Labor support

Great post about continuous support during labor.. (with a video)

http://enjoybirth.wordpress.com/2009/11/12/continuous-support-during-birth-is-golden/

Right out of the gate. . .

I proved this morning that you can, in fact, sin before your feet hit the floor (from your bed).  

You see, I went to bed too late last night.  

Then my boys woke up at 6:03 a.m (that would've been 7:03 if not for the absurd time change). 

Then at 6:04 my boys start bickering over something and then they come pouring into the hall and then my room, all the while yelling "MOMMMMMY!!!" 

Then at 6:05 Eva starts crying because said boys have now woken the sleeping tigress (who has yet to adjust to the time change) and will only cause her to get more upset with each passing minute.  

Of course, this series of events made me boil inside.  I sharply rebuked my boys to get back in their rooms and then did what I knew I shouldn't: go lay back down in my bed.  

Yes boys still fighting... girl still crying.  

Boil. Boil. Boil... 

Then I jump out of my bed, stomp my way into the boys' room (this is more of a warning that mommy is coming.. how scary is that??) and then swing open their door (again, scary).  Jorge jumps into his bed out of fear (sad, yes) yet that does not break my anger.  I get down in Alexs' face and harshly say, "EVA is TRYING to SLEEP!! BE QUIET!! NOW!"  

You have to know Alex.  He puts his thumb in his mouth and his bottom lip is quivering.  He's going to try to be strong and not cry, well honestly, because I just yelled at him to be quiet.  

I stand up fully ready to waltz out of that room and close the door.. but the sight of those two boys, and the power of the Holy Spirit (praise God).. broke me.  

I sat on the floor and grabbed Alex and called Jorge to me as well.. and cried.  

And asked for their forgiveness.  

They were very gracious and kind and forgave me quickly.  

The Lord too. 

Praise God for forgiveness.  

My super boys.

So we don't "do halloween" in our house, but I will do the mess out of 50% off costumes the week afterwards.  As you may know, our little men have a growing collection in their "costume box."  

 

I can rest at ease knowing that Captain America and The Incredible Hulk are tirelessly defending the Garcia casa today.  Im sure I will have fun prying these off of them when it's time to head to my nephew's birthday party later this evening.  

Eva Isabel

Eva on her first birthday (back in August). 

Birth Pet Peeve #42

Okay, while I don't have an official "Pet Peeve" list or anything, I'm sure I could come up with at least 42 items of frustration.  

However, I do have one that has been on my mind not only because I have been hearing it "happening" to other mothers I know, but I have also experienced it first hand.  

First, let me ask you a question?  Would you ever assume that your very well educated and experienced OB would be able to tell you when he/she thought you might conceive?  

Have you ever asked your OB when he/she thought you might become great with child?

Have you ever had an OB tell you, without your asking, when they thought you might conceive?  

I'm going to take a big guess that the answer is NO.  Why would you, right?  It's not like they can predict these things.  

HOWEVER.. fast forward to 39 weeks of pregnancy and all the sudden you and said OB are convinced that if they said, "you are going to have this baby by this weekend, I'm sure of it" that now all the sudden they have supernatural powers that have been hidden up until now.  

You might want to ask them to purchase a lottery ticket for you too, while you're at it.  

Okay, I jest.  But here is my frustration: 

NO ONE, except the LORD HIMSELF, knows when that baby is coming.  Can you guess? Sure that's why its called and ESTIMATED due date (EDD).  That is NOT an eviction day: either the baby comes on that day or else.  

Besides the fact that no doctor is that smart to "know" when baby is coming they also do not "know" how long a labor will last.  

With my third child I walked into my OB appointment at 37 weeks, with no contractions and yet, when my beloved doctor checked me I was a whopping 5 cm's.  He was in complete shock.  Of course he started asking me if I had had any contractions of any intensity (as if I could forget what a contraction feels like) and whether I had any bloody show..etc.  I told him.. "nope. I've just been taking my Evening primrose oil everyday."   Well the next thing out of his mouth was, "Well, Rachel, I think you will have this baby by the end of the weekend."  Of course, I laughed thinking "how silly."  

But what happened next was a surprise , even to me.  I got in my car.. called my hubby, my sister and every other friend I have to tell them "guess what?  I'm 5cm's dilated.. and the doc thinks I'll have the baby by Sunday."  NEVERMIND the fact that I knewI had been taking EPO, this was my third child, I had NOT ONE contraction and dilation can happen even before labor officially "begins."  

Nope. None of that mattered.  My doctor is knowledgeable.  He's seen women in labor for years.  He's delivered countless babies.. surely he knows a labor about to begin when he sees it.  

WRONG.  

I stayed 5 cm's for another week.  In fact, at my next appointment (when I hadn't had that baby by SUNDAY), he came in and what did he say?  "I am so shocked to see you here!"  Why?  Because you now realize that with birth nothing is guaranteed and that you can not predict the future?  I then told him how disappointed I was when Monday morning came and I didn't have that baby and I begged him to never, never, never, never, ever, no matter how much you have the urge to "encourage" a mom, please, please, DO NOT tell her something that you can not, in fact, guarantee. I was dead serious and I believe he actually considered my words.  

Here is the point.  You need to consider every single gestation not in terms of 40 weeks but in terms of 42 weeks.  Even ACOG standards consider postdate to be 42+ weeks.  Meaning, even the "holy grail" of medical standards says you don't need to induce until 42+ weeks, unless there is medical indication.  

Point being:  40 weeks is not the eviction day, its the estimated due date. And when you will begin labor is unknown.  The AVERAGE gestation for first time moms is 41.5 weeks.  Average means some go before, and some go after that.  

And whatever you do.. if your doctor tells you that supposed encouraging info "I think it's going to happen this week (or enter day/time here)" remind them (and yourself) that NO MAN knows the future and that we would call that prophecy, and in the days of  Old Testament Law... if your prophecy didn't come true you were killed.  

Not that I'm saying a hormonal, frustrated, very pregnant woman should consider killing.. even if you want to.  

what to do, what to do??

There really is no way to make this short and sweet but I will try.. in bullet points.  (whew, I'll try):

*After Eva's birth we switched insurance coverage to a lower tier of the same company. 

*Found out last week that where my hospital copay for delivery used to cost $250 (from upper tier) it would now cost $1000 for us to deliver at a hospital other than UAB (where my hubby works).  

*Talked to Brookwood (current OB office) and the main hospital people there agreed to negotiate that to only charging $500 instead of the full $1000.  

*HOWEVER, it is still a $0 out of pocket cost for us to deliver at UAB.  

*I went ahead and set up a consult with their "high risk" OB office (that I was told I would have to go to...even though i do not consider insulin dependent Gest. Diabetes "high risk" in the true sense of "high risk.")

*LOVED the doctor we met with.  She said my birth plan was great and thought I'd get the birth I wanted, however she thought I would be "better suited for the care I want, in the normal UAB OB office and could refer me to a doctor there and that they would be adequate to care for my diabetes."  

*I called said office and set up an appointment.. but felt I needed to call back and try to get in with another doctor I had heard some awesome things about (she used to practice with midwives, loves natural childbirth, etc).  When talking to that doctors nurse, I mentioned my insulin and she said, "oh wait, well if you are on insulin we CAN NOT see you here."  I tried explaining that the doc at the "high risk" office thought they could and this nurse just assured me that they could not.  

*so I call back to the high risk office and speak to that nurse and she says they would be happy to treat me.  it was at that time that I asked what was meant by the "team approach" of care that that doctor thought I might not like as much.  Here is the gist. 

Typical Private practice/UAB normal OB office- you have a primary OB that you see for most of your prenatal visits.  There may only be about 5 (max) doctors in the entire practice and while you see a couple during your pregnancy, you mainly just see your own doc.  Then at delivery, either your doc or one of the 5 (on call) will deliver. At delivery you will have the doc and the nurse in the room (only).

UAB high risk practice- not set up like a private practice. There are 10 doctors in the clinic.  You will see all 10 throughout your prenatal care and at the time of delivery, you will have either one of them as well as (because it is a teaching hospital) residents, nurse and whoever else in the delivery room helping to monitor your delivery.  that's the team approach. 

I told the nurse that I didn't care who they wanted to put in the room as long as they left me alone and didn't say anything that wasn't part of my birth plan.  Even with my strong language the nurse was very adamant that NO ONE would deviate from my birth plan and I could do whatever I wanted to.  And the funny thing is, I believe her.  

Here are the facts that I know:

*While they may want to all watch me like a science experiment because of being "high risk."  The doctor assured me that I would get the birth I want. 

*The doctor herself told me with pride, that their office operates on "evidence based medicine and wants to do everything they can to reduce the risk of interventions." 

*While most private practices talk pitocin after two hours of no cervical change, this doctor said "we don't mention it until six hours of no cervical change.  And we made that decision not based on "research" but because we know the risks of pitocin." 

*This doctor herself left the private practice model of care because she was getting sick of the way that care was being determined based on the bottom line.  C-sections, especially, were rising because of doctor convenience or chance of losing $$ to another doctor.  

Sooo, while I get a little worried thinking about the possibility of having that many medical staff in my delivery, I am fully confident in my own ability to dialogue and only wonder is it all worth it or should I just pay the $500 and stay with Brookwood.  

?? 

To be continued.... 

in case you were wondering..

we are still here.  

boys are doing great.  Eva is becoming miss independent.. which makes me sad. 

The baby is still growing in my belly.  And it apparently has HUGE problems with my favorite guilty pleasure: Taco Bell.  Yes, I ate that "junk."  but about three hours later I threw it up and therefore can guarantee that I will not be eating it again for a very loooooong time.  The same thing happened to another food item when I was preggers with Eva.  

We are going camping next weekend for Reformation weekend.  Annual trip.  Lots of fun.  Last year I had an almost two month old baby.  This year I have an almost three month baby (in the womb).. how's that for irony.  

Getting excited about my own birth since I've been meeting with mommies recently about their own births.  so that's fun.  

well i will stop with the update.  My sister Mishka is on her way to my house and I still need to do some cleaning.. just for the house to be destroyed by six kids 7 yrs old and under.  fun times!! 

Forced post

Just so you know, I am forcing myself to make this post.  Almost in the same way that I have to force myself to eat food these days.. or force myself to do anything productive at all.  

I seem to like Facebook better these days because it takes way less energy to do a status update than to type out a blog post.  Laziness at it's finest, folks. 

I don't want to come across as "that" pregnant lady so I will try to keep it positive in giving the updates going on in our world.. for those that care. 

1. I am 10 weeks preggers and doing better.  But I say that with caution. I still am nauseous but it has gotten a little better.  Now the fatigue has set in and I am so off schedule these days that I just can't dwell on it.  I know it's temporary.

2.  My boys are beating each other up.  I have banned all movies in this house that so much as hint at fighting.  Even if it's against monsters. I am so SICK.AND.TIRED of them not understanding that, while they may wrestle with each other, they may NOT do it to other children.  

3.  On that note, Jorge got tag teamed at Pump it Up yesterday for that very reason.  He kept picking on three boys his same age and size and I kept warning him to leave them alone, or else.  And well.. or else happened.  they all got tired of it.. at the same time.  He was on the bottom of the pile and it made him cry.  What did I do?  the boy had to sit in time out while I explained what just happened and why it happened.  Hopefully, he learned his lesson. 

4.  I am going to be getting pretty busy with births come December.  I have one a month until I birth my baby in May.. well I have possibly (sigh) three in March.  I may have to seriously reconsider that!  Tonight I am meeting with a couple that was referred to me by Greta (a mom who made it all look easy during her own birth).  Thanks Greta.  

5.  I am laughing at how predictable I am as a pregnant woman.  I only truly love the second trimester.  The first is covered in nausea and fatigue and the last trimester is covered in feeling huge and unable to move about easily.  Oh and fatigue.  So I guess I got a three month window where our lives will resemble some sense of order and then its back to blah land.  ;-) Am I the only one like this?  Wait, don't be that mom that tells me how wonderful you feel throughout your ENTIRE pregnancy.  I might throw up. 

6.  Baby girl is adorable.  Just thought I'd throw that in.  She says a few things but I especially love that she calls her baby doll "baba."  And she loves that little doll.  Eva was also in the 5th percentile at her last checkup.. she is such a petite little thing.  

7.  #4 had a heartbeat of 175 at my appt last week.. still too early to determine gender.. but I do remember Eva's being really high  in the beginning.. (sigh) we shall wait and see.  Either way we will be thrilled to pieces.  

Okay that's enough numbers and chit chat.  I must go lay down while it is quiet in the house.  ;-)

Non-Overwhelming Birth Plan

I may change my mind on this after years of doing this, but I am pretty sure that my view on birth plans is going to be different than with most doulas.  Here are two presuppositions that make my view the way it is: 

1.  I assume that a shorter birth plan is a good idea, especially if you are planning on using a doula.  Let me explain.  A doula understands what it takes to have a natural childbirth in a hospital setting.  Therefore, we automatically advocate for such needs whether it's written on a piece of paper or not. 

2.  I assume that since you are giving birth in a hospital, you are understanding the "battle" for that birth plan and therefore desire to do everything in your power to make it a team effort, not a war zone.  Let me explain.  There are doula's out there in this great big world that are angry, frustrated and bitter with the fight for natural childbirth in a hospital setting and therefore do not trust anyone that is in said hospital on their payroll.  This make it very hard for them to work in a way that promotes unity.  However, if you approach it with the expectation that you may run in to road blocks, but that dialogue goes a long way, then advocating for the patient may not create the "war zone" some are familiar with.  

Back to the birth plan. Understanding that a long birth plan only frustrates medical staff, even the nicest of doctors, will help you understand that a shorter one may go a lot farther.  Also, understanding that having a doula is statistically proven to increase your chances of having that birth plan succeed makes a longer birth plan unnecessary too.  

Here is an example of a "longer" birth plan.  And this one is even longer.  Here is my point: these birth plans are great to get acquainted with, but will be scoffed at if handed to a doctor.  But if you aren't planning on having a doula, by all means take it and keep it with you so that you can refer back to it yourself when "road blocks" start happening.  And expect them too. It's only "natural," its a hospital.  

But if you are using a doula, I believe the following birth plan (with anything else added that you want to add) covers the biggest "road blocks" that may come up: 

1.     I would like to have SROM. (spontaneous rupture of membranes/bag of waters).

2.     I would like freedom of movement after SROM as long as head is well engaged. (That is generally accepted to be -1 station, to prevent cord prolapse). 

3.     I prefer to have EFM for 20 minutes out of every hour. (ACOG standards are 30 minutes for first stage labor.) 

4.     I would like a HEPLOCK only, and no IV fluids unless dehydration is suspected. 

5.     I do not want to be offered pain medication. If I need it, I will ask.

6.     I do not want to have an Episiotomy. 

7.     I prefer not to be coached in pushing, rather to push when I am ready and for as long as I am comfortable.  No counting, please.

8.     I would like to push in any position that is most comfortable including: squatting while standing on the floor, all fours while in the bed or sitting up.  I do not wish to push in Lithotomy position.  

TTThere you have it.  Obviously you can add any that you want for after birth:

      I would like for the cord to stop pulsating before it is clamped.  

      I want to wait for the placenta to deliver on its own, without forced pulling. 

I     I would like to nurse the baby immediately to help with bleeding, as opposed to using Pitocin automatically.  

      Then there are the issues dealing with the baby:

I     Whether you want the Vit K shot or not, the eye ointment or they baby bathed in your presence.          

     

     I really do hope this helps.  It is important to know that the goal is to be firm but kind.  Understanding that the battle is against a culture of "how things are done" not a personal attack on "someone."  At the end of the day we are all people with feelings.. so be firm in what you want, but don't make people feel like idiots for doing what they do naturally.  If that makes any sense.  Sounds like what I want to say about some of the medical staff and their treatment of moms and doulas.  But it does go both ways.  

I

Birth Story: Patrick and Tara, Natural Birth

This birth happened last month, but I am just now able to post about it.  I was contacted by Tara after a friend of a friend recommended she give me a call.  Tara had talked to two other doula's, and for different reasons, they did not work out.  At the point that she called me she was getting nervous that she may not find someone to help in time.  She was 34 weeks with her second child (Kirsten, 5) and the first baby came at 35 weeks.  

We set up the informational meeting at her house, which we found out was about .5 miles from my house, and were able to review her desired birth plan.  The birth plan she had was given to her by a previous doula (one that didn't work out) and in my opinion it was too long.  There was no doubt in my mind that most any doctor would NOT want to read through all that, let alone have a serious conversation about it.  It was two pages, typed, single spaced if that gives you any idea.  Tara admitted that she really just went along with it but that she wasn't sure about all the details on the list.  Now while they all sounded "reasonable" I assured her that I could sum up that two page paper in about 8 bullet points that wouldn't put off the doctor.  (*separate post about that later*).  

Fast forward to Saturday, September 19th (two days before EDD).  Around 7:30 Tara called me to tell me she had lost her mucus plug.  Throughout her entire last trimester she seemed to have lots of uncomfortable hip and lower back pain.  So when I asked her to keep me posted on when contractions started, she (thankfully) called me to tell me that she wasn't having so much pain in her belly but was having it in her hips and lower abdomen and her back.  I asked if they were coming in "waves" and she said yes!  Good, those count!  

So the waves were coming every 10 minutes or so.  Around 10 she called and said she had been lying down and it was getting more painful but still about 10 minutes apart.  Since she hadn't eaten yet, I encouraged her (*read, threatened) to eat something and to then try getting up and walking.  She did both and at 12 p.m she called and said that once she started walking that they were coming every 4-5 minutes and were very painful. At that point I suggested that she try to sit on the birth ball and rest (from walking) and see if they slowed down.  At that point, I talked to Patrick and asked how she was handling the pain, to which he said, "she is getting more intense." 

So I got in my car and head to her house.  When I got there at 12:15 she was able to talk in between contractions and within the hour she was starting to cry (not uncontrollably) with each contraction.  She kept saying "I can't do this pain, I just don't handle pain well."  That really made me laugh because to look at her she was a PRO!  She was staying calm and relaxed and was working one contraction at a time.  *later at the hospital during their annoying 50 questions they ask while you are trying to labor, the nurse asked, "how do you deal with stress? by talking to someone, crying, internalizing it, etc" to which Tara said she cries.  Interesting to know since she would tear up when she had a contraction.*

So it was about 1 p.m and the contractions were still 3-4 mintues apart and, while her signpost wasn't "self-doubt,"  I suggested we head to the hospital.. mainly because their hospital was a 30 minute drive away.  So Patrick got their van ready and he drove us while Tara and I were in the very back of the minivan with the back row seat folded over.  Poor momma had to deal with a small area to work with, while on a bumpy ride all while having contractions every 2-3 minutes.  You could definitely say it was a long 30 minutes.  But she did great!! I mean that.  In fact, when they kept asking me how long I thought it would be I just said, "it could be in an hour it could be three hours."  No man knows, but based on signpost, I thought we had a while.  

So you can imagine our excitement when we got to the hospital and she was 8/90/-1!  Awesome!  Tara did part of transition in the van!! What a trooper.  She really felt better sitting up in the bed so that is where she pretty much where she camped out.  She stayed on top of her contractions and about 45 minutes later she told us she was feeling lots of pressure.  Her doctor was in the room at that moment (which let me just say, she had an amazing doctor!) and wanted to just check, which Tara was okay with.. she was 9 with an anterior lip and at a 0 station.  Just as the doctor was pulling her hand out I asked "and her bag of waters is still intact, right?" and literally at that moment a gush came.. it was so funny because the doctor, knowing that momma wanted a spontaneous rupture of membranes, immediately said, "uh well, (as she pulled her hand out) I PROMISE that wasn't me!"  

about 15 minutes later Tara started to bear down with each contraction.  She pushed for a total of one hour and 15 minutes.  She even tried "squatting" while on the bed (she was on her knees leaning on Patrick" but the baby was having some ugly decels so we tried sitting on the bed at a 45 degree angle and the baby did much better (turns out that was because there was a nuchal cord, wrapped around the neck 360 degrees, so gravity was NOT helping).  

At 4:04 Tara pushed out (with NO tearing) Isaiah who was 6 lbs 14 oz and 19 1/2 inches long.

She didn't think she would be able to handle the pain, but she did!  She, and Patrick, did an amazing job!  The nurses were so compliant with the birth plan and kept referring back to it and at one point when the doctor was in the room our nurse said, "what do you want to do about (something I can't remember)"  and the doctor said, "well whatever momma wants!"  It was beautiful and refreshing.  Our nurse was so hands off that at one point during the pushing I looked at her and said, "feel free to step in at any time, I am not trying to run this show.  We are a team!"   She said, "oh no.. everything is going great and I did natural births for 15 years and I know the one thing the momma needs is to be allowed to do what she needs to do."  Tell me that ain't awesome!  

Great job Tara.  Your sisters were shocked to find out you "actually did it."  But I knew you could even before the big day!  You rocked!  You truly made it look easy!