger baby? Something a little off in the heartbeat? Strep-B positive? There's no way to relax easily through these things.
What if, while you're trying to relax, you have a labor and delivery nurse trying to check your cervix every hour or suggesting you have an epidural now? That's no fun.
In other words, with a hospital birth it is practically impossible to experience painless childbirth, because there are too many distractions which will take away from your relaxation and increase your anxiety.
How about the epidural birth? Well, I know a lot of women who enjoy their epidurals and don't have negative side effects. But a huge percentage of them have episiotomies, vaccuum extractions, etc., at the end of stage two. Only some of them are lucky enough to have the perfect sized or positioned baby, and their pushing stage tends to be prolonged a bit. They might not experience a lot of pain during labor and birth, but they are likely to have a good deal of discomfort after birth with stitches and very strong uterine contractions, which typically seem stronger after epidural births. (Could it be that "painful" unmedicated births make postpartum cramping seem milder? I don't know.)
Don't get me wrong, I'm not thrilled about the fact that childbirth brings pain with it. I've never had what I consider a painless childbirth experience. I hope I haven't previously misrepresented myself on this blog. My second birth was more comfortable than the other two, and the contractions were mostly painful toward the end and during transition. Also crowning was painful. My third birth was very painful. The tension was high, my labor was fast and hard, the lip on the cervix was very painful to have pushed back, and crowning (again) was pretty darn ouchy.
How should I measure these two births which I compare? Were they failures? Should I even bring in my first birth? If I even ignore the feeling of helplessness and confusion that pervaded during that labor, should I reminisce yet again about the immediate postpartum hours when the epidural was wearing off and I practically went into shock? How about the weeks and weeks of pain from the 4th degree tear or the yeast in my milk ducts?
So do we need to become masochists to enjoy having babies? I hope not!!
What I really think is that we need to have reasonable expectations, and our health-care providers and childbirth educators should assist in this. If a woman is choosing to go unmedicated and is experiencing increasing pain, a provider or labor and delivery nurse should respect that woman's decision and not undermine her by suggesting an epidural as she hits transition. Having pain during childbirth is not a negative reflection of the care (unless the care is negligent and increases the pain). And childbirth educators should beware of promising that "if you're doing everything right" you'll experience "painless childbirth." That's like promising a sales-person that if they do everything right than they'll someday be rich, or that a truly talented actress will eventually become a celebrity. Such outcomes are possibilities, but there is no guarantee!
Where is all of this ranting coming from? Well I've now talked to two women who took hypno-birthing classes, and they both had great births and did terrific jobs in their labors. Unfortunately, their teachers had given them the expectation that, as long as they were doing everything right, they shouldn't experience pain in childbirth. While each of these women labored, they experienced considerable pain for different reasons, and it increased their frustration and pain and detracted a little from the experience.
It has been sobering to hear these stories (though I'm sure they are both dealing fine and have great attitudes just the same). I just feel that it was irresponsible for their teachers to instill such unrealistic expectations about labor and childbirth. Telling someone that it shouldn't hurt if they're doing everything right is only going to create feelings of self-doubt in a woman when it actually does hurt (for whatever reason - the position of the baby, the level of anxiety, etc). All the self-doubt will do is make it even harder for the woman. This isn't fair. She is doing a great job and should feel so.
And the same should go for the woman who labors with an epidural. In a small way, I actually admire my friends who are very accepting about the more difficult post-partum periods that tend to follow epidurals. I know so many women who think that episiotomies are not a big deal. They don't mind taking stronger meds for post-partum cramping. They are at peace with the idea that a slightly more "painless childbirth" yielded a slightly more painful post-partum. At least they have reasonable expectations. I was devastated to be in so much pain after my first birth. I'm sure that it only made things worse.
So if anything productive is to come of this rant of mine, I hope it's this: Childbirth is an incredible feat, and I hope that you and your provider don't ever try to measure how well you've done (or are doing) on how much pain you experience. If you had a killer labor, you are a rock star! If you had an easy labor, you are a rock star! Childbirth is not a contest to see who can suffer less.
If you want a positive labor, do all that you can to take care of yourself, get a respectful, supportive provider, choose a good location, take a good class, educate yourself, and make well-informed decisions about your labor. Then do your best and trust yourself. You may find that you are amazed at how comfortable you are, or you may find that the pain is stronger than you expected. But believe in yourself and your decisions. You are doing something amazing!
That is all. Happy birthing, Ladies!! :)
What is "painless childbirth?" If you are at your midwife's office, you might see an advertisement for a class that can help you achieve "painless childbirth." In other childbirth camps, an epidural can supposedly give you "painless childbirth." When my husband and I first discussed the possibility of me birthing unmedicated, he questioned why I would want to deal with the pain if it wasn't necessary. In other words, why would I choose pain when I could have "painless childbirth?"
Where did we all get this idea that childbirth was supposed to be painless? Please please please don't get me wrong, I am not saying this in frustration toward laboring women. Who I'm really ticked at right now are the medical care providers and the childbirth educators who are setting this unrealistic standard by which we are supposed to measure our birth experiences.
"Painless childbirth" is a possibility with some women. But it takes a lot of factors to make it possible. Your baby needs to be positioned well. Your labor cannot be flying along at lightening speed. You have to reach an extremely deep level of relaxation and not have something disrupt it. You need to be well rested. It's not very likely with an extremely prolonged labor. It's more likely in a birthing center or in a home birth. You would need the right coaching or support from your birth partner and/or care provider. You need an absolute minimal amount of intervention. In fact, all of the "painless" births I've watched on youtube were tub births.
Another possibility is that you go to a hospital to be induced (before labor has started), and you are allowed to receive your epidural before the Pitocin kicks in. You have no negative reactions to the epidural, and you pop in a movie and wait out your dilation stage. When your nurse has determined that you've hit 10 centimeters, your baby just happens to be in the perfect position and is a lovely 7 pounds even. You have good strong arms or good helpers, somehow your legs get into the perfect position, and you push 3 times before your baby gently slides out with no tearing and no episiotomy. You hold your little one for nursing and a snuggle. And when your epidural wears off, you feel fabulous. There's another "painless childbirth" scenario!
Do either of these sound like one of your births? If so, you are one lucky lady!!
I'm not trying to be negative. Both of these pictures sound great, but there are so many variables in these two equations which can go wrong and make your would-be painless childbirth a real disaster (or at least, a painful childbirth).
Let's take the first unmedicated birth. Most women have their babies in hospitals, because they feel it is safer for them and for their baby. This automatically means a few things will take away from their comfort level. Either they will arrive early, but they'll be poked, prodded, checked, and disturbed enough that they can't stay relaxed enough for a painless birth. Or they will arrive late enough in their labors that they're headed right into or coming right out of transition, and being triaged and checked in at that stage is bound to make things painful.
What if there are some complications in your delivery? Got a posterior baby? A bigger baby? Something a little off in the heartbeat? Strep-B positive? There's no way to relax easily through these things.
What if, while you're trying to relax, you have a labor and delivery nurse trying to check your cervix every hour or suggesting you have an epidural now? That's no fun.
In other words, with a hospital birth it is practically impossible to experience painless childbirth, because there are too many distractions which will take away from your relaxation and increase your anxiety.
How about the epidural birth? Well, I know a lot of women who enjoy their epidurals and don't have negative side effects. But a huge percentage of them have episiotomies, vaccuum extractions, etc., at the end of stage two. Only some of them are lucky enough to have the perfect sized or positioned baby, and their pushing stage tends to be prolonged a bit. They might not experience a lot of pain during labor and birth, but they are likely to have a good deal of discomfort after birth with stitches and very strong uterine contractions, which typically seem stronger after epidural births. (Could it be that "painful" unmedicated births make postpartum cramping seem milder? I don't know.)
Don't get me wrong, I'm not thrilled about the fact that childbirth brings pain with it. I've never had what I consider a painless childbirth experience. I hope I haven't previously misrepresented myself on this blog. My second birth was more comfortable than the other two, and the contractions were mostly painful toward the end and during transition. Also crowning was painful. My third birth was very painful. The tension was high, my labor was fast and hard, the lip on the cervix was very painful to have pushed back, and crowning (again) was pretty darn ouchy.
How should I measure these two births which I compare? Were they failures? Should I even bring in my first birth? If I even ignore the feeling of helplessness and confusion that pervaded during that labor, should I reminisce yet again about the immediate postpartum hours when the epidural was wearing off and I practically went into shock? How about the weeks and weeks of pain from the 4th degree tear or the yeast in my milk ducts?
So do we need to become masochists to enjoy having babies? I hope not!!
What I really think is that we need to have reasonable expectations, and our health-care providers and childbirth educators should assist in this. If a woman is choosing to go unmedicated and is experiencing increasing pain, a provider or labor and delivery nurse should respect that woman's decision and not undermine her by suggesting an epidural as she hits transition. Having pain during childbirth is not a negative reflection of the care (unless the care is negligent and increases the pain). And childbirth educators should beware of promising that "if you're doing everything right" you'll experience "painless childbirth." That's like promising a sales-person that if they do everything right than they'll someday be rich, or that a truly talented actress will eventually become a celebrity. Such outcomes are possibilities, but there is no guarantee!
Where is all of this ranting coming from? Well I've now talked to two women who took hypno-birthing classes, and they both had great births and did terrific jobs in their labors. Unfortunately, their teachers had given them the expectation that, as long as they were doing everything right, they shouldn't experience pain in childbirth. While each of these women labored, they experienced considerable pain for different reasons, and it increased their frustration and pain and detracted a little from the experience.
It has been sobering to hear these stories (though I'm sure they are both dealing fine and have great attitudes just the same). I just feel that it was irresponsible for their teachers to instill such unrealistic expectations about labor and childbirth. Telling someone that it shouldn't hurt if they're doing everything right is only going to create feelings of self-doubt in a woman when it actually does hurt (for whatever reason - the position of the baby, the level of anxiety, etc). All the self-doubt will do is make it even harder for the woman. This isn't fair. She is doing a great job and should feel so.
And the same should go for the woman who labors with an epidural. In a small way, I actually admire my friends who are very accepting about the more difficult post-partum periods that tend to follow epidurals. I know so many women who think that episiotomies are not a big deal. They don't mind taking stronger meds for post-partum cramping. They are at peace with the idea that a slightly more "painless childbirth" yielded a slightly more painful post-partum. At least they have reasonable expectations. I was devastated to be in so much pain after my first birth. I'm sure that it only made things worse.
So if anything productive is to come of this rant of mine, I hope it's this: Childbirth is an incredible feat, and I hope that you and your provider don't ever try to measure how well you've done (or are doing) on how much pain you experience. If you had a killer labor, you are a rock star! If you had an easy labor, you are a rock star! Childbirth is not a contest to see who can suffer less.
If you want a positive labor, do all that you can to take care of yourself, get a respectful, supportive provider, choose a good location, take a good class, educate yourself, and make well-informed decisions about your labor. Then do your best and trust yourself. You may find that you are amazed at how comfortable you are, or you may find that the pain is stronger than you expected. But believe in yourself and your decisions. You are doing something amazing!
That is all. Happy birthing, Ladies!! :)
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