Wednesday, January 25, 2012

Mommy Got Back

Not exactly sure where in the baby book you file this story, but here it is:

I wore a dress muumuu today, and as I was filling out Callum's daily sheet at daycare this morning, I felt a light breeze as he played with the back of my skirt, though thankfully, I don't think anyone saw London or France. As I knelt down to give Callum a farewell hug and kiss, he started giggling and said, "I played with your big butt! I laughed!"

I corrected him: "No, Mommy has a TINY butt."

His response: "No, Mommy. You have a big butt."

Tuesday, January 24, 2012

About that Midwife I'm Seeing...

I am seeing a midwife for Baby Jedi's prenatal care and birth. Upon learning this, most people give me a skeptical raised eyebrow, a tilted head, and a multi-syallabic "oh." I used an OB with Callum, and while I will never regret that decision and believe that I received excellent medical care, the experience left me traumatized (healthy mom and baby notwithstanding). Anyway, here's a terribly long post about why I switched providers. Let me be clear: my decisions and opinions are not a judgment of your decisions or differing opinions.

There's not much about childbirth that can be controlled.

You don't know when labor will begin. 
You don't know how baby will present himself. 
You don't know how you'll respond to least, not the first time.

You can control where you labor. 
You can control who will attend your labor - partner, friends, doula, medical care provider. 
You can control your own preparation for labor. 
You can control the coping mechanisms you use during your labor.

When I had Callum, my goal was to avoid a c-section and as many interventions as possible unless medically indicated. My stance on pain relief via epidural: wait and see. That was the extent of my birth "plan." I found the idea of planning the minute details of a birth ludicrous, and I feel much the same way today (though I do plan to create a page or less of bullet point birth "preferences" to share with my care providers). In hindsight, the only part of my labor that did go exactly as I would have planned was that it began spontaneously (at exactly 41 weeks, on the day I was scheduled to be induced). During labor, I was so focused internally and mostly unaware of things happening around me. To this day, I cannot tell you the names of my delivery nurses nor describe what they looked like. Although Chris's handwritten notes indicate otherwise, I did not know that Callum was occiput posterior until my OB requested to use forceps for delivery. 

I know that after 6 hours of hard back labor and progress from 0cm to 3cm in that time (which, in hindsight, is pretty FRAKKING awesome), I lost all confidence in my ability to continue laboring without an epidural. I was tethered to an external fetal monitor that limited my range of motion, and I believe that my request for intermittent monitoring was denied (though in my stupor, it's possible I did not state the request clearly). When my OB checked me, I remember him saying something along the lines of "I hate to see you in pain like this" and "An epidural will help you relax so you can have this baby sooner." He offered to break my water, but I declined, as I knew the c-section countdown clock would start. It seems in labor, I'm also vulnerable to persuasion.

I hated the epidural. It made me nauseous, goofy as hell, and I could not feel a thing. Chris would watch the monitor and tell me when I was having a contraction. Only toward the end did I feel any sensation that seemed reminiscent of a contraction. I remember being quite surprised that I could feel something...just not the pain. It never occurred to me to ask that the epidural be turned down. Not surprisingly, my labor stalled at 4cm for the next 4-5 hours, so they cranked up the Pitocin until Callum showed signs of distress. My OB returned (having just finished mowing his lawn and having not appeared to have since showered), broke my water, inserted an intrauterine pressure catheter (it screws into baby's scalp and more accurately records the strength of contractions), and turned the Pitocin back on.

My labor finally got going again, at least as defined by my OB (1cm of change every 60-90 minutes), and by 4:00 in the afternoon, according to the nurses, I was ready to push. I doubt that I was a particularly good pusher, as I had no sense of what I was supposed to be doing or where to focus my efforts. I still couldn't feel anything. I remember loudly farting (OK, fine, probably pooping) in close proximity to one of the nurses and getting the giggles. I knew that when my OB showed up, the end was near.

It turns out that but for the epidural, I would have had a c-section. The pain and pressure of a forceps delivery - even though the cloud of the epidural - was indescribably horrific, because I knew exactly what was being done. It scared Chris; it appeared to him that the doctor was using a lot of brute force. For me, the fear was all consuming. I think it was in that moment that my hormones went haywire and perhaps why I struggled so much with nursing and some very dark baby blues and postpartum anxiety (I shit you not: I was convinced we should have been eaten by wolves). I saw the needle the OB used to stitch me up, and I swear to God it looked like something you'd crochet with (that's a nice thought: a crocheted vagina).

I remember one of my postpartum nurses, who I'm sure was trying to comfort me, compared my recovery from a 3rd degree tear to that of a c-section. I was not amused. Many months later, after an allergic reaction to some pain medicine for a never-ending cough, I confessed to my family physician's nurse that I took some of my leftover postpartum Zofran (anti-nausea medicine that helped me keep the postpartum Percocet down) with the new pain medicine. She looked at me in disbelief and said "but you didn't have a c-section?!" I guess some women who give birth vaginally are sent home with Advil and a stool softener. I assumed everyone got the good stuff!

Callum's birth has always weighed heavy on my heart. Of course I am thankful for a healthy outcome. The experience itself left me wanting something different, and I realized I wasn't all that impressed with my OB's care. We overheard him scoff when we requested that Chris's blood be typed at our first appointment. He failed to mention his week-long European vacation during my 40th week of pregnancy until I was 38 weeks along, and then would not allow me to meet any of his partners (after he'd promised at my first prenatal visit to be at the delivery). He did answer all of my questions, but was certainly very pro-epidural, and did not offer or discuss other types of pain relief. He did recognize that this was not the birth experience I had hoped for.

This time around, I have chosen to change those factors over which I have some control, the biggest being my choice of provider. Midwives specialize in normal pregnancy and childbirth. Because I have chosen a midwife to attend my birth, I have also switched to her preferred hospital, as it is more familiar with and accepting of midwifery. (An aside: midwife-attended home births in Nebraska are illegal. While I don't think a planned home birth would be a comfortable option for Chris and me, I find it ridiculous that the option is legally prohibited, and I know of two women who went "underground" for planned home births, presumably attended only by family and friends.) My midwife is a Certified Nurse Midwife. She and her partners are part of practice that includes four OBs, and she will transfer my care to an OB if my pregnancy becomes high risk or my labor has complications. She has made no promises about attending my birth and strongly encouraged me to schedule at least one appointment with each of her midwife partners. She is responsible for taking my vitals during each appointment; I have no nurse to run interference with the OB. Though our earlier and later prenatal appointments are only 15 minutes long, the "middle" appointments are 30 minutes long so she can educate me about pregnancy and childbirth and take the time to answer my questions.

Most importantly, the midwife will be with me throughout my labor and delivery to provide medical and emotional support. When I show up at the hospital, she'll be there too, and she won't leave my side until Baby Jedi is born. She can get in my face to tell me what's going on and what to do, and she offers a tried-and-true menu of distractions, position changes, coping mechanisms, and practical experience. With continuous positive support, an unmedicated low intervention birth is realistic and something I hope to achieve. That being said, my birth "plan" for Baby Jedi is the same as Callum's: NO REGRETS. Get him out with as few interventions as medically necessary, and we'll take a wait and see approach to the drugs.

I've also been reading and learning more about unmedicated childbirth (thank goodness for my Kindle so I can read these on the down low in the presence of others). Many of the midwifery books are bit too new age for my taste and attempt to completely discredit the medical "model" of birth followed by OBs. There IS a middle ground! I try to skim these sections and focus on the practical advice on preparing for and coping with labor pains. Maybe I'll get around to preparing a reading list...

And finally, to dispel some myths about modern midwives and midwifery:
  • I can have an epidural under her care. She is not trained to use forceps or the vacuum, and in the event of a c-section, will serve as the OB's first assistant.
  • She is not some wizened old granny with sachets of herbs in her skirt and a tackle box of obscure plants and tinctures.
  • Likewise, she does not appear to be some crunchy granola braless hippy, and I appreciate her collection of cute shoes.
  • She accepts my insurance, and therefore, I will not pay for her services with livestock and a sack of grain.
I am really, really excited for Baby Jedi's birth! I can't wait to meet him!

Wednesday, January 4, 2012

22 Weeks

The second child is already getting the shaft when it comes to regular pregnancy blog posts. Here's me a week or so ago, somewhere around 22 weeks along:

I've got more belly than that today, though it kills me to compare this to my 20-week belly with Callum.

You guys?!?! I haven't been that skinny since...well, since that picture was taken, and I've done since birthed THAT baby.

I've not written much about this pregnancy, as it's truly been SO DAMN EASY (first trimester nausea and misery notwithstanding...and even that was short-lived). I have nothing to whine about, nor is anything I'm experiencing particularly humorous or noteworthy. My "wacky" symptoms include frequent peeing and frequent hunger, an occasional but entirely manageable achy lower back, a few food and smell aversions (though in my defense, green peppers and scrambled eggs don't smell particularly great to my non-pregnant self), and some fatigue. I am pooping with acceptable frequency, and my farts are no more lethal than yours. I'm sleeping well, and I have yet to really want or need the bevy of pillows that kept me comfortable at night last time. My emotions have been kept mostly in check, and I'm not nearly as physically aware of the hormonal fluctuations as I was last time. I grunt more than usual when changing positions or getting off our (way too soft) couch, but that just comes with the territory.

Perhaps the novelty of being pregnant has worn off - I don't immediately dive into my copy of Mayo Clinic Guide to a Healthy Pregnancy every single time I experience a new pregnancy side effect. Maybe I'm more focused on how this one will make his debut and what I can do to make that a positive healing experience for me. Or, maybe I realize how simple it is to care for a tiny newborn while he's still on the INSIDE, and I can sleep for multiple consecutive hours. Could it be that I've mellowed a LOT in three years?

Or, perhaps this is just the calm before the storm.