My Thoughts as a Pregnant Woman about Forgiving Myself

This is a post I wrote on the blog I was keeping throughout my pregnancy...little did I know that less 24 hours later, I would be admitted to the hospital and induced into labor...another story for another day. But this post is an example of how sometimes in pregnancy, like in any other aspect of life, things may not go how you plan and you have to accept that it's not always your fault, especially if you know and do your best.

 

Maybe not an epiphany, but…

…definitely a tough realization. I had “it” last night while talking to my sister…it was one of those things where you talk and talk so much that eventually something profound pops out of your mouth without even thinking about it.

I was explaining to my sister all the reasons why I want a completely unmedicated birth (in no particular order):
1) I want to avoid the slippery slope of unnecessary interventions. For example, if you are induced and they start you on Pitocin, your body is forced to labor before it is ready, which leads to much stronger and more painful contractions than you might have actually had if you had avoided the drugs. Now that the pain is SO strong, you feel like you need an Epidural, so you get one. the thing about an epidural (or any pain medication) is that it slows down your contractions, and before you know it, you’re being given MORE pitocin because you’ve plateaued or slowed down more than the hospital would like. The pain is back full force, so you get more pain medication. Lo and behold, the doctor walks in and tells you that the baby’s heartbeat has slowed/risen/become erratic, etc. and now you need an emergency c-section. What they won’t tell you is that the heartbeat got like that because the baby couldn’t handle the constant changes in the uterus due to the medications.  Now your baby is in danger and you need emergency surgery just because of one intervention that didn’t even need to happen.
2) It’s safer for the baby to labor naturally, not just because of the reasons I listed above, but because every medication you could be given (and there are LOTS of kinds, not just pitocin or an epidural) can leave your baby in a stupor for hours, even days after birth. I would rather bond with a baby that is more alert than know he has no clue who I am because I made sure he was born zonked out.
3) the most important reason in my gut is that I VALUE the hard work and dedication it takes to give birth naturally. I don’t know if it’s this city and it’s “get in, get out, get on with life” superficiality, or what…but there is ZERO support here for mothers that want to go natural. You’re likelier to be told you’re insane for trying (even by other moms) than receive any sort of support. There’s no natural-method birthing classes in the entire county, insurance doesn’t cover midwives (if you can FIND one), there’s no resources on cloth diapering or baby wearing…even breast-feeding past 3 months is weird and taboo here. I’ve spoken to two OBs and even hospital staff regarding my wishes for a natural birth, and every SINGLE time, I was answered that all my requests would depend on what drug(s) I was on at that particular stage of labor. So literally EVERY person I spoke to regarding my birth assumed that I would have some sort of drugs at some point of the labor, even when I had prefaced the conversation with “I want a natural birth, so…”

 I mentioned that earlier this week, I had a breakdown because I was so frustrated with the anxiety of the upcoming birth and not being able to plan for everything because every time I spoke to someone else about my birth plan, I was told at least a couple more things I could not count on having. While I was talking to my sister, I realized that my problem was the planning. I desperately want a natural, drug-free birth, but the fact is that all the books I’ve read on the topic and all the videos I’ve watched to prepare all assume that I will be among supportive people in an environment suitable for natural labor and delivery.

I am not. And I will not. And as much as I blame myself for that, it is unreasonable to because there’s nothing I can do about it.

The hospital requires continuous fetal monitoring. They don’t have wireless OR waterproof monitors. This means that once I am admitted to the hospital, I will literally be strapped to a bed in one position until I have the baby. In my original birth plan, I wanted to labor in a tub, or at least in a shower because I’ve found throughout the pregnancy that all my pains can be eased substantially with warm water. Well, there ARE no tubs, and I am not ALLOWED to shower until after the baby is out, “considering whatever drugs you’re on have worn off at that point”. Why? “Hospital rules.” That’s it. I’ve not once been given a legit medical reason why I can’t do X, Y, Z…all I get is “it’s hospital policy and they’re not flexible” which is basically they’re way of saying “don’t try to fight us on this, you’re going to lose.” In fact, I was even told by one of the doctors that if I want to labor in the shower, I better “stay at home as long as possible”. Hmm.

Because the hospital requires continuous monitoring, I am also not allowed to walk, squat, or otherwise change position at all because I cannot take the monitor off. Every resource I’ve come across says that changing positions can be the difference between tolerable and intolerable contractions, and that laying on your back is the absolute WORST and most PAINFUL way to labor. Well, that’s apparently the only choice I have.

I’ve been mentally preparing for the fact that labor is going to be hard and painful and will require a LOT of determination on my part, but that’s considering that I’d have the ability to labor in a way that would encourage or facilitate what I want/need. In my current situation, I’m fighting an uphill battle because I’m putting pressure on myself to do something that’s ALREADY so difficult, PLUS I have the hospital policy pushing back at me. It’s an uphill battle at best.

So what conclusion did I come to?

I cannot plan. I should not worry. I am as prepared as I can be, but I do not know what to expect, and I shouldn’t expect anything because it will only lead to disappointment if/when things don’t go the way I thought they would.

So I am still going to do my best to cope with the pain naturally using the techniques that I have been focusing on for months. But I am also trying to come to peace with the fact that I might feel I need pain medication, and that I shouldn’t hate myself or feel disappointed if I go that path. As it is right now, I know I will feel like an absolute failure if I opt for pain medication, but I realize I need to cut myself some slack because the hospital is literally making everything as backwards to what I need as they can, and there’s nothing I can do about that.

As soon as I said out loud to my sister that I should try to forgive myself in advance in case I DO opt for pain medications, a calm came over me. As long as Bu gets here healthy, I should focus on that and not HOW he got here, though I do still feel it’s so important to do my best and go natural for the both of us. I’m not 100% ok with being this flexible yet, but I can’t  regret something I haven’t even done yet, and if I DO do it, I can only use it as a learning experience for next time.

And by next time, I mean I am NEVER setting foot in an OB or hospital again when it comes to having children. I must find support for a more natural path here, otherwise I foresee all of Bu’s future siblings being born outside this city. This pregnancy has made so many beautiful things in my life, but it has also made me deeply dislike this city and it’s attitude, and I’d love nothing more than to give my children a chance to live AWAY from it and it’s influence.

Breech Presentation...What? Why? How?

A baby in "breech" position is basically considered an automatic cesarean, at least in the United States. Many doctors are no longer trained in breech deliveries, and so the immediate conclusion that they come to is that mom will need major abdominal surgery due to their lack of training. It is what it is, right?

Wrong.


What is Breech?

• Frank Breech, which tends to be the most favorable. This is when baby’s bottom presents first and feet are by the head.
• Footling Breech is when baby has one or both feet presenting first.
• Complete Breech is when your baby is comfy sitting cross legged.

Why won’t my doctor do a vaginal breech birth?
This could be due to a variety of reasons:

• They may not have a lot of experience attending vaginal breech births.
• May not feel comfortable attending vaginal breech births.
  
• May have had a bad experience in the past.
  
• There may not be suitable back-up at the hospital where they practice (on call anesthetists, pediatricians, experienced midwives, 24 hour operating room staff).
  
• They may not believe in vaginal breech birth.
  
• Defensive practice in current childbirth culture means that doctors are more likely to err on the side of intervention (cesarean section) rather than non-intervention (vaginal birth).
  
• It is easier for a doctor to perform a cesarean section than a skilled vaginal breech birth.
  
• Cesarean is an accepted birth method in today’s culture.

How should I approach my child's breech position?
*Do nothing.
Depending how many weeks pregnant you are, you may decide just to wait for your baby to turn. The majority of babies turn spontaneously pre-term.

*Non-medical turning
Alternatively, there are various non-medical turning techniques you can try.  You can read more on Spinning Babies. 
 
*Look for a care-provider who will support you in whatever option you choose
Many maternity care-providers do not support vaginal breech birth and will advise a planned cesarean section at 38 or 39 weeks if your baby does not turn.  This is partly because most obstetricians and midwives do not possess skills in vaginal breech birth and so they are unable to offer this option safely. However, depending on various maternal and fetal factors, vaginal breech birth is not necessarily any riskier than cesarean section, particularly with the support of an experienced attendant. 

Before 37 weeks of pregnancy, breech presentation is much more common - about 20% of babies at 28 weeks are breech, and 15% at 32 weeks. Before term, which is defined as 37 weeks, it doesn't matter if the baby is breech, as there is always a good chance that she will turn spontaneously. Some babies do turn by themselves after this time, but it is much less likely, and some preparations should be made to decide how delivery is going to take place. About 10% to 15% of breech babies are discovered for the first time late in labor!


Very soon, I will post two guest birth stories. One of these stories is from Felicia, who had a cookie-cutter, non-complicated pregnancy but was forced into cesarean delivery solely due to a breech presentation. The second is from Kristel, whose daughter came out booty-first at home in the water. These ladies are examples of how having supportive care providers can make the difference between the birth experience you want and the experience that is forced upon you.

Further Reading:
Spinning Babies 
The Webster Technique
Breech Decision Making Sheet

UPDATE: Please click HERE for the Breech Babies tab, so you can read the birth stories mentioned above and any other resources on this site regarding breech babies.



Sources: 1, 2, 3, 4

Guest Post: "Baby After Bypass"

So I was fat. I still am fat (not that there's anything wrong with that!), but I was REALLY fat when I was little. I was born and raised in Jersey and I have a stubborn German for a father and a pile of moosh n' love for a mother. I heard a lot of crap from my dad about being heavy. "Put the food down." "You'll die big you know." "Try to lose weight so you can play with your friends..." I don't ever think he meant anything bad by it, but it really took a toll. And as for my mom: "lets go get ice cream so you won't be sad anymore.." (you can see how this snowballs, right?)

When I entered high school I had already had years of bullying. As if being big wasn't enough, I had pimples, I wore glasses, and I had super short hair. I was a target for sure. But as I went to doctors for check ups, we realized one thing: weighing 380 pounds when you were 15 years old was pretty darn unhealthy. It was literally killing me and I was scared.

Around this time gastric bypass was pretty knew, but something drastic needed done. I had all the visits and analyzing one could ever want, and I was in. I was going to get the Roux-En-Y gastric bypass procedure on December 13th, 2002. I went under the knife and came out alive. AND SUPER GASSY! In one week I lost 36 pounds. In one month I lost 90. In 6 months I lost 200 pounds. I could finally walk up the stairs and not be in pain and out of breath. My life had changed for the better.
I did have some complications but they were minor. I still have skin, 10 years later, that I'd like gone, but I'm married now and my husband loves me for what I am and he thinks I'm sexy. (I met my husband on match.com and said hello because I thought his beard was AWESOME. It was love at first beard )

My husband and I said we wanted a family and we started TTC in january of 2012. Frustrated 3 months later we were told to relax and grab some champagne. We did...and voila! Pregnant! I had some concerns having had the surgery and being pregnant. Also, trying to conceive wasnt difficult and it was fun my husband is big too so our positions are limited but our energy never is! We wanted a baby so bad so we tried all the time. The surgery had no impact on our ability to conceive.

 I asked all the doctors if I was safe and how to get my calories in. NOTHING that went in my mouth could be crap calories. Everything I ate had to be good for me and for baby. So that's what I did.
Everything I had was high in protein and I ate many small meals through the day. I drank protein too, tried to cut back on coffee (so hard!), and tried not to head to fast food too often. I did have my fair share of ice cream and pickles for sure, but I did crave healthy things too which helped a lot. I had a complication free pregnancy: no gestational diabetes, no problems whatsoever. I kept myself in check and made sure to do things right. This baby was too important to my husband and I.

In February I gave birth to a chubby 7 pound 13 ounce boy: Edward Remy. I was in labor for 2 hours before fully dilated, and pushed for 18 minutes until he came into this world. He truly is the most amazing thing. My husband and I can't wait to have another!

The gastric bypass was harder to deal with when it was initially done. I was young and didn't follow "the rules" like I should have, but I managed to keep the weight down (although I gained back a little bit). Once I got pregnant I didn't want anything to damage my tummy or my baby, so I kept in close contact with the gastric doctors and they helped me a lot. I would do BOTH of these things again if given the chance. I've never looked back!

This story was shared by Molly, momma of one from Levittown, PA. Molly is the owner of MollyCakes Bakery, find out more about her awesome cakes here.

for Doulas, EVERY day is Labor Day!

I would have LOVED to have participated in my local Improving Birth rally today, but I had a family commitment that I couldn't break... I was there in spirit with all my birth-loving sisters!

Speaking of sisters, I had to share this poster that was created by Kristen June Renz for the rally, using a quote from Cheryl Diane Lewis of Natural Mother Magazine. It spoke so much to me!

Cervical Checks and why I'll forever DENY, DENY, DENY.

*DISCLAIMER: This post is made up of both my opinions and research. The research and reading I did while writing this is cited. Do NOT take this post as medical advice as I am not a doctor and don't claim to be. However, I hope that reading this does make you aware that you have options, and that it's best to do your own research into your options and the consequences of each choice. Remember: if you don't know your options, then you have no options.

A conversation in one of the internet forums I belong to recently turned to routine cervical checks and what I think of them. My exact answer was:

"I'd rather go through my Pitocin augmented, pain med free 46 hour labor again rather than EVER getting another cervical check"

I remember being in labor, thinking I was going to die during the cervical checks. Literally. I was making my peace because I was certain the pain of those checks was going to throw me into shock and my heart was going to suddenly stop beating. The labor was nothing compared to those checks.

Needless to say, I'm not really a fan. But I was in labor, I was scared, and I didn't think I had a choice. BUT I DID. I just didn't know it. Now I do know about my choices, and I can assure you my next pregnancy and labor/delivery will go much differently as a result.

Routine cervical checks (when a doctor does an internal measure of how dilated and/or effaced your cervix is) usually start happening at about the 36 week mark in pregnancy, though they may start as early as 34. The reason your OB gives you that fancy gown to change into at your appointments is to make these tests possible. They check you, give you a number, and possibly make judgements or plans surrounding your birth based on what they find.

Now here's the thing....these figures tell the doctor NOTHING. Some women are dilated to 3cm for weeks and it has no bearing whatsoever on when they'll go into labor or how long the labor will take. Other women are completely shut until the moment they're in labor, and have 5 hours between their water breaking and seeing their baby emerge.Cervical checks are absolutely pointless if you are not in labor.

What about during labor? Well, you might want to know. Your doctor might want to know. But again, your "number" at any given point of labor has no effect on, nor can it predict, how much longer it'll be before you can push. In fact, here's three things I learned about cervical checks during my labor (besides how astronomically they hurt me): 

*Firstly, different people have different sized hands and  checking for dilation is not an incredibly scientific process. Two different people might check you within minutes of each other and get two completely different measurements. 
*Secondly, knowing that number may just discourage you. Imagine being at full on transition strength contractions for 6 hours on Pitocin, only to be checked and have a nurse tell you that you opened up another half centimeter in those whole 6 hours. Talk about taking the wind out of your sails.
*Lastly, checks during labor take the laboring mother out of the flow. It's an interruption that takes you out of whatever space you put your mind in to get yourself through the next contraction, or whatever your focus object is, or the anticipation of meeting your child that helps you get through the pain. Whatever your "happy place" is, you have to snap out of it every time anyone even talks to you, let alone tells you to lie down for one of those checks.

Another thing I didn't know? Cervical checks can lead to infection, especially if your water is already broken. If only I had known that, I would have denied each and every one of those checks right off the bat. You live and you learn, right?

So what am I going to do next time instead? Keep my pants on! Unless the prenatal appointment includes the GBS test, there's nothing that's going to happen at that office that can't happen while I stay in my own clothes. As far as during labor, there are other ways that a medical professional can tell how close you are to being ready to push. If anything, I suppose one could opt for minimal checks and perhaps choose to not be told the "progress" so as to not get discouraged. Plus, minimal to no checks mean less chance for a doctor to pull the "failure to progress" card. 

What is your experience with cervical checks? Perhaps they didn't hurt you and I was just lucky ;) perhaps the number encouraged you to keep going when the going got tough...I'd love to hear all opinions and perspectives on this!


Additional Information:
*Stages of Labour and Conclusion
*The Assessment of Progress

Advice to fellow plus size preggos

You absolutely CAN have a healthy pregnancy at any weight! I weighed 285 when I got pregnant and got up to 318, with no hypertension, high blood pressure, diabetes, NOTHING!

My advice: BE YOUR OWN ADVOCATE! Read and research everything, and don’t take anything your doctors tell you at face value. A lot of doctors don’t have a lot of experience dealing with overweight/obese moms-to-be and might default to giving you generalized advice assuming your health is crap when it may or may not be, regardless of your weight.

I labored drug-free for 46 hours (!), and only ended up having a c-section because I would not dilate past 3 cm…my weight was not a factor. I researched all my options fully (google was my best friend!) and was very strong in my convictions of how I wanted my labor and delivery to go, but only because I learned enough to confidently push back against the doctors and hospitals when I felt they were taking a course of action not because it was safest, but because of their ignorance or because it was more convenient for them.

It’s your labor, your delivery, your child, your life…you CAN do it! And don’t let anyone tell you or make you feel different. I feel I am a much stronger person overall BECAUSE I was a plus size preggo!!! :)

and CONGRATULATIONS!!!!!!!!

VBAC vs RCS risks

VBAC vs Repeat CS Risks as presented by iCAN

VBAC or Repeat Cesarean
What is safe? What are my options?
If you have had a cesarean delivery and are planning another birth you have to make a decision to have a Vaginal Birth after Cesarean (VBAC) or a Repeat Cesarean Section (RCS).  This can be a hard decision with all the misleading information out there on both topics.  Lets look at some of the facts.
VBAC (Vaginal Birth after Cesarean)
The biggest concern with VBAC among women is uterine rupture. Permitting labor to begin naturally with a low transverse scar ("bikini cut") VBAC after one previous cesarean carries a risk 0.4% of uterine rupture with an increase in an augmented or induced labor. (Landon, 2004)  Successful VBAC's have lower complication rates than planned RCS which have lower complications than a "failed" VBAC. (Landon, 2004)
VBAC is a safe and appropriate choice for most women with one prior cesarean and for some women with two prior cesareans according to ACOG, 2010.
"the chance that a VBAC candidate will require emergency surgery, is for all practical purposes, no higher than that of any other pregnant woman" and "the risk of VBAC is not substantially greater than the risk of any type of childbirth" (Bruce Flamm, MD, Birth after Cesarean)
VBAMC (Vaginal Birth after Multiple Cesareans)
Here is a link to a study done in 2006 by Landon, Risks of Uterine Rupture with a Trial of Labor in Women with Multiple and Single Prior Cesarean Delivery.
The study of 975 women with multiple previous cesareans found a rupture rate of 0.9%. They also showed VBA2C within two years of a previous cesarean delivery to have a 1.1% rupture rate. Not nearly as high as many doctors tell you. Those risks are still lower than those risks of a 3rd cesarean.
Landon concludes, Vaginal birth after multiple cesarean deliveries should remain an option for eligible women.
Overall trial-of-labor success rates were 73%Single prior cesarean delivery success rate of 74%Multiple prior cesarean deliveries success rate of 66%Two prior cesarean deliveries success rate of 67%Three prior cesarean deliveries success rate of 55%
Cesarean
When a cesarean is necessary it can be a life saving procedure for mother and baby.10 true reasons for a Cesarean
Cesarean Risks include placenta accreta, hysterectomy, blood transfusion, ICU admission, which increases with each surgery and uterine rupture. Whereas with successful VBAC uterine rupture and other labor related complications decrease significantly.
The risks associated with RCS increase with each cesarean performed.
Maternal death is very low with each option: 0.02% with VBAC and 0.04% with RCS. (Landon, 2004)

Make an informed choice about the risks of Repeat Cesareans vs. VBAC's
1st C-section Risk of hysterectomy: 0.65%Risk of blood transfusion: 4.05%Risk of placenta accreta: 0.24%
2nd C-section 1st VBAC Risk of major complications: 4.3% Chance of successful VBAC: 63.3% Risk of placenta accreta: 0.31% Risk of uterine rupture: 0.87% Risk of hysterectomy: 0.42% Risk of hysterectomy: 0.23% Risk of blood transfusion: 1.53% Risk of blood transfusion: 1.89% Risk of dense adhesions: 21.6%
3rd C-section 2nd VBAC Risk of major complications: 7.5% Chance of successful VBAC: 87.6% Risk of placenta accreta: 0.57% Risk of uterine rupture: 0.45% Risk of hysterectomy: 0.9% Risk of hysterectomy: 0.17% Risk of blood transfusion: 2.26% Risk of blood transfusion: 1.24% Risk of dense adhesion's: 32.2%
4th C-section 3rd VBAC Risk of major complications: 12.5% Chance of successful VBAC: 90.9% Risk of placenta accreta: 2.13% Risk of uterine rupture: 0.38% Risk of hysterectomy: 2.41% Risk of hysterectomy: 0.06% Risk of blood transfusion: 3.65% Risk of blood transfusion: 0.99% Risk of dense adhesion's: 42.2% NOTE: "Major complications" include one or more of the following: uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.
All VBAC stats for this chart are taken from the Mercer and Gilbert study, 2008 which includes induced and augmented labors. Additional studies have shown lower uterine rupture rates (especially with spontaneous labors) and higher VBAC success rates with non augmented or induced labors.

According to the World Health Organization (WHO) Countries with some of the lowest perinatal mortality rates in the world have cesarean rates of less than 10%. There is no justification for any region to have a higher rate than 10-15%.
In all 50 states VBAC is legal and in some states it is legal for a midwife to attend an OOH (out-of-hospital) VBAC. However of the women interested in VBAC 57% are unable to find a supportive care provider or hospital.
With the new AGOC (2010) guidelines in place we hope to see VBAC's increase and have more women find supportive care providers!You CAN birth!!