Trust: It's a Work in Progress: September 2013

Sunday, September 29, 2013

You Might Be A Momma If...

... You have a black belt in 'stealth run', commonly used when trying to reach one baby before he/she wakes the other.

Wednesday, September 25, 2013

Birth Story Part 5: Labor and Delivery

*Disclaimer* This post, and subsequent ones, will probably contain quite a bit of TMI and be quite long. Feel free to skip to cute baby pictures if you're concerned about knowing me a little too well at the end :) I am including quite a few details both for my memory and for those who might consider a Homebirth. Obviously, every birth, momma, midwife and situation is unique. Please don't substitute my opinion or experience for your own researched judgement.

I apologize ahead of time if this post is a bit disjointed. Parts of labor I remember vividly and other parts are a blur.

Contractions started around 4-5 and were really steady at 10 minutes apart. By the time Eb went to bed and Wantina came to check on me (around 9) contractions were more like 5 minutes apart, but I could still talk through most of them. I bounced on the ball and visited with Wantina until about 11 when she checked me again - I was 2-3 cm and she was able to strip my membranes (slide finger between cervix and bag of water along with putting pressure on points evenly all around my cervix)! Eb woke up a little while after that and Wantina took a nap on the couch while Chris and I tried to put him back to sleep.

During that half hour my contractions changed to where I needed to vocalize through them. I had to leave Eb and Chris so I wouldn't keep him up and moved into Evie's room where we had the love seat. Chris joined me after he had Eb back down and brought distraction in the form of Duck Dynasty :) That helped for the next couples hours, I was able to be on my knees and lean on the couch and get through pretty well, but at some point my contractions changed again and I just needed to focus and move a lot - so no more Duck Dynasty :( During that period Chris was invaluable. He supported me during contractions while standing, vocalized with me through them, helped me relax between them, talked me through the anxiety that would rise after each one... Yeah all in all he was awesome :)

Around 4 in the morning Eb woke up and we decided it was time for him to go to Grandma and Graddad's because I was afraid I would scare him. While Chris was taking him over Wantina checked me again. I had been bracing myself for a very long labor. Often First-time VBAC moms who haven't had a successful vaginal delivery before (like me) will labor as long as first time moms, with 24-48 hour labors totally in the realm of normal. So with that in my mind was not expecting a lot of progress - which is why I was celebrating when I was 6-7 cm dilated!!! I was over half way there!

Contractions continued to intensify and held steady at about 3 minutes apart from there on out. Wantina called her trainee, Laura Jean, to have her come out and bring the birthing tub with her. They had it set up and full by 7 ish and wanted to check me one more time before I got in the water and wasn't as accessible. I didn't feel like I could lay down so they had me on the birthing stool, as she was checking (and just announcing I had reached 9 cm!) my water broke and flooded everywhere - and suddenly I HAD to push!

For some silly reason, probably from watching too many movies where the doctor says 'okay, now push', I had it in my head that pushing would be voluntary. It wasn't. At least, for me it wasn't. With every contraction came the irresistible urge to push, and loud pushes they were! I had up to this point simultaneously been looking forward to and dreading pushing - I dreaded the possibility of a tear but I also knew this was almost the end and that many women found pushing a relief because they could finally feel like they were 'doing something'. Unfortunately, pushing was frustrating for me. I had trouble figuring out how I was supposed to push to help my body get Evie out, which is probably part of why I had to push so long (some other things were going on that I will highlight along the way).

Something else that surprised me was the doubts that came tumbling out if my mouth during this time. I suppose because you are so focused on what you are doing you have no brain power to maintain inhibitions or reason like you normally would, so all those fears you thought you worked through (but really just buried) come bubbling to the surface and out your mouth. Mine were in the form of 'I can do this?' spoken after many contractions to Chris and exclamations of 'I can't' while pushing. The truth was I WAS doing it, but that was my deepest fear leading up to, and all the way through the birth, that my body just couldn't deliver a baby. That it was gong to give out or shut down part way through. Apparently I hadn't worked through that fear as well as I thought, but fortunately I had support to remind me I was doing it and my body was doing just what it should.

After my water broke I still wanted to get in the birthing pool, so Chris and Wantina helped me in and I spent over an hour in there, practicing pushing and, believe it or not, napping between contractions. The warm water helped me relax so much that I really could take 3 minute power naps between most contractions while I practiced different positions to push in, but I had a hard time keeping my grip and feeling steady enough to really push while in the tub. So out we got again and tried the birthing stool, but again, I just didn't feel stable enough so I ultimately ended up holding onto the bed post and squatting.

Wantina was able to check me in this position and gave me some directions on pushing and did some tweaking, which I learned about after, that helped. First, she told me (yep this ones TMI!) to push into my hemmeroids. This finally got me pushing in the right area a d with the right muscles. I'm sure there is a better way, but that was something I could relate with prior experience and it finally clicked. Second, she discovered that my cervix wasn't wanting to stretch over Evie's head but instead move down with each contraction. So she ended up physically pushing it up over Evie's head for several contractions until it would stay put. Third, she was providing perenium support and stretching to try to keep me from tearing, unfortunately she was unsuccessful but she probably reduced the severity. The real kicker for effective pushing though was me just making up my mind to get this conquered and get her out, even if it was awkward and I didn't know exactly how to do it best.

Within a half hour of that decision Evie was born. Crowning was painful, but honestly my hemms hurt more at the time than that I think (the tear must have happened during crowning, at least I don't remember it specifically). At one point I was able to touch her head, but that didn't give me as much inspiration as I had hoped, more desperation to get her out I think. I was able to get her head out in the squatting position but she didn't come as easily as she should have after that so Wantina had me go hands and knees so she could assist her the rest of the way. When she finally came out it was the weirdest gloop, stomach flip type feeling - not painful, but almost nausea inducing. Turns out she had one arm behind her back (yet another reason I struggled with pushing). Three more pushes once I was on hands and knees and then, at 9:52 a.m. about 17 hours after labor started, they had me sit so I could hold our new baby girl!

My first words were 'It's red!' In reference to her hair which looked very strawberry blonde her first few days of life (I was fully expecting a girl version of Ebenezer, dark hair and carmel skin). Chris had tears in his eyes as he studied our newsest little one. I sat on the floor rubbing her back to help her finish getting the fluid out of her lungs while she took her first breaths and we waited on placenta. Laura Jean kept marveling over her umbilical cord, apparently it was really healthy looking? I didn't have anything to compare to but she was really impressed. Once the cord stopped pulsing and the placenta delivered they helped Chris cut the cord and moved me up to the bed.

Evie and I snuggling, you can see her slight 'cone head'.

My memory gets blurred here, so please bear with me :)

Evie came to bed with me and we got some good skin to skin time while I tried to get her to nurse. She wasn't super interested immediately, and instead just rested. I got really cold and shaky for a little while and they said it was the shock to my system of her being delivered combined with me needing to eat (I really didn't eat during labor at all, not because I couldn't, but because I didn't really want to, which surprised me), so they quickly got me a sandwich and started giving me chlorophyll (helps your body build blood quickly). Sometime in here Wantina stitched me up and Chris and Laura Jean took Evie to clean her up and weigh/measure/footprint her. Wantina numbed me really well so stitching only hurt a little. I had a first degree tear that went slightly deeper towards the back. We put my aptly named pad sickles and arnica on quickly to help with swelling.

Weighing Evie.

Again not good with timing, I got sat up, cleaned up some and to the bathroom at some point (all slowly to be sure I wasn't going to pass out), though it took me a couple trips before I could empty my bladder. Once I had Evie back she finally successfully nursed for about ten minutes and then fell asleep again. Chris and I took a little nap before he went to get Ebenezer and the rest of the family.

It was almost 2 (?) when Chris helped me get dressed and settled in the chair before he went to get Ebenezer. He was, and has been the sweetest big brother I could have imagined! He studied and touched her while standing by my chair at first and soon he wanted to sit with Mommy too. So with Daddy's help he got in my lap. He just smiled and studied her and cuddled with me and we talked about what a good big brother he was - you've never seen a prouder boy!

About 20 minutes later my immediate family arrived and we got to introduce them to our new baby girl! I wish I'd gotten pictures and more of them were able to hold her (but that's another post), but we have been able to make up for that since then :)

Soon everyone went home and it was time to start a new chapter in life as a family of four, and take another good nap!

Nap Time Sillies

We interrupt your regularly scheduled programming with this super cute commercial - nap time sillies!

When Chris is at work Eb, Evie and I often nap together in the big bed. I can't effectively rock Eb and Evie at the same time, and Eb needs some help going to sleep still, and Evie isn't real great at naps without nursing through them, and I reply on naps to catch up on the sleep I lose during the night - so the easiest solution is to pile in bed together!

It melts my heart how often Eb falls asleep touching Evie's head...

All of us sleeping in the same bed can make for some silly bonding when we wake up, like Evie tasting big brother's arm while he is trying to help her hold her head up for instance...

All in all we really just enjoy the snuggles!

Our week in Pictures 9/25/2013

Most of our week was laid back, here are some of the higlights - Eb's favorite was the stickers!!!

Still loving nap cuddle time! Eb still falls asleep touching his baby sister, melts my heart every time!

Evie decided to see how brother tastes...

And decided he was DELICIOUS!!!

We got to have a late summer family get together with my side, it wore Evie out!

Tuesday, September 24, 2013

Birth Story Part 4: The Wait

Evie's due date came... And went, with no baby. We had some action, I had contractions almost daily since 36 weeks and at 39 weeks I had 3 hours that seemed like it might be the real thing, but wasn't. To say I was anxious might be the biggest understatement if the century.

We scheduled an unltrasound and NST with Clark for 41 weeks, hoping the whole time not to have to go. We had the induction talk at that point and I was pleased to find out that not only did I have an alternate option for induction (a balloon catheter that physically dilates your cervix) but they were willing to try small amounts of pitocin if needed to start or augment labor. Since I didn't want to schedule an induction until I absolutely had to they scheduled another NST for Monday (12 days past due date). During my appointment with Wantina the next day (8 days past due date) we started talking natural induction methods.

She likes to wait until 41 weeks to start natural induction just to give Mommas bodies every chance she can to go into labor on their own while still having enough time margin to augment. Well, now I was 41 weeks and ready to start trying anything to get Evie to come before 42 weeks. Wantina left me one of her huge midwifery guides along with herbs and the command to study the induction section so I would have full understanding of what I was trying and what it was supposed to do for my labor. This book was crazy huge (and it was volume 2!) so it was good I found it interesting! The section on induction was about 11 pages and after double checking with Wantina I started herbs on Friday (9 days past and counting) and waited... And waited... And waited all weekend with no real change. Longest. Weekend. Of. My. Life.

I should mention that during this time after the last bout of serious contractions I had not been feeling pressure like before and when Wantina checked me for dilation (and hoping to strip membranes) we found that while my cervix was ripe Evie wasn't engaged or putting any pressure on it. Evie also seemed to be stuck in a posterior (sunny side up) position - not good for labor and probably why I wasn't progressing. Wantina recommended I see my chiropractor to see if he could help us get her to turn, and in the mean time spend lots of time bouncing on the birthing ball, walking, squatting, crawling around hands and knees and making love of possible.

In spite of doing all the above, our second NST rolled around on Monday (12 days past due) and still no action. While Evie passed her stress test just fine, I left with a heavy heart. The CNM checked me for dilation, both of us hoping to strip membranes, only to find there was no progress. Evie was still 'floating' and I was not dilated. She recommended inducing Wednesday (exactly 14 days past due - the longest most doctors let you wait), we asked for one more day so Chris could keep his internship appointment. She agreed, as long as we had one more NST at the 42 week mark.

I began praying as never before, both for this delivery to go differently and for peace during the wait and no matter the outcome.

I was finally able to see Dr. Grome that evening. He showed me how to do the Thompson breech technique, which is used to help babies in any unfavorable position. Basically you are putting pressure on different points to encourage baby to shift position (Dr. Grome described it as baby is too comfortable and we want them to get uncomfortable in the wrong position so they will get in the right one). He performed it in me a couple times and I showed Chris how to do it once more before bed.

We the breech technique again the next morning (Tuesday, 13 days past due) before Wantina came to check on me and... It worked!!! When she checked me Evie was engaged and she could get her finger through my cervix (1 cm dilated)! Since I was pretty desperate to get things going she left me a bottle of caster oil to try, which had just worked for another of her Mommas over the weekend. She recommended blending it in a milkshake to get it down easier, milkshake was preferable over OJ since it didn't burn on the way out :/ As soon as Chris got back with one from Shell (I like the ones I make at home and didn't want to form a food aversion to them!) I blended it up and chugged it. (Note to self - a small or medium would have worked to cover taste / texture, large was almost too much to drink.)

That was about 1:00 in the afternoon... About three the diarrhea started... About five contractions started... And they got close together... And a little stronger... And they didn't stop!

Monday, September 23, 2013

Birth Story Part 3: Prenatal Care

I probably broke records for the number of prenatal visits during a healthy pregnancy! Since I wanted to keep the doors open to me at Clark Memorial I maintained the remainder of my traditional appointments there AND I had Wantina visiting our home more often than she normally might have, so she could get to know me and our new little one in somewhat of a time crunch (we didn't commit to a Homebirth until I was about 28 weeks along).

I'm not sure what I expected from these visits but I was pleasantly surprised at how thorough they were. She went through standard checks like blood pressure and weight, she even brought strips for to check my urine (these were super broad range and covered more than the ones used in the doctor office, which I've learned really only check for protein). In addition she asked about my energy, emotions, sleep, how my older one was doing, exercise, vitamins, water and diet. She made several suggestions for diet changes and exercises to help me prep for labor and keep Evie in the best position possible (back out, head down). She was super excited to see Standard Process already on our cabinet (the brand of supplements Dr.Grome gives us) and to find out we already use raw milk, kefir and as much organic as we can afford. I was thrilled she not only knew about these things but also supported and endorsed them (not freak out like so many others in her position). The more she came the more we discovered we were really a pretty good fit.

We went almost straight into weekly appointments and quickly compiled our list of birth day needs and ordered a complete birth kit from a supplier she recommends (only about 90$!). At week 38 she had me start using Borage oils capsules in my birth canal to encourage my cervix to ripen (Borage oil contains natural prostigladins similar to semen).

We felt confident that we were doing everything we could to help Evie come on her own - all that was left was the waiting...

Sunday, September 22, 2013

Birth Story Part 2: The Search

Realizing my fear of the hospital sent me searching for the only other option available in our area, a Homebirth. I would have considered a birthing center, but there isn't one within two hours of us. So I started searching tge web and seeking out others who had homebirths to pick their brain and get encouragement.

First I checked out what kind of certification most Homebirth midwives carried. I found that some didn't ever get certified, some were CNMs (certified nurse midwives, like what we were working with in the hospital), but most were LPMs (liscensed professional midwives). Obviously it would be great to get a CNM, but most of those who practice outside of the hospital are on the west coast, so the next best option (the most common and also still a great option) was a LPN. Liscensed Professionals Midwives go through national certification which requires them to attend over 100 births, progressively taking on more and more responsibility for each Momma's care. They are supervised and advised by an alradeay liscensed midwife, have additional studies they have to complete along with a standardized test. Most of these ladies also take doula and lactation training during this time.

I found a website listing doulas and LPM's in our state, but most of them were 2 hours or more away from us (again, we really do live in the boonies). I was really hoping for someone closer but started contacting these folks in the mean time. During this search I met up with our chiropractor's wife, who has had several homebirths, to pick her brain and hear her experiences (Dr. Grome was also shredding my scar tissue from the section during this, so my memory is a little fuzzy on convo details!). They recommended Melanie, a midwife they knew and trusted. I excitedly called her only to find out that she was trying to take July off (when I was due) :( she was super encouraging and recommended another, more experienced, midwife who actually only lives 20 minutes away. She promised that if I didn't feel comfortable with her for some reason she would find a way to work me in.

This is how we finally found our way to Wantina. In the course of our first interview we learned that she is a LPM and started the linsence process right out of high school. She has since then 'caught' over 700 babies. She did a great job answering our plethora of questions that first day, and the many more that came in the days and meetings to follow - including some hard ones suggested by my Mom such as have you lost any Mommas or babies (she hasn't lost any Moms by the way and only delivered two still births, both babies had fatal defects). What sold us on Wantina was we felt she had enough experience to know if something was going wrong, AND were that the case she was going to get us to the hospital and the care necessary in a timely manner - not pressure for a Homebirth 'No Matter What'.

While we had finally decided this was what we wanted to try, a slight hangup was that we still wanted our orriginal hospital as a backup in case I needed induced or something didn't go as planned. The difficulty was planned Homebirths haven't been possible legally in Indiana until just this year. Although the laws states a Indiana licensed midwife can administer a Homebirth, there has not been a way to get liscensed until this year. As such, if the hospital administrator finds out you are planning one they will kick you out of the practice. Even if your doctor or midwife might be okay with you having a Homebirth (which mine was when I got the gumption to tell her what I was considering), the administrators are so concerned about liability they don't want any connection with one. Since the law just changed this shouldn't have been a concern, BUT, because this is a transition time and policies are still changing, we didn't want the hospital administrator to find out because they could technically still kick us out until the actual hospital policies were changed.

So now we had a midwife and the beginnings of a plan, and really only a few weeks to go before the main event since we waited so long to switch. We also had a lot of appointments ahead of us!

Saturday, September 21, 2013

Birth Story Part 1 - Setting the Stage

*Disclaimer* This post, and subsequent ones, will probably contain quite a bit of TMI and be quite long. I am including quite a few details both for my memory and for those who might consider a Homebirth. Obviously, every birth, momma, midwife and situation is unique. Please don't substitute my opinion or experience for your own researched judgement.

Setting The Stage:

As you know I was desperately hoping for a VBAC (vaginal birth after cesarian) this time around. While this came with a slightly higher chance of hemmoraging, I still felt like it would be better on my body than major surgery (another c-section), it would give us the most options for family size in the future (hypothetically there are a limited number of c-sections your body can handle), and psychologically I felt like I had left something unfinished, like I still needed to heal and somehow succeeding at this (or at least giving it my best go) would help me with that healing process.

I know it's silly because of all the variables involved, but I felt like I had somehow failed during Ebenezer's birth - like my body malfunctioned by not going into spontaneous labor and I had been too weak to assert the things I knew I needed. I know the variables are too numerous to say for sure that changing those things would have meant a vaginal delivery, but they haunted me none the less.

I also keenly felt the pressure of the fact that this was my last shot at a natural delivery. No ethical doctor or midwife will allow a mom to attempt a second VBAC if she has never had a successful vaginal delivery.

I had high hopes for this delivery though. We were with a hospital that has a great natural and VBAC delivery percentage and a great reputation. I liked two of the three CNM's we were working with and they seemed prepared and capable to help me get a natural delivery. So what changed? Why did I seek out something different?

Getting my Rogham shot (circumventing any complications from a mom with a negative blood type having a baby with potentially positive blood type - like me) changed that. Going through the hoops this hospital required to get one shot (seriously, four hours folks, and part of it was unnecessary in my mind because they insists on checking my blood type even though my records stated I was negative and needed Rogham with Eb) reminded me forcefully that even though we had good intentions and a good team, we were still in a hospital and bound to their rules if any aspect of labor strayed outside their parameters.

... And it almost gave me a panic attack being back in that setting. It reminded me of all those feelings of fear, helplessness and frustration I had during Eb's birth. It made me afraid I would freeze during labor, or that my own emotions would cause delays or complications. It made me realize how terrified of the hospital I had become.

So we seriously started researching an option we only considered before on passing - a Homebirth.