Tuesday, June 14, 2011

Misinformation's Role in Breastfeeding

A friend of mine is a doula as well.  She had a client deliver a baby in an uncomplicated, unmedicated full term birth last week.   There were no complications, the baby latched on within the first hour of birth, and was nursing every 2-3 hours in the first days after birth.

Everything was going about as perfect as it could be.

Until she went to the doctor when the baby was three days old. 

The baby, who weighed about 7  pounds at birth, had lost a few ounces.  Mom's milk wasn't in yet. 

The pediatrician recommended formula supplementation due to the concerns about the baby's weight.   The baby, who again, was full term and was not experiencing any problems with blood sugar or jaundice.

This is an example of a place where the medical system is failing families.

Did you know that most medical schools provide very little, if any education at all, about lactation?  How exactly are the physicians supposed to teach patients about nursing if they've had little education in it themselves?

Most pediatricians and obstetricians are given huge supplies of free formula to distribute to their patients as "gifts".  What's the harm in taking a sample, right?  The harm, I would argue, is tremendous. 

The truth is that healthy, term infants almost never need supplementation.

Babies are supposed to drink only the colostrum the mother produces for the first few days.  This early milk is incredibly nutrient rich, and serves as a laxative to help the baby purge the meconium from their system to help avoid jaundice.

It is those first few days, with only the colostrum, and the increasing hunger of the baby, that causes the mother's milk supply to come in adequately.  Giving a bottle here or there will interfere with the supply being established correctly.

Feeding a newborn a bottle will teach them that food comes immediately.  In my experience, this will interfere with nursing perhaps more than anything else.   It is because in nursing, the baby has to latch and suck long enough to trigger the let down reflex.  The milk does not start flowing immediately.  Giving the baby a bottle, which works immediately, interferes with the baby's natural feeding process.

Thousands, if not millions, of well -intentioned first time moms have reluctantly supplemented after being told their babies were losing weight in those first few days.  Trouble is....THIS IS NORMAL.  Healthy, term babies can easily tolerate losing up to 5-10% of their body weight in those days.  It isn't a cause for alarm, especially before the mother's milk comes in.  Unfortunately, this is where doctors begin to show concern and mothers start to doubt their body's ability to nourish the baby without artificial assistance. 

Once that doubt sets in, it's a recipe for disaster.  Loss of confidence in nursing undermines the overall confidence in parenting.  Moms can start to feel like they are failing their baby.  They give a bottle, then the baby gets frustrated quickly at the breast.  They eventually give up.  And for what reason?  The loss of a few ounces that the baby is designed to lose anyway? 

The better guideline is that a newborn should be nursed on demand, but not less frequently than every 3 hours, timed by the start time of the feeding.  They should not lose more than 10% of their body weight, and should return to their birth weight by two weeks.  If those goals are not reached, it still does not automatically mean that formula is the solution. 

Often, the best way to reassure a new mother that the baby is eating well is to weigh them before and immediately after a feeding.  Many breastfeeding support groups have scales available for this purpose.  This reassure mothers that they are indeed producing an adequate supply. 

Another big misconception is that pacifiers will create nipple confusion.  I do not believe this to be true for the simple reason that pacifiers do not feed the baby.  A baby will learn quickly that milk does not come from a pacifier, and will use it for sucking needs that exist outside the need to eat.  I encourage new mothers to wait until nursing is established and the milk supply fully in before giving a pacifier.  Beyond that, if the baby has a high suck need, by all means, use a pacifier. 

Bottle feeding can be a great way for the father and other family members to bond with the baby.  Again, as with pacifiers, once nursing is well established, it can be added to the routine without major incident.  Wait until the milk supply is fully established, then give a bottle every other day or so at one feeding.  For the first few months, the mother should pump during every bottle feeding.

When bottle feeding, it is important that breast milk not be combined in the same container as formula.

I could write books about this subject, but I will stop here for now.  I will address pumping, milk insufficiency and formula feeding in later posts.  If you have any specific questions, please feel free to ask!

Sunday, June 5, 2011

Am I in labor?

Labor is the culmination of months of gestation, the precursor to birth, and the turning point of the greatest significance in a pregnancy. 

Yet, it's often one of the hardest things about pregnancy to define.

In this day and age, most women go into their pregnancies, particularly their first ones, with expectations about how it will go.  They've been brainwashed by television and movies, about the sudden arrival of labor, usually by a dramatic burst of water.  Screaming and yelling ensues, and shortly thereafter a baby arrives.

Trouble is, it hardly ever works that way. 

I'd like to try and clear up some of the misconceptions about labor here, and help you determine when labor actually begins.  It's not usually a black and white issue, more shades of gray.

- Only about 10% of women will have their amniotic sac rupture prior to the onset of labor.   Far more likely, you will experience hours or even days of contractions prior to a spontaneous rupture.  Left alone, most women will not have their water break until they reach about 5 or 6 cm dilation.  If your water breaks, even if you aren't in labor, you need to go to the hospital or call your midwife.

- You only have a 5% chance of having the baby on your actual due date.  Some babies come early, some babies come late, very few of them actually show up on the day you circled on that calendar.  Most women should be prepared to labor anytime after 37 weeks, though it can begin earlier for some.

- Your due date isn't an expiration date.  Left alone, most first pregnancies would go postdates.  What this means is that if you get to your due date, then pass it, and still don't have a baby, it doesn't mean that there is anything wrong.  The average first pregnancy left alone would be closer to 41 1/2 weeks, not the 40 we are accustomed to.  Healthy women with uncomplicated pregnancies can go two to three weeks past their due date without medical concern usually.

- You may not know when you are actually in labor, especially if it's the first time.  Assuming that it begins on it's own, labor is a very gradual process.  You experience an increase in Braxton-Hicks contractions, which eventually turn into pre-labor contractions.  Those eventually turn into early labor, and it's often difficult if not impossible to know when you've crossed the line for good. 

- Many women have false alarms, particularly as the Braxton-Hicks contractions increase.  They can occasionally become a little painful even.  It is normal to have these false alarms, but still frustrating.

- The hallmark of true labor are contractions that do not go away with changes in activity.  Towards the end of your pregnancy, you may notice that you have contractions when you are tired or have over-done it.  Dehydration can also trigger contractions.  Getting rest and staying adequately hydrated will lessen these type of contractions eventually.  If they keep coming no matter what you do, it is more likely to be true labor.

- Most women have digestive problems prior to the full onset of labor.  You may become nauseous or have diarrhea.  You may not feel like eating at all, but should focus on light meals.  Many women also have headaches and backaches before labor.  Nesting is common, a sudden urge to clean or organize the baby's room.  None of these are slam dunk signs that labor is near, but they often are precursors.

- Early labor can last for hours or even days for some women.  At this stage, you have decent breaks between contractions, and they still may be somewhat irregular.  You aren't too uncomfortable and can go on with your normal activity levels.  Many women never realize they are in this stage, particularly with a first baby.  In this stage, you should focus on resting when you need to and eating lightly. 

- The average first labor is 14 hours.  This is the time that mother perceives labor, though in most cases it has undoubtedly been longer than that.  The natural labor process brings with it a gradual increase in endorphins, which enables the mother to tolerate the increasing discomfort from the contractions.  Having said that, 14 hours is an average.  Some women have very rapid labors, some have very prolonged labors.

- It is common to wake up in full blown labor or having had your water break.  This is because of the fact that it's often possible to sleep through the earliest stages of labor.  Your body is in a relaxed state during sleep, and the contractions are often far more effective than they are when you are awake. 

- I don't rely on any time frame or charting to decide when to go to the hospital.  From my personal experiences, and those of my clients, they are good tools generally, but seem not to apply more often than they do.  I'm referring to the 1 minute contraction, every 5 minutes, for 1 hour rule.  Some women have extremely effective contractions every 10 minutes.  Some can contract every 5 minutes for 12 hours with almost no cervical change.  I look to the other symptoms for guidance of when to go.
    * Drastic increase in discharge, or bloody show
    * Increased pressure
    * Back pain with contractions that increases over time
    * Inability to talk during contractions

- You really can't judge how you will do with tolerating labor until you've been there.  Some women have astonishingly high pain tolerances, others sense every twinge and it becomes unbearable quickly.

- Most hospitals will not admit you unless you are 3-4cm and having regular contractions at least every 5 minutes. 

If you aren't sure you are in labor, it never hurts to call your doctor or midwife.  Chances are that they will want you to come in and be checked.  Good luck!!! 

Thursday, April 21, 2011

Postpartum Recovery

When you are pregnant, you imagine what it's going to be like after the baby is born.  You have these visions in your head of maternal bliss. 

Then you get there. 

And it's not very much like you thought it would be.

You are sore, and you ache.  You are tired and emotional.  And you are overwhelmed.

Here's a practical guide of what to expect and how to get through the first few weeks.

Dizziness and Instability - Right after birth, you may feel dizzy and unstable.  Ask your partner or nurse to help (or stay close) when you get up to use the bathroom and shower for a few days.  You've lost a lot of blood and fluid.  It is very important to stay hydrated.

Sleepiness and/or Insomnia - Both are common.  You've just been through a tremendously exhausting experience, and the adrenaline keeps you going for a while.  After it wears off, it is common to be extremely sleepy. 

Bleeding and Discharge - You will bleed, whether you had a vaginal delivery or c-section.  The first few days will be heavier, bright red blood with occasional clots.  It is normal to pass small clots.  If you pass anything larger than a quarter, let your care provider know.  Usually, passing a lot of clots can be a sign that you are overdoing it.  Rest and let your body heal.  After a few days, the discharge will gradually change to what is referred to as lochia.  It can be pinkish, brownish or even white, and will last for a few more days to a couple weeks.    Before you are discharged from the hospital, ask for some of the large maternity pads to take home, as well as a spare pair or two of the mesh disposable panties.  They are so unattractive, but will be your best friend.

Cramping - You will experience cramping for weeks after birth, the most noticeable in the days right after.  The cramps will be stronger with nursing, and will continue until your uterus returns to it's pre-pregnancy size, about 6 weeks from birth.  You can use over the counter pain relievers to help manage the pain.

Muscle aches and pains - Some women come out of labor feeling a bit like they've been run over by a truck.  Labor is hard work.  Pushing is hard work.  It's common to feel soreness in areas you aren't expecting to, like your arms or back.

Headache - These are common after birth, often due to sleep deprivation and dehydration.  If you had an epidural (or spinal)  have a sudden very painful headache, it's possible it is a spinal headache.  Let your nurse know immediately, as there are specific treatments for those headaches.  One of the best ways to know if it is a spinal headache is if it resolves by laying completely flat.  If so, it's probably a spinal headache.  They can last a few days if not treated.

Incision pain - If you had a c-section, you will have a two-fold recovery.  In addition to the recovery from the pregnancy itself, you are recovering from major abdominal surgery too.  Resist the urge to just lay down and rest all the time, you are better off if you keep a low, but tolerable level of activity.  Check your incision daily for signs of infection.  Do not lift anything heavier than your baby for 6 weeks (this includes the car seat carrier - let someone else do that).   Let people help you.

Swelling - Many women experience significant swelling in the postpartum period, often even worse than the swelling at the end of pregnancy.  The best thing you can do is to continue to drink lots of fluids, and maintain a tolerable level of activity.  If your swelling continues to worsen, discuss it with your care provider. 

Fear of using the bathroom - This is very common.  Particularly if you experienced any vaginal tearing or hemorrhoids, it is common to resist the urge to have a bowel movement.  Don't.  Waiting will only make it worse.  Use stool softeners, and be sure to eat lots of fiber rich foods. 

Vaginal tears and swelling- Whether you had an episiotomy or not, many women have some degree of vaginal tearing after birth.  Immediately after birth, they will place on ice pack on your perineal area.  If this helps, you can ask for more ice packs while you are in the hospital.  Ask your nurse for a squirt bottle, and use it with warm water while urinating and defecating.  It will dilute the acidity of your urine so it stings less, and help cleanse the area as well.  In addition to the squirt bottle, witch hazel pads can help with swollen tender areas.  There is also a spray called "epi-foam" that works to numb the area temporarily.  Ask your nurse about these items as soon as you get into the recovery room.   Also, even the day of birth, start doing Kegel exercises.

Trouble urinating - This is also quite common, especially if you had a large baby or vaginal tears.  Using the squirt bottle can help trigger urination and make it less painful.  If you truly find that you cannot urinate, let your nurse know asap.

Hemorrhoids - These pesky veins make their appearance for some women toward the end of pregnancy or after pushing.  They can be internal or external, and can swell quite large and even bleed.  Ask your nurse for witch hazel pads, and be sure to use stool softeners until they are reduced.   Keep your activity level up, and try to avoid sitting in one position for too long while you have them.  If they get worse, contact your care provider.

Intense hunger - It's said that a woman in labor burns as many calories as a marathon runner, and I've found that to be the case.  You emerge from labor voraciously hungry.  Be sure to eat balanced meals, full of protein and fiber.  You need to ensure you are drinking enough water as well.  While nursing, you will need about 500 more calories to produce milk, make them count. 

Rapid weight loss - At the time of birth, you will lose about 10-15 pounds automatically between the baby, the amniotic fluid, the placenta and blood.  You will continue to lose weight over the next few weeks, from a decrease in blood volume and fluid.  Do not expect that your body will go back to the way it was before, though.  Your uterus doesn't even return to it's pre-pregnancy size for 6 weeks.  You can begin exercising around 6 weeks with your physician's advice. 

Roller coaster emotions - There will be some dramatic ups and downs in the days and weeks after labor.  This is common and expected.  If you feel, however, that you are spending more and more time feeling sad or detached from the baby, let your partner and care provider know.  The baby blues are very common and will pass, but post-partum depression is a more serious matter.  Do not be afraid to ask for help.

Hair loss and skin changes - It is very common to lose a lot of hair in the first few weeks postpartum.  Do not be alarmed.  Many women break out in acne after birth too.  If you developed stretch marks during pregnancy, they may begin to fade.  Eventually they will lighten to a whitish color, but the elasticity may never return.

Breast swelling, tenderness and warmth - Your breasts will swell in the first few days after birth.  Immediately after birth (and before as well), your body is producing pre-milk called colostrum.  It is nutrient rich and provides all kinds of benefits to newborns.  Just because there isn't a lot of it doesn't mean it isn't enough.  Healthy, term breastfed babies do not need supplemented in the first few days.  As your milk begins to come in, you may experience excessive swelling, referred to as engorgement.  This is temporary.  Expressing a little milk before each nursing session may reduce the swelling enough to help the baby latch.  Your breasts may feel heavy and warm and quite sore to the touch.  Ice packs can help some women, heat packs help others.  There are cooling gel packs you can place in your bra as well.  You should have some soft, stretchy bras to wear in the first weeks, as you will probably feel better with light support, even at night.

Leaky breasts - It is very common to experience leaking, especially with a first baby.  Your body is trying to figure out how much milk to make, and it's not a perfect system.  Often when nursing, the other side will leak.  There are disposable breast pads, but I found that washable cotton ones worked better. 

Sore nipples - The first few weeks of nursing are a time of trial and error.  I wish that it was always a natural, beautiful, easy thing.  It's not.  Work with your nurse and a lactation consultant before leaving to hospital to ensure that the baby is latching on correctly.  You may feel sharp stinging at first, but it should not last through the entire nursing session.  It will get better with time.  To ease nipple soreness, let them air dry as often as possible.  Lanolin creams help as well.  The best thing you can do is make sure your position is good, the latch is correct.  With time, your body will adjust. 

Overstimulated - After going through the birth process, it's common to feel touched out.  Too many people have seen too much, you have been too exposed, too many demands have been and are being placed on your body.  It's normal to feel this way.  Try to find time to relax and soothe your self, take long showers while someone else is watching the baby. 

Postpartum Check-up - If you had a c-section, your doctor will probably want to see you in a week or two.  If you had a vaginal delivery, it is more likely to be six weeks.  In the meantime, take care of yourself.  Rest when you can, don't over-do it.  If you have any of the following warning signs, contact your physician immediately:
  •     soaking more than a pad an hour
  •     vaginal discharge has a foul odor
  •     you have a fever over 100.4F
  •     you are passing large clots
  •     you develop a severe headache
  •     your incision is not healing properly
Good luck!  This is a short period of time, and it is completely worth it!  Relax, rest, recover.  And love on that baby.  :)

Monday, April 18, 2011

Doc, can you give me my wife back?

Pregnancy hormones.  Ahhh.

They are wondrous and miraculous for all that they facilitate, this is true.  But they also do some wacky things too.

My own personal experience with it involved crying hysterically for four hours once because I wanted a double double from In N Out, and my husband went to McDonalds instead.  At some point, I knew that I was being completely ridiculous, but had no ability to control my emotions. 

Four hours.

It happens.  As a pregnant woman, especially for the first time, you may feel a bit like you are on an emotional roller coaster.  Gloriously happy, hopelessly paranoid, teary at every commercial on television.

One minute you are practically throwing yourself at your significant other, the next you are sure that he is leaving you tomorrow. 

One day you are planning your child's fifth birthday party years in advance, the next you are just completely convinced that there is something gravely wrong with the baby.

One second you are jovial and happy, the next second you are barking orders to everyone around you. 

The reassuring part of it all is that it's normal.  All of it. 

I've seen all different variations of the hormone swings.  Some women just have their regular personality magnified, others seem to be a completely different person entirely. 

If it's confusing and hard to go through it personally, it's even more challenging for the people around you.  They aren't part and parcel to the hormones and in large part are flying blind.  They don't know if today is the happy day or the paranoid day. 

More than one husband has half-jokingly asked the doctor when his wife would return. 

Fortunately, it's a phase.  The wild hormone swings are present from conception all the way through the postpartum period.  Some of the worst swings happen in the first few days after birth.  Your body went from needing all those extra hormones to purging many of them rapidly, and it's a drop off that hits some women hard.  I know it was always worst for me on day 3.

The best piece of advice I can offer to the women experiencing it is to understand that it is a normal process.  You can't control how you feel,  just like you can't control the hormones raging through your body.  What you can try and do is temper your response to them.  If you know you are having a rough day, set your expectations a little lower.  Realize that those around you are trying desperately to understand you most of the time, and they really aren't trying to drive you nuts.  (this one is tough, I know)

To everyone around the emotional pregnant woman, give her a little leeway.  She's growing a person, after all.  Whatever you do, don't blame everything she does or says on hormones.  She just might have legitimate reasons for being frustrated which have nothing at all to do with hormones. 

Try to understand her.

And if she wants a double double, go get her one.  Seriously.

This too shall pass.

Saturday, April 16, 2011

Will I love the second baby as much?

I orignally wrote this a while back, but figured it should be shared here too.

One of my very best friends is currently very pregnant for the second time. Soon she will be welcoming into her family a little girl. And her only son will no longer be an only. He will be instantly transformed into a big brother. And life as they know it will change. Again.

Parenthood is an interesting experience. It doesn't matter how many people tell you how hard it is. It doesn't matter how many times you are warned. It doesn't matter how much time you have spent with other people's children. How much you think you are prepared. It's harder than you could have ever imagined. Every single facet of your life is affected, irreversibly and immediately. It's no less dramatic the second time around than the first.

She's worried about a lot of things right now. Things that every mother entering that home stretch of pregnancy worry about. Things that other people are supposed to reassure you about, not feed into. Things that other people are supposed to be supportive about, but aren't always. Will she love this child as much? Will her only child be okay? How will they all handle the transition? How can she try to do things different this time around?

The anxiety that comes with those last days of pregnancy is bad enough. The anticipation leading up to delivery. The little voice in the back of your head, always a little leery. Is the baby going to be healthy? Will there be any complications? But when you are already thinking about all those things, having doubt embedded in your head by others serves no good purpose. Are you doing the right thing by having another baby?

I've tried as best I can to reassure her that things will be okay. That even though she is now questioning if she can love this baby as much as her first, that she will. I've tried explaining to her that it's not a matter of sharing a smaller piece of your love - it's that your heart seems to grow. You aren't giving any less to any one. You give more to more. But as with most things involved with parenting, she won't know that herself until she experiences it.

I've tried to reassure her that by having another baby, she isn't harming her son. That he will learn things like waiting his turn, sharing, patience. Important lessons that he will carry through his life, and be a better person for having learned them. That she will soon see sides of him that would never be seen if not for the addition of a sibling. Compassion, protection, teaching. There will be challenges. There will be arguments. There will inevitably be conflict. There will be times that she questions how she can fill the needs of both her children simultaneously. But she will. And the good will always outweigh the bad.

I say these things to her, but I don't know that she truly believes them. She's been told otherwise by someone else. But that someone doesn't know these things. That someone only has an only. And there are some things that you can't possibly be qualified to judge about until you've been there. And there are some things that you should never, ever say to a pregnant woman.

She is as close to being my sister as a person could be without any genetic ties. And she is about to be the mother of two children. And she is about to know exactly what I mean. Love you!

Thursday, April 14, 2011

Natural Induction of Labor

Before I even begin to write anything here, I must premise this post with my disclaimer.  I am not a medical professional.  This information is presented here only for educational purposes, and should not be used without consulting your physician or midwife first.

These techniques should only be considered by women who have already carried their pregnancies to full term.  They are particularly useful for those who are set to be medically induced but would like to avoid that.

This list is not all inclusive.  There are herbs and supplements that I am omitting from this list simply because they should not be used without direct supervision of a midwife or doctor.  I've seen them in action, and they do work.  However, they should be managed by someone experienced with them.

Not everything on this list will work for everyone, and not everything that works will kick in automatically. 

Ultimately, if your body and your baby aren't ready to go into labor, trying to force the issue may just lead to further frustration. 

As for the argument that some of these methods are "old wives tales", I call foul.  Women wouldn't have been doing these things for thousands of years if they didn't work.

- Sex: Yep, the very way you entered this pregnancy could be the way out.  Sex works for a couple different reasons.  First, there are natural prostaglandins in semen, which work to soften and shorten the cervix.  Second, it is relaxing.  Third, uterine contractions are caused during an orgasm and can trigger labor.  Fourth, The more you enjoy it, the more likely it is to work.  Orgasms release oxytocin.  Some women are more sensitive to these side effects than others.  Don't be disappointed if nothing happens right away, it can take a few days for the prostaglandins to kick in (or a few tries...wink, wink).

- Evening Primrose Oil: Found at natural health stores, this supplement functions like the prostaglandins mentioned above.  It can be taken orally after about 34 weeks and vaginally once you hit full term.  It helps soften the cervix, but doesn't generally do much more than that.

- Eating spicy food: This is one of the least effective methods, but can make a difference if it creates intestinal cramping.  One muscle being tensed leads to another...

- Driving on bumpy roads: Again, this one isn't terribly predictive, but can help settle the baby down further into your pelvis.  The dropping of the baby puts more pressure on your cervix, which thins it and makes any contractions you have more effective.

- Nipple stimulation: This one works.  Well.  Only do this if you are committed to going into labor.  Nipple stimulation produces natural oxytocin, which is the same hormone they mimic when pitocin is administered in a hospital setting.  It doesn't work right away all the time and can take a while.  If you start contracting, ease off the stimulation during contractions.  This method can lead to over stimulation, so be cautious with it.  Be sure to discuss this with your care provider.

- Red raspberry leaf tea: This tastes good and does help with toning your uterus, but I've never seen it do more than that.

- Walking, sitting on birth balls:  These won't generally put you in labor, but will help prepare your body for it by keeping your joints moving and opening up your pelvis.

- Crazy curb walk: This is an exaggerated method beyond walking.  Basically, you walk with one foot on the curb, the other in the gutter for as long as you can stand it, then turn around and go the other way.  You look ridiculous, but this really helps open up your pelvis and drop the baby.  I really encourage women who've had their membranes stripped to do this. 

- Acupressure:  There is a pressure point on the ankle that can stimulate contractions when used.   It is approximately two finger widths above the ankle bone on the inside of the foot.  Apply firm direct pressure for a minute and release.

- Castor oil: This is the last ditch effort for many women.  Castor oil is a strong laxative and causes intense cramping and diarrhea.  The cramping in turn can trigger contractions.  It doesn't work for everyone, but universally creates discomfort.  I'd advise you not to even bother trying this unless you are already dilating and having at least occasional contractions.  Plan to do it first thing in the morning on a day that you have nowhere to go, and buy some wet wipes for in the bathroom....you're going to be in there a lot.  There have been some studies that showed an increase in meconium with castor oil use, which can indicate stress for the baby.  Consult your doctor or midwife before trying this.

- Stripping or sweeping the membranes:  You need to ask your doctor or midwife to do this for you, though some will offer without being asked.  Usually once you are full term, they are willing to.  Essentially, the procedure involves sweeping a finger or two through the cervix and around the inside to release the sac from the lining.  It irritates the area, stirs up the prostaglandins and can manually dilate the cervix a little.  It isn't comfortable and feels like a very long pelvic exam.  It can cause a rupture of membranes.  Cramping and contractions are common immediately afterwards.  To encourage a regular pattern of contractions, you should try to stay up and moving afterwards.  I'd caution against having this done unless you are ready to have a baby right away, and would encourage you to only ask to have it done if your significant other (or someone else who can drive) is with you...just in case it works quickly.

- Rupturing membranes: If you are looking at a medical induction and have run out of time to try all the other techniques, you can ask if your doctor or midwife will break your water and wait to see what happens.  Sometimes that is enough to kick your labor in, without other interventions.  The downside to this is that once your water is broken, you can't go back.  The contractions will hurt more, there is significantly more pressure, and you still may need induction or augmentation with pitocin.  Plus, once your water is broken in a hospital, you are put on the 24 hour clock for delivery. 

Remember to consult your physician or midwife with any questions, and good luck!

Tuesday, April 12, 2011

My Hands

I am a doula. I help women become mothers. With my heart and my hands and little else. Though it is something that I don't get the privilege of doing as often as I would like to, I still describe myself as one. It isn't just a job to me, it's a way of life. It means more to me than a set of tasks and responsibilities. Most people have no idea what that means, and I love explaining it. Even once I explain what it is, there are people that will look at me strange, unsure of what it is exactly that I do.

I never set out to be a doula. In fact, I didn't really know what they were until after Aidan was born. I had heard the word, but it didn't mean much to me. It wasn't until I met a few, mostly through the breastfeeding support group, that I started to learn about them. These were women that helped other women have babies. I was intrigued.

When Ashley was born, one of them, who had become a very good friend, attended her birth. Aidan's birth had been a bit dramatic, since it all happened so fast. We were scared, I got a totally unnecessary epidural, and Aidan had serious complications. It was not a perfect birth experience. Pretty far from it, actually. I was hoping for something better with Ashley.

Ashley's birth wasn't much better honestly, it was chaotic and she was also whisked off to the NICU. But with the help of my friend, I was able to do it all without pain medication. And from that day forward, I was determined to help other women have a better birth than I did.

When Ashley was only a few months old, I started working towards my certification. I had some books to read, then I took my training. My first client was also a good friend of mine, and I had a lot riding on her labor. I wanted so badly to help her. And I wanted to do a good job.

She wanted very much to labor without medication or other interventions. It ended up being a very long and drawn out labor, since the baby wasn't in the best position. I'm sure she was in pain the entire time, but I did as much as I could to help her. I used every single thing I had learned in my training that night. And finally, after almost 24 hours of labor, I was the first person ever to see her son as he entered the world. She had done it her way, and it was breathtaking to watch.

My latest client fought for her labor too. She was in a position like too many women these days, forced to be induced, forced to give up many of the things she wanted for her labor experience. Staring in the face of a c-section after hours and hours of pushing, she fought through it. And she did it. And I helped her.

I've helped women mourn the loss of their ideal births, and I've helped women mourn the loss of their babies. An unfortunate truth is that not every pregnancy ends happily. I helped a mom with a single birth that began as a twin pregnancy. And I was there with her, as she cried, celebrating one life while simultaneously longing for the other.

Being a doula is a gift. A privilege. It is the most amazing and energizing feeling to hold the hands of a woman becoming a mother. To help her bring life into the world. To sit in the silence with her, as the entire room hushes, waiting to hear the first cry.

I have witnessed some of my clients transform into helpers. Become doulas, become lactation consultants. My hands helped them, and they are paying it forward. Being a doula truly is a gift, I am so blessed.

Breastfeeding - the decision to stick with it

When you are pregnant, you are bombarded with propaganda. From every angle imaginable, you get information coming at you. About how to labor. About where to have the baby. About what kind of diapers to use. About which car seat and stroller to buy. And about what to feed your child.

It's a topic a little close to my heart, as I have tried with each of the kids to exclusively breastfeed. And it almost worked. Aidan and Ashley never touched formula. Ally had one bottle in the hospital out of necessity. And then I had AJ. And we've gone through cans of it. When he was first born, it was because he had low blood sugar. Then, when he was older, over a year already, we didn't have a choice but to give it to him again. He wouldn't nurse during the day, but had trouble with whole milk. Again, not really a choice.

The problem with choosing what to feed your child is that so many people make it seem like it's not a choice. And, I suppose that it really shouldn't be one. The default should be breastfeeding. It's what our bodies were made for. It's the only food in the entire universe made just for that child. It really is the best. The trouble is that our society decided a while back that formula was just as good, or even better. And new moms believed it.

With formula feeding becoming more and more common, fewer moms nursed. Over a couple of generations, breastfeeding went from being the normal way to feed a child to a gross thing that shouldn't ever be done in public. It became the thing that got a woman and her child kicked off an airplane.

It went from the natural thing mothers did to something that hardly anyone knew anything about. The women of my generation haven't had enough women of older generations to rely on for help. There aren't enough people to ask questions of. No one to reassure us that everything would be just fine. No one to tell us that we would be able to make enough milk. No one to tell us that babies can do just fine without formula for a few days until your milk comes in.

When Aidan was born, I didn't have many people to ask questions about nursing. And it was hard. Really hard. All the books and the pamphlets and the pictures you ever see about nursing when you are pregnant tell you that it's natural. They make it look like it's just something that should come so easy. But then it isn't. He was early and sick and couldn't latch on right. I was sore and discouraged, but determined. So much so that I made it work.

I found that the people who were supposed to be the ones helping me, the nurses and the lactation consultants only made things harder. The people who really made a difference, the only ones who really helped, were other moms. The moms just like me, trying to figure it all out for the first time.

I was able to nurse my children, all of them, almost all the time. For some people, that isn't how it works. Sometimes life gets in the way. And for those times, formula is the answer. But before new moms go there, they should be given all the help and support they need. Before they give up trying, they need the tools to be successful. And we, as a society, need to stop believing that breasts are only sexual objects, and that there is something dirty about nursing. Breasts were designed to feed babies. And that is exactly what they are supposed to do. And almost all the time, with the right support, they can.
Truly the hardest thing about nursing is overcoming all that. Once you believe that your body can do exactly what it is designed for, you've won half the battle.

When Interventions ARE Needed

This morning, I am thankful for a great many things.

Thankful that I am blessed by wonderful friends who become my clients and who trust me to help them when they need it the most. Who let me into their lives and their hearts. Who let me hold their hands and wipe their tears. Answer their questions and calm their fears.

Thankful for all my mommy friends, many of which help me so that I may help others.

Thankful for my in-laws who willingly subject themselves to the chaos of temporarily parenting my kids when I need to be somewhere else.

Thankful for the fact that my husband bought pizza and soda last night. He knew that was exactly what I needed to come home to. Man, I was hungry by the time I got home. Labor can do that to a person, even when you aren't the who is in it.

Thankful for the end of the school year and the fact that I didn't have anywhere I needed to be early this morning. I needed to sleep just a little longer today.

Thankful for my healthy children and thankful for the fast and uncomplicated labors I have had.

But mostly this morning, I am thankful for doctors and nurses. The doctor who allowed my friend, my client, to do things her way, even though she didn't really want to. Who gave her the gift of trying. I am grateful for fast acting nurses, for a compassionate anesthesiologist who let me still help even when my time was done. Who understood that being a doula meant I had to help them even though I wasn't the one getting them through this delivery anymore.

Thankful for all those things that I stand against generally as a doula. Inductions and epidurals and internal monitors and c-sections. I am thankful for them this morning, because even though they might be used more often than they should, they are there when you really need them. And last night was one of those times.

A baby was coming, it is true. He just had plans that were different than ours.

It's a good lesson to be reminded of, really. Sometimes we are truly just along for the ride. I was glad to be on that ride with them last night. Everyone reached their destination safely, even if it was a bit scary there for a while.

A beautiful, wild, scary ride.

Happy Birthday Baby Boy

Hitting the Wall - postpartum hormones

I'm not quite sure what made me think about this today. I'm pretty far removed from these experiences in my own life. Perhaps it is because even the memories of those days are so vivid it's pretty hard to forget them for long.

I tend to be reminded of them when I am helping another new mom. When I am talking her down from the ledge, assuring her that everything will be okay, that this is all completely normal. I say those things, yes, but I never really believed them myself when I was in that place. When I hit the wall.

All of the amazing miracles that can take place during pregnancy require hormones. And a ton of them. Then all of a sudden, one day you give birth and most of the hormones aren't needed anymore. They go away, all of a sudden, and you hit the wall.

It's one of those things that people can warn you about, but you really and truly have no idea what you are in for until you experience it yourself. There's no denying it when it happens. Usually, it comes around about 48-72 hours after birth. I've often wondered why that is the day that most people are sent home from the hospital. Your milk comes in, you hit the wall, and they send you packing.

You go from the postpartum euphoria, of being completely in love with this baby and stuck in a surreal place of wondering if it is all really happening to being pretty sure that you have completely lost your mind. You cry about nothing. About everything. And. You. Can't. Stop.

You question whether you can really do all the things now required of you. You doubt your body's ability to make enough milk. You decide you are going to be a terrible mother.

Your husband wonders what exactly happened to you between an hour ago and right now. What is wrong? Did I do something? She was fine just a minute ago, really....

The good news is that, like most things involved with labor, delivery and having a newborn, you just have to survive it. Most women experience the hormone drop off and dissolve into a pile of sobbing goo. It's not just you. We almost all do it. It doesn't mean you are weak or unfit or any of that. It just means your body all of a sudden purged a ton of hormones.

Too bad you don't see it coming.

Funny thing is that after you've had a baby, you should be able to anticipate it. But you don't. You think that you'll be fine this time around, you know what to expect, been through it all before. Nope. It still happens. Fortunately, it's a brief period of time. A transitional thing. And it only lasts about a day. Then you get to go back to being blissfully happy with your newborn.

Just have to hit the wall first.

This, among other things, is one of the reasons I became a doula. I didn't have anyone to hold my hand through this time period, when I hit the wall the first time. To tell me it was all going to be okay. That it was hormones. That I wasn't really losing my mind. I like to believe that I can help other new moms through this phase. When I am helping a pregnant mom, I warn her about this. I know that I can tell her about it until I am blue in the face, but she won't believe me until she lives it. No one ever does. But I will be there, for during and for after that phase.

I love being a doula. It really is the most amazing job. I don't just help women have babies, I help them become mothers. Mothers who can dissolve into a pile of goo, and really be okay with it.

Monday, April 11, 2011

Recovering from a traumatic birth

As a doula, I spend a lot of time talking to women about their labors.  Helping them work through what happened and why, show them the reasons why things were done, all that.  Whether it was last week or 40 years ago, labor is the kind of experience that stays with you. 

Sometimes you have to revisit those hours to figure out why the events took place in the way that they did.  You have to ask yourself questions, you have to try and understand the rationale of the doctors, nurses and midwives.  You have to find some level of peace with what you've been through.

This is essential for all women, but even more so for those who had a traumatic birth experience.  The fear of it happening again the way it did the first time leads many women to in turn fear the next pregnancy.  Some push it off for years.  Some never try again.

I'm always annoyed at the people who say things like as long as the baby is healthy, that's all that matters.  Not exactly.  While the health and safety of the mother and baby are obviously paramount concerns, they aren't the only ones.  And belittling everything else provides a great disservice to women in general. 

You should come out of labor feeling enriched and empowered, strong and feminine.  You should not exit the delivery room feeling violated and defeated, damaged and weak.  Yet it happens every day.

I was not surprised that my first question asked here was about a traumatic birth and the fear of a repeat.  Without having been there and knowing all the details, it is impossible for me to say exactly what happened and why, but I can venture guesses.

This mother labored 29 hours prior to having an "emergency" c-section.  I use the term loosely, and will explain below.  She then had several boluses of epidural medication delivered, so much that it actually impaired her ability to breathe.  Terrifying, and all too common.  She came out of the hospital with a baby, yes.  But she brought home fear too.  An assumption that she will need a repeat c-section and that her pain will not be manageable safely. 

All legitimate concerns.  And all those legitimate concerns are making her hesitant to try for the next baby. 
 
This mom is worried about a repeat.  I don't blame her. 

She thinks she will have to have another c-section.  Whether that is the case depends on a few things.  First, she would have to find a doctor and hospital that allow VBACs to even consider it.  Second, there would have to be no maternal factors prohibiting a VBAC, like a vertical incision, prior pelvic injury, or abnormally small pelvic outlet.  Most cases of failure to progress, the baby being too big, or fetal distress are more related to how the mother labored and with what interventions than anything else.  Most cases of failure to progress are either induced or just not given enough time.  Most babies fit through most pelvises.  She could very well be a candidate to attempt a VBAC.

She is afraid of the breathing issues she had repeating.  The trouble she experienced before is related to the way the medication is administered, and the lies that people tell about epidurals in the first place.  The truth is that they aren't as amazing as advertised.  Sometimes epidurals don't work at all, sometimes they only cover half your body, sometimes you feel like you can't breathe but can still feel pain.  They aren't perfect.  Epidural anesthesia carries with it a fair amount of risk, and interfering with breathing is one of them.  There is no way to really predict if she would have the same trouble next time around, but it is something that the anesthesiologist should be made aware of in advance, particularly if she needs a repeat section.

My best advice would be to hire a doula, attempt a VBAC and try to go without an epidural completely or put it off as long as possible.  Give gravity a chance to work, let your endorphins kick in as a natural pain reliever.

If it's impossible to find a doctor and hospital willing to allow VBACs, or if there are other legitimate reasons not to attempt one, realize that a scheduled c-section is a whole different experience than one that comes after a long labor.  You know what you are going in for, you can plan around it, you can have a sense of expectation about what will happen.  It is far less traumatic the second time around.

One of my favorite doula stories was about a friend of mine, completely defeated the first time she labored.  Induced, epidural, prolonged pushing stage, episiotomy, vacuum, long painful recovery.  She was afraid to go through it again.  I convinced her that it didn't need to be that way.

Second time around, she labored beautifully even though she did need to be induced, avoided pain medication, pushed for only a few minutes and was pretty sure she could conquer the world.  Which is how labor should be.

Recovering from birth trauma sometimes only comes after the next baby is born.

One thing that traumatic birth experiences does accomplish in a positive light is that it almost universally creates more educated moms the second time around.  Mothers who ask more questions, mothers who try alternatives, who seek second opinions.  Surviving birth trauma is in some ways empowering all on it's own in that regard. 

The desire to not let history repeat itself is strong, especially when it's your body.

I will be writing many posts in the future specific to induction, epidurals, VBACs and more, please check back.

And good luck.  Don't be so afraid that you refuse to try again.  It can be better.

Sunday, April 10, 2011

Postpartum Hormones & Emotions

I'm not quite sure what made me think about this today. I'm pretty far removed from these experiences in my own life. Perhaps it is because even the memories of those days are so vivid it's pretty hard to forget them for long.

I tend to be reminded of them when I am helping another new mom. When I am talking her down from the ledge, assuring her that everything will be okay, that this is all completely normal. I say those things, yes, but I never really believed them myself when I was in that place. When I hit the wall.

All of the amazing miracles that can take place during pregnancy require hormones. And a ton of them. Then all of a sudden, one day you give birth and most of the hormones aren't needed anymore. They go away, all of a sudden, and you hit the wall.

It's one of those things that people can warn you about, but you really and truly have no idea what you are in for until you experience it yourself. There's no denying it when it happens. Usually, it comes around about 48-72 hours after birth. I've often wondered why that is the day that most people are sent home from the hospital. Your milk comes in, you hit the wall, and they send you packing.

You go from the postpartum euphoria, of being completely in love with this baby and stuck in a surreal place of wondering if it is all really happening to being pretty sure that you have completely lost your mind. You cry about nothing. About everything. And. You. Can't. Stop.

You question whether you can really do all the things now required of you. You doubt your body's ability to make enough milk. You decide you are going to be a terrible mother.

Your husband wonders what exactly happened to you between an hour ago and right now. What is wrong? Did I do something? She was fine just a minute ago, really....

The good news is that, like most things involved with labor, delivery and having a newborn, you just have to survive it. Most women experience the hormone drop off and dissolve into a pile of sobbing goo. It's not just you. We almost all do it. It doesn't mean you are weak or unfit or any of that. It just means your body all of a sudden purged a ton of hormones.

Too bad you don't see it coming.

Funny thing is that after you've had a baby, you should be able to anticipate it. But you don't. You think that you'll be fine this time around, you know what to expect, been through it all before. Nope. It still happens. Fortunately, it's a brief period of time. A transitional thing. And it only lasts about a day. Then you get to go back to being blissfully happy with your newborn.

Just have to hit the wall first.

This, among other things, is one of the reasons I became a doula. I didn't have anyone to hold my hand through this time period, when I hit the wall the first time. To tell me it was all going to be okay. That it was hormones. That I wasn't really losing my mind. I like to believe that I can help other new moms through this phase. When I am helping a pregnant mom, I warn her about this. I know that I can tell her about it until I am blue in the face, but she won't believe me until she lives it. No one ever does. But I will be there, for during and for after that phase.

I love being a doula. It really is the most amazing job. I don't just help women have babies, I help them become mothers. Mothers who can dissolve into a pile of goo, and really be okay with it.

Intoxication

Baby, oh baby.

best.smell.in.the.world.

Seriously.

There is something divinely intoxicating about the smell of a brand new baby. Something that can make you forget about all the unfairness and injustice and cruelty in the world in an instant. Make it all fade away. Make everything new and right and perfect. Fresh.

It's a smell that never ever gets old. No matter how many babies you hold, you never tire of it. At least I don't. It is part of why I became a doula. Of course I want to help women through their pregnancies and labors. I want to help them with nursing. But a big part of why I became a doula has nothing to do with those. Part of it was done purely for selfish reasons. I love babies. Especially the brand new ones. Can't get enough.

I've told my dear husband that it is in his best interests to support me being a doula. The hours drive him crazy. Babies don't always cooperate with weekends or plans. They interrupt my sleep and his. Still, he knows that he need to encourage this outlet. Simply put, I need a baby fix every now and again.

I need to breathe in that sweet smell. To marvel in the perfection. To witness the miracle.

Next to being a mom, being a doula really is the best job in the world.

My Soapbox - Reasons why I am a doula

Excuse me for just a moment. I'm about to climb up on my soapbox. If you don't want to read my opinions about something very close to my heart, then stop reading now.

Also, if you get squeamish when women talk about labor and mucus plugs and episiotomies, then you'd best stop now. Because really, they don't gross me out in the least. I could talk and talk and talk about these things. I guess that's part of why I'm a doula.

I've never quite understood how so many people are so terribly uncomfortable talking about pregnancy and labor. It is a part of the circle of life. To keep going on as a species, we have to have babies. And yes, that means that at some point, one human being needs to exit another.

I have a date with a labor & delivery unit this morning. A client, a good friend of mine, about to embark on the journey of induced labor. I'll be there to help rub her back, to remind her of what she wants when her body tells her to forget, to reassure her when the doubt inevitably sets in, to translate the language that doctors and nurses speak.

I love babies. Especially the fresh ones. I love being a doula.

I get to see the face of a baby often before anyone else does. I get to witness the amazing power of a woman as she realizes how strong she is. I sit in the hushed silence, when the world stops spinning just for a moment, as we wait for the baby to cry for the very first time. To go from being connected to that which created it, nourished it and protected it for nine months, to a living and breathing creature wholly separate. It's a tremendous physiological process to see happen, nothing short of a miracle every time.

If you've never been witness to a birth, I highly recommend it. It is really one of the most breathtaking things to see. And no, being there when you gave birth to your own babies does not count. Not at all.

I love being a doula. Not just for the women I help when they are in that place themselves, but for the others. Those who ask my advice, my opinion at other times. When they are struggling with infertility and feel like they are the only one who has ever felt this way. When they have lost a child and believe they will never be able to try again. When they are pregnant and have horribly embarrassing questions, even the ones they don't want to ask their doctors. When they need help with nursing or weaning. When they can't figure out what this rash is, or what this cry means. When they need help to work through what happened when they labored with their babies, whether it was ten minutes ago or ten years ago.

Women tell me things because I am a doula. They trust my knowledge and expertise, not because I have letters after my name, but because I have helped so many others. And I've often been there, wherever they are, myself.

What I find most troubling about the stories women tell me is that they so often felt like they had no choice. That they were at the mercy of their doctors, their nurses, their hospitals, the clock, the rules. That they never realized that they could ask questions before something was done to them. That they could say no, or that they could wait. The truth is that, as with most things in this life, the vast majority of what happens during labor allows time for choices to be made. Short of them wheeling you down the hallway for a crash c-section, there is time to ask questions. To wait and see. To give it another push, another minute, another hour.

But most women don't know that. And no one seems to be there to tell them. This is where I come in. Why I do what I do. It breaks my heart to hear stories of women that are defeated by labor. Who were subjected to interventions they didn't want or need. Who didn't know they had options. Who didn't know they could say no.

One of the first clients I helped had a labor experience like that. Things didn't go the way she wanted. In fact, they were just about exactly the opposite. Yes, she had the baby, but it wasn't a happy and peaceful labor story. It was a bad experience for her. So much so that she dreaded ever doing it again. She was terrified when she got pregnant again, afraid history would repeat itself.

By then, though, she had met me. I told her that it didn't need to be that way again. She doubted. I encouraged. I helped her take ownership of that second labor, though it took a tremendous amount of convincing on my part. But take ownership, she did. She even did the crazy things I asked her to. She did them with a vengeance and determination that surprised me. And it was a beautiful thing to see. She believed in her body again. She could have conquered the world that day, I think.

This is what is missing so often from childbirth these days. The ownership. I'm trying to change that, one woman at a time. No matter the circumstances, no matter the complications, we as a society need to give labor back to who it rightfully belongs to. Us.

I'll get down off my soapbox now. I have somewhere I need to be. I've got a date, and it's one that I can't be late for. A baby is coming.

A baby is coming.

Saturday, April 9, 2011

Unreality TV

A friend of mine, and a fellow blogger, recently wrote about labor. About what she expected it to be like, and about how much it wasn't at all like what she thought it would be. And about why she expected it to be so.

Which made me chuckle a little.

It made me remember how I used to torture myself the same way that she did, even after I knew better. How I'd sit and watch those tv programs about pregnancy and labor. How I'd be on the edge of my seat as the mother started to feel the first twinges of pains, how I'd wait through the commercial breaks to see if the baby was okay.

Most women know which shows I am talking about. The ones with the cheesy music and the creative camera angles and the requisite drama in every episode. Those ones.

Here's the thing. Those shows are just that. Shows. Real labor isn't like that at all, even though the shows supposedly are portraying real life. They aren't. They are heavily edited real life, which isn't real life at all.

How do I know? I mean, aside from being a mother who has birthed four children and a doula who has witnessed the births of many more? Well, I know first hand, actually. I was taped for one of those shows.

When I was in labor with Ashley, they were filming Maternity Ward at the hospital I delivered at. I wasn't so much in labor as refusing to leave the hospital until the baby came out, truth be told. I'd been contracting all night and I knew that if I left, labor would fully kick in at any moment, and that when it did, I'd have to be at the hospital already or I'd be giving birth on my bedroom floor or in the car, neither of which sounded appealing.

I'm known for fast labors with insane progression and almost no time pushing. When a baby wants to come out of me, it wants out now.

So, given my history, the doctor opted to keep me there and break my water since that was safer than the alternative. Of course, I was deemed high risk since I had gestational diabetes (diet controlled) and she was a little less than a month early. Que up the dramatic music...will this mother get through labor safely? Will the baby be okay?

I was settling in to my room and not particularly uncomfortable when the producer for the show came in. He was all excited, since my labor was sure to be a dramatic one. With risks and speed, it had to be, right? For some reason I don't fully understand, I agreed to let them film me. Maybe deep down I knew that the shows were misleading and maybe, just maybe my labor could help communicate more reality in their show. Who knows?

The doctor broke my water and not much happened. They hooked me up to pitocin (the devil's contractor, I call it), and within mere seconds full blown labor arrived. I was talked into sitting on the birth ball and was managing the contractions fine. Never mind my friend sitting in the corner eating a sandwich and Tom doing squats at the foot of the bed to make me laugh...they sure weren't helping, those two.

After a short while, the contractions got stronger and closer together. I was still fine. I warned the nurse to prep the room and she looked at me like I was crazy. Then she checked me. And then she believed me. Asked if I needed any pain medication. Nope. Even on pitocin, she asked? Nope.

Chaos ensued. The doctors and nurses came in, the techs prepped all the stuff, the transformer bed transformed and in came the camera crew. At some point, my parents arrived and were trapped in the room by the onslaught of other people. Plus, I'd drawn a crowd. Every free nurse on the floor was peeking her head in the door. It's not every day you see a mom on pitocin go without an epidural.

I remember telling them to hurry up. The baby was coming, and I wasn't waiting to push. I was breathing and talking and not freaking out. I did yell/scream that one time, when she crowned, but that was about it. She was fine, though they took her to the NICU because of her gestational age for observation. I was fine.

Later that day, the producer came in and broke the news. I wasn't going to make the show. Though I'd had great potential, I hadn't come through for them. I didn't scream and carry on like a woman without an epidural was supposed to. I didn't have birth trauma, and the baby was fine. I had a fairly uneventful labor, and apparently that isn't tv worthy.

Normal isn't worth watching, at least not in the eyes of the producers. By extension, the only stories that make it on to those shows are the ones that aren't normal. Think about the ramifications of that for our generation of women, those who have sat and watched these shows with our first babies thinking they would tell us what to expect.

So, to all the women out there watching these shows now, keep my story in mind. The shows aren't really an accurate picture of reality. Normal and uneventful aren't exciting enough to make the cut. It's no wonder most women go into labor nervous and scared. When you look at how it is portrayed as compared to how it really is, there is a huge disparity.

Reality isn't exactly reality. I know, first hand.

Postpartum Depression - my story

I think I am ready to write about this.

Wait.

Deep breath.

I'm not at all sure that I am ready to write about this.

I think it is time.

I guess I am just going to have to take a leap of faith here. Not many people know about it, almost no one really, and it's something I have a very hard time talking about. Mostly, I just don't talk about it. Pretend it doesn't exist. That it didn't happen to me.

Because it wasn't supposed to. Not to me. I was way too smart, too strong, too versed in the signs, too prepared for it. It wasn't supposed to happen to me. But it did.

I can feel my chest tightening up, which says to me that even though it's been years I am still very much not over what happened. I don't know that I ever will be. That I will ever really feel in control again.

You see, once something like this invades your life, it changes you. You don't just one day get better and go back to being the person you were before it all came crashing down. You instead are always looking back, wondering if you've done irreparable damage, thinking that you did. Wondering if it will sneak back into your life. Wondering if it might be here right now.
Knowing that it very well could be.

I had postpartum depression. And it damn near ruined my life.

I'm a doula. I'm trained to recognize the symptoms in other women. I should have known better. I suppose that on some level I knew, I just thought maybe I could handle it.

There was the slightest hint of it when Ashley was a baby. She was colicky though, and I dismissed it as normal frustration. It's only reasonable to get frustrated when your baby cries for six hours straight, right? It passed though, and I didn't think much of it.

Then Ally was born. Things were okay for a few weeks. Really. Then we moved away from our family and friends. We moved away from comfort and safe. I don't know that the move was the straw that broke the camel's back, but it sure as hell made it happen faster and more catastrophically.

I was alone. Stuck in the house all the time with three kids. I didn't know anyone. I didn't know where to go or what to do with them. Slowly the panic started to set in. Then, maybe a week or so after we got here, it hit full force.

I had a version of postpartum depression (PPD) closely related to obsessive compulsive disorder (OCD). I started to have intrusive thoughts. I would envision myself hurting the baby.

The most frequent thought was that I would see myself drop her down the stairs. The house we were renting at the time was a ranch with an open stairwell to the basement. And I can tell with full honesty that there were entire days I sat and stared at those stairs. I hated to walk past them. I'd grip her tight to my chest every time I had to pass them.

I'd take the kids out for a drive and find myself out on some mountain road, then picture the car sailing off the cliffs.

I'd put her to bed and see myself smothering her.

I was afraid of what I might do. Afraid I might do what I saw. Afraid that I was a horrible mother. No one in their right mind thinks these thoughts. I mean, I knew that I would never hurt my baby....but why was I thinking like this?

It is absolutely terrifying when you are not in control of your thoughts.

The thing with this form of PPD is that it only gets worse with denial, as I learned. I hid it well though. No one knew, not even my husband. To the outside world, I was totally fine. Functioned normally, did everything I needed to do, put on a happy face. But inside I was at the mercy of unrelenting horrible thoughts.

This went on for months, getting progressively worse.

Until one night, just before Ally turned a year old. I was sitting in bed, reading a book before I tried to sleep. I won't mention the name of the book, mostly because I don't want anyone to think poorly of it or that it had anything to do with my condition. By then, I had gotten to the point that my mind internalized everything I did, saw or read and distorted it into some sick and twisted way to hurt the baby.

In this book, a family went to the zoo. Upon reading that, my mind immediately shifted to me, throwing my child over the fence to the alligators. I slammed the book down and started to sob uncontrollably. I knew then that I couldn't take it anymore. Whatever was wrong with me was something that was only getting worse and I couldn't hide it anymore.

I was powerless to stop it.

My husband was, of course, in complete shock. His first and most legitimate concern was whether I was homicidal or suicidal. I wasn't. I just knew that there was something very wrong and I needed help.

I cried myself to sleep that night, my husband's arms around me. He was scared. I was terrified.

The next morning, I called a midwife friend, one I knew to have personal and professional experience with PPD. She was worried. Told me to get help. Now.

I called a therapist and met with her that day. After talking to her for a few hours, she came to the conclusion that my self diagnosis was spot on. She thought I needed medication. I told her I would do anything to avoid it. She said sometimes there is no other choice. I said I knew.

I did know. That's the problem. I knew and I still hid it.

Then something happened. I could breathe again. Turns out that in my case, telling someone was enough to stop the downward spiral. Hiding it only made it worse, and admitting that I had a problem, not just to my husband and friend and therapist, but to myself was the best thing I could have ever done.

I had to face the truth that I needed help. From that day forward, I would still think about things, but in a different way. They weren't the brutally violent and vivid visions anymore, more like hazy memories. With time, they stopped completely.

I did a lot of research on the subject once I admitted to myself what was going on. Turns out I fit the description almost perfectly for women who suffer from this version of PPD. Intelligent, balanced, in control.

I was too smart for this. Too aware. Too on top of everything. Or so I thought.

It took me months to tell anyone besides my husband. I didn't want anyone to worry. I didn't want anyone to think less of me as a mother, as a woman, as a doula. I felt shame not just for having it, but for not getting help sooner.

I feel like the entire first year of Ally's life was a blur. I don't really remember her being a baby. I look back and I wonder what kind of mother I was when I was in that place. It can't have been a very good one. I feel like I've done a disservice to my kids. With time I have somewhat forgiven myself. I know I need to be better about that.

When Ally weaned, I feared it would return. In some women, PPD resurfaces when nursing ceases, since there is a dramatic decline in hormones when that happens too. I never had to cross that bridge since I ended up pregnant almost immediately after she weaned. Again, I feared it would come back with AJ. It didn't.

But he's still nursing. I have another bridge to cross yet.

I know there are many who read this that will probably be shocked to hear my story. Who had no idea. I hid it well. I know there are some out there who question whether this is a real condition. I can tell you first hand, it is. I am sure some people will wonder why I am writing about it now.

I guess I am writing to be honest. I am scared it will come back. I am better equipped now to recognize it and I know to get help right away if I need it. That doesn't take away the fear.

Mostly, though, I am writing this for all the women out there who know where I've been. Who may be there now. If you need help, get it. You may need medication, and that is okay.

If you know someone who needs help, please make sure they get it.

There is a more severe condition known as postpartum psychosis. Before I dealt with it, I thought the mothers who drowned their children were just using that as an excuse. Today, I know that left to it's own devices, the postpartum brain can turn dark and evil. I know the path those women walked. I can see what happened to them and their children.

For more information, please see:

http://www.mayoclinic.com/health/postpartum-depression/DS00546

http://www.postpartum.net/

http://www.postpartumdepression.net/index.html

I'm not afraid of storms for I'm learning to sail my ship. -Louisa May Alcott-

Siblings in the delivery room - special bond or scarred for life?

Every so often I find myself screaming at the radio.  Happened again a few days ago. 

There is a radio show here, two male DJs, and they frequently discuss life situations.  The whole what would you do if this were you kind of thing.

I take most of what they say with a grain of salt for several reasons.  First, they are paid entertainers.  If they only ever said things that were safe and obvious, they wouldn't be exciting enough to keep their jobs.  Second, they are both men, which makes them pretty much unqualified to talk about some of the things they talk about on the show.  Like breastfeeding. 

Last time I checked, men don't lactate. 

They were talking about something just as close to my heart a few days ago, and something that they aren't any more qualified to discuss.  Childbirth.  A listener had called into the show to express concern that a friend was allowing her three year old daughter to be present when she delivers her baby any day now.

The birth in question here was a planned home birth, in a completely uncomplicated pregnancy.  The daughter expressed a desire to be present, and both parents and the midwife were all in agreement that it was okay.  They had made arrangements for another person to be present to care for the three year old in the event she changed her mind.

Forgive me, but I don't see how exactly that is anyone else's business.

But saying it isn't their business wouldn't make for good radio.  So, they instead had to start talking about how this poor child would be scarred for life.  And how dare the parents make her be there.  And how gross and disgusting childbirth is.  And so on and so forth. 

Then they took calls from all kinds of people who agreed with them.  That childbirth is a dangerous medical procedure, with no place for children to be there.  About how she might ask questions about things she shouldn't know about.  About how she'd end up sobbing, curled up in a ball in the corner.

Here's the thing...Aidan was there when both Ally and AJ were born.  And...gasp....he is a boy.  He was three when Ally was born, seven when AJ was born.  He wanted to be there, at my high risk hospital deliveries.  Tom and I were fine with it.  We had someone else there to be with him at each delivery in case it was too much. 

He saw everything.  Yes, everything.  He remembered to plug his ears when the baby was crowning the second time around, warning his Grandma....in just a minute, mom is going to scream

He's never been scarred.  He's not abnormally interested in the female anatomy or how babies are made or any of that.  He has a special connection with his siblings because he was there when they were born.  Aside from Tom and I, he was the first one to get to hold them. 

I know that I am crunchy.  I am a doula.  I've helped at many other births where siblings were present.  Not a single one of them has been upset about what they saw or heard. 

I don't view childbirth as a dangerous medical procedure.  It's a natural part of the circle of life.  It's not something that is supposed to be dirty or scary.  And I certainly don't think it is something we should protect children from. 

It is how they got here, after all.

Every Month - my experience with infertility

There are times that I think I am ready to write about this topic, and then there are all the other times. There are times that it resonates so clearly even after all these years, and then far more times where I feel unworthy of writing about my experience with it.  I look around at people I know who have struggled far longer and endured more heartbreak.  And then I deem myself vastly unqualified

This is something that people ask me about because of my experience as a doula.  Something that I have helped clients with.  Something that I have listened to friends cry on the phone about.  Something that I had to confront personally, albeit relatively briefly.    It is something that you never think will happen to you.  Until it does.

Though no one who knows who I am now without knowing who I've been before would think it, we once struggled with infertility.  It's hard to believe it was a struggle for us, especially given that we can't seem to stop having kids these days. 

That wasn't always the case.

There was a time when we were told we would never be able to have children without a lot of medical assistance.  There was a time when we were told to give up and wait a few years.  There was a time when we didn't know if we'd ever be able to have kids at all.  There was a time when we pooled resources to investigate fertility options.  There was a time.

People who see my children today and don't know the whole story tend to be skeptical.  Surely, there is no way we struggled.  And yet it is the truth.

The hard and painful reality that many couples learn is that getting pregnant, having a baby and forming a perfect little family often doesn't happen the way you envisioned it.  Infertility is one of those things that young people are peripherally aware of, if at all, and assume will never happen to them personally. 

I know that I never thought it would happen to us, certainly not before we were even attempting to get pregnant in the first place.

Our children arrived earlier than we had ever intended, but for a reason.  We had always planned to wait a few years before even starting to try, always assuming that it wouldn't be a big deal to get pregnant.  Then, one day, cancer showed up.  And years before we were even contemplating starting a family, we were being told that there may never be a family at all.

It's not a good place to be in. 

If you are anything like me, having someone tell you something may not be possible only makes you want it more.  We were determined to do everything in our power to try and make it happen.  I was determined.  It worked.  Until it didn't.

I got pregnant, but I didn't stay pregnant.  I lost the baby just shy of 12 weeks.   And then, for a long time, nothing.  That could very well have been our only chance, and it was gone.

Overall, we had about 9 months of trying to get pregnant after that, all the while knowing that it probably wouldn't work.  He'd had radiation treatments which come with a high chance of permanent sterility, but we refused to give up.  Technically, we only had a few weeks of formal infertility.  Of an official diagnosis.

I would never ever want to go back to the place I was in for those 9 months and three weeks.  This is what that time was like for me.

One thing that no one ever warns you about when you are young and in love and idealistic is that sometimes life is cruel and unfair.   Sometimes you can't get pregnant.  And when you want to be pregnant and you aren't, it seems like every other woman in the world is. 

Everywhere you go, all you see are bellies and babies.  Why can they do this?  Why can't I?

You have a friend who gets pregnant.  Or a family member.  Or a co-worker.  And they don't tell you because they don't know how.  You find out eventually.  You smile because you are happy for them, really and truly happy for them.  But inside, you are crying.

You spend too much money on pregnancy tests.  You think this new one that says it can test a few days earlier might be better, so you spend even more on it.  You pee on them and there is nothing.  Every day. 

Every month. 


And then you don't need to waste the money anymore that month.  You bleed. 

And you mourn the loss of something that was never there.

Every month.

Every single month.

You resolve yourself to try again.

You hope.

You chart.

You schedule things that shouldn't be scheduled.

You hope.

Eventually, you buy more tests and start the morning ritual again.

You start to hate your body.

You decide it has failed you.

You decide that maybe you aren't meant to be a mother.

You cry.

You pick up the pieces and do it all again.

You start to feel nauseous and can't decide if it is all imagined in your head or real.

Every month.

Until one day when you swear you see a line.  Except it isn't. 

You get your hopes up, then they are crushed. 

People tell you to relax.  You want to tell them to shut it, but you smile and thank them for their advice.

You cry.

You have dreams about babies and you wake up and there is nothing.

Every month.

I've often wondered what the purpose of the trials of infertility are.  There are plenty out there who believe that everything happens for a reason, but I struggle to see how this could be reasoned. 

Some people get pregnant without trying.  Some people try without getting pregnant. You just don't know in advance which category you will be in.  Until one day when you find yourself justifying buying the 3-pack of pregnancy tests in the drug store because you know you will use them all.

This is a topic that I could write volumes about.  The things we went through, the things people I love have been through.  The things some of my clients went through to get to the point where they hired me.   Every story is different and yet we all share one thing in common.

We know how it hurts to want something you can't seem to have.

Today I am not going to write about all the reasons for infertility or the treatments,  how we eventually had babies or how it shaped our roles as parents.  Because that isn't what today is about. 

Today is about trying to communicate what it was like for me when I was in that place. 

About letting other women who are in that place know that though their struggle is uniquely theirs, they are not alone.

And today, even though it's been more than ten years since I was there, it still hurts.

It still hurts.

Something Borrowed

I normally try to avoid writing things that I know will be too controversial here. 

Don't get me wrong, I love to play the Devil's Advocate as much as the next person.  I did go to law school for a reason. 

Here, though, I try to avoid saying what I really think about things that will turn people off.  I avoid touching certain topics. 

Ironically, one of my professors in law school always comes to mind when I am trying to avoid talking about anything controversial.  She was an eccentric one, to say the least...but then I think professors should be.  I'm sure she has gone on to bigger and better things by now, and I'll not mention any names for that reason.  Everyone I went to school with will know who I'm talking about though.  She was young and feisty, she sipped Coke out of the side of her mouth constantly and said "um" far more often than anyone in the legal profession ever should.  Mr.Cohen?  Remember the tally marks we'd keep? 

Anyway, she'd always talk about the third rail.  The things that no one in politics would ever touch, for if they did, there was instant death.  Abortion was the biggest one.  Medicare was another.  Go anywhere near those subjects and you're just asking for trouble. 

Though these days my life isn't filled with discussions on those subjects as much as it used to be, there are other third rails I've discovered in my journey through parenthood.  The biggest one being breastfeeding.

It's such a hot button issue that there are two categories of bloggers who talk about it: those who stir up controversy on purpose, and those who generally avoid it and talk about it only in passing.   I generally fall into the latter of the two.  I've mentioned it here, yes.  I nursed all my kids, the first three exclusively.  AJ was supplemented, but only right after birth for weight issues and after he turned a year.

I'm a doula, I'm a natural birther, I'm a breast feeder.  I'm crunchy. 



What I haven't done here is climb up on my soapbox to talk about nursing.  I know that it is a super emotional issue where just about any mother can be instantly offended.

Breastfeeding really is the third rail of motherhood, and I'm about to touch it. 

There is currently a topic running through the blogs and even the media as a whole right now though, and I can't ignore the subject anymore.  They are talking about milk sharing. 

The FDA just issued a statement about it, basically saying that informal milk sharing is dangerous and if people need to obtain human milk they should only do so through use of milk banks. 

The reality is that there are many babies who need breast milk for health reasons.  And some of their mothers cannot make enough milk, or any at all.   I will, for now, ignore the fact that most women who don't think they can make enough milk probably could in reality if given the proper support and determination.  Milk insufficiency, though a legitimate condition, affects a very small percentage of women. 

So, what you have is babies who need milk.  And women who pump too much.  They just don't always happen to be mother and child.

A lot of people are just grossed out by the whole idea of milk sharing.  I think that is amusing to say the least.  In this country, we drink milk without an issue....as long as it comes from another animal.  But drinking milk from a human???  That's just plain weird. 

Many people cite the dangers of milk sharing.  They say that you could be exposing your baby to all kinds of diseases and substances passed through from the donor mother without knowing what is in it.  Some cite storage concerns, that the milk may not have been handled and frozen properly and is therefore dangerous.

How is any of that more worrisome than the formula recalls?  I almost died as a baby from salmonella....that I got from a jar of baby food.  Don't believe that the food supply is safe just because it's nicely packaged from some corporation.

There are milk banks, yes.  It is possible to get breast milk that has been screened for disease and processed.  The banks collect donated milk and pasteurize it, which negates a decent amount of the health benefits of breast milk in the process.  The thing that most people don't understand about milk banks is this: they aren't free.  They charge insane prices per ounce of milk.  When you figure that most babies will need somewhere between 24 and 60 ounces of milk a day, that adds up quickly.  Sometimes insurance covers it, sometimes it doesn't.  I know I don't have $300 a day to feed one child.

So there are moms out there who ask their friends, their family members.  I'd say that most cases of milk sharing are not between strangers.  It's not like women are swapping milk in dark alleys with people they don't know.  They know the women who give them milk.  They trust them.  The donors understand how important the milk is.  Most women who spend the time pumping and storing milk are not going to be doing it for anything other than altruistic purposes.  It's extremely time consuming and not very much fun to be honest.

Women helping other women feed their babies.  It's not anything that hasn't happened since the dawn of time.  It's just something that happened quietly before and is now out there in the open.  And the FDA has an opinion about it now.  So everyone suddenly has an opinion about it. 

Frankly, I don't see what the big deal is.  Everyone always gets defensive when people talk about how we choose to feed our babies.  I don't honestly see how this is different.

This is one of those topics that is close to my heart.  Once upon a time, I pumped religiously every day.  Once upon a time, I had a baby who refused to take a bottle.  Once upon a time, I had a freezer full of milk.  Once upon a time, I had a friend who had to instantly wean her newborn.  And once upon a time, that baby still got breast milk until her first birthday.  ;)

Link to what the FDA says about milk sharing
A local milk bank site, for information on cost. Here, $3.50 per ounce.

Popular Posts