Friday, December 17, 2010

The Place Beside

I wrote this June 1, 2009 as a place-holder for the challenges I often experience when called upon to witness the grueling reality of life in the NICU.

The Place Beside

A curtain lifts, a curtain falls
What will I witness today?
A certain touch, a certain look
When will it always be the same?

My heart races, my heart rises
Who feels it most inside?
Your heart races, your heart sings
Where does the compassion hide?

A person lives, a person dies
What does that say about me?
A task awaits, a task can wait
When will a littlest one be safe?

Saturday, October 23, 2010

words fail

So I started this blog assuming I'd have a lot to share about going to grad school, being a mom, and working too. Yes, I have a lot of things floating around in my head, but very little to "say" in a literary way. I've decided that it is not only due to lack of time (although that is a huge understatement and underestimated factor from the pre-grad school days), but rather, I am processing so much right now that I am not worthy to elaborate just yet on any of it.

I will say though that I am somewhat amazed at myself. Working 30 hours a week, raising 3 children and all that entails with sports, piano, homework, etc..., plus grocery shopping, house cleaning, cooking, husband care..., working out (not a lot but I do it!), and reading and paper writing for school. I hope that I am being a good role model for my children. I hope that they see my stick-to-it-ness, my cheerful attitude, my resolve to be the best I can be.... I really hope they see it because I would hate to find out that this is all just self-indulgence and that my family has gained nothing while I gain so much. I hope that the costs are worth it. I think they are, so I will keep at it, doing my best - in the hopes that my children will want to do their best too.

Monday, August 9, 2010

NICU Series by DiscoveryHealth - Why did I expect more?

I finally got around to watching my Tivo'd episodes of Discovery Health Channel's series "NICU". Why didn't I realize it would be "A Baby Story" dressed up in ventilator tubes and strung in bright, overwhelming lights? So disappointing.

The series is really about traumatic birth events where infants end up in the NICU by the grace of god or they would DIE. Yes, I realize that the NICU is a necessary place with lots of good, very well-intended physicians, nurse and others. Many babies would not survive without the highly technical care that a NICU provides. What was offensive to me was the sweeping dramatization and sensationalizing of the real trauma being inflicted upon those mothers and fathers and infants in the NAME of saving lives. That was the show. Not a sensitive, inside look at the life of infant and family experiencing the many days, weeks and months of a NICU admission. The show only highlighted the traumatic birth, over-reactive medical care, and then fast-forward, the baby's discharge day.

Here's a news flash: It doesn't have to be that way!!!! The trauma, the rough handling, the universal separation of infant and mother, the lack of breastfeeding, the overall normalization of medicalized births and beginning of life? It doesn't have to be that way. Mothers and infants have a right to be together after birth. Being close to the mother helps stabilize the baby's breathing, heart rate, nervous system, temperature, glucose and more. Overwhelming and painful experiences impact the developing brain, the brain doesn't "shut off" because the body is being saved. We can resuscitate and preserve neurological development at the same time. The opposite of all of that is what anyone who watched the show now knows of a NICU.

The lived experience of the NICU shouldn't be cheapened by such a show. Mothers, fathers and children shouldn't have to feel the ambivalence of being grateful for the care that saved/preserved their precious one's life while at the same time carrying the scars of separation, birth trauma and losing those never-to-be-had-again moments. The toll is great, too great. Any show about the NICU must honor the real experience and serve to highlight those places where compassion, sensitive and appropriate care is the norm.

Friday, July 30, 2010

Driving Lessons - For Wisconsin

Now I know that in the big scheme of things this isn't really worth getting myself all work up about, but I seriously about have a stroke every time I find myself driving through Wisconsin. What up with the left lane possession-phobia? Geeeyaaah!

Seriously, some basic common courtesy, highway driving etiquette is needed in this State! I'm sure that the majority of Wisconsinites are fine, wonderful people when they are NOT driving on the highway. When they are, they suck. So here are my suggestions for them:

1. The right lane is the lane you get to go whatever speed you like, really! No pressure.
2. The left lane, the one you like so much, is for PASSING. Sure, if there's no one around, hang out in that left lane all you want.
3. When another car comes along however, that would like to go just a smidge faster, please yield. Here are some finer points to yielding:
- DO NOT speed up only to slow down as soon as you encounter more traffic that makes it impossible for someone (me) to go around you.
- DO NOT speed up and block other cars into the right lane if they might venture to pass you on the right since you have refused to change lanes.
- If by some luck, the other drives does pass you, do not race down the road hunting the other down to prevent their speedier progress.
4. I promise, changing lanes is not difficult at all. Just a slight turn of the steering wheel usually does it. And yes, you can get back to your beloved left lane as soon as I go by, that car a mile ahead should not be a problem in the event they are going the same slowish rate as you (well, except for your sudden love of speed when other cars approach).
5. When there is traffic, sure, it may take awhile to move over, the car with the intention to pass should not hang out on your bumper or anything. As long as you are actually passing other cars in the right lane, that's cool. Just MOVE OVER once you've actually passed all of those cars. Please.
6. A turn signal is not a beacon to your inner toddler - yes, you must share the road and let a car that needs to change lanes to make their exchange/exit safely. You do not always have to be "first"

Since this lesson may not reach the majority of Wisconsin drivers, if any, and due to the fact that knowledge alone results in 0% change in practice, the following tips are for those of you from the other 49 who may find yourselves driving on a Wisconsin highway. You must understand the psychology of the Wisconsin Left Lane Lover. :
1. As long as you appear to want to get around them, they will go as slow as they like.
2. If you try to pass on the right, they will speed up.
3. You don't actually have to pass them if you stay in the right lane and it appears that you might get ahead of them. They will now go a rate of speed that is appropriate and you don't really have to go around.
4. However, with so many Left Lane Lovers, the right lane is generally free and clear anyway. You can drive in the right lane all day long most of the time without any obstacles.

Is there another route between Minnesota and Chicago?

Tuesday, July 27, 2010

The First Decade of a Millenium

This post takes its cue from a post by Sarah over at One Starry Night about change. Sarah shared some intense life events over the last decade and that she fears change. If you don't follow Sarah, I definitely suggest that you go check out her blog. She is a truly authentic person and I think that's why her photography is so amazing!
Well, her post got me thinking about my own reactions to change. I tend to embrace change and am always looking forward to "what's next?" I'm not sure what that says about me, maybe that I should take time to enjoy the moment and perhaps be more reflective about what has passed. Since I'm in the midst of some big changes right now, looking back over the last decade seemed like a great idea!!

2001 - In June I gave birth to my first son. It was a dream come true, except for the c-section. Even that was sort of a blessing in disquise. I returned to work the week of September 11th. I mourned that my little boy would grow up in a world fundamentally different from the one I'd known. At work, I started on my APIB reliability (Assessment of Preterm Infant Behavior) and went to my first NIDCAP Trainers Meeting in Skamania, Washington.

2002 - A good year for my family. In August I became pregnant again. Trainers meeting was in Colonial Williamsburg, VA

2003 - I gave birth to my daughter on her brother's birthday by CBAC (cesarean birth after cesarean - a term used to describe a "failed" vaginal birth attempt after cesarean). Probably one of the worst years of my life but as with most things, it really did serve to make me a stronger person. Another mark on this year was the sudden onset of optic neuropathy experienced by my husband while we attended the NIDCAP meeting in Estes Park, CO. This is typically a "first strike" symptom of Multiple Sclerosis. *knock-on-wood* so far so good for the most part!

2004 - I achieved reliability on the APIB and continued my studies to train under Heidi Als, PhD to become a NIDCAP Trainer. Trainers meeting was in Oklahoma City that year. "I loved that world" my 3-yo son said as we left - Trainers meetings are great for my family who get to play while I'm working away!

2005 - Achieved reliability as a NIDCAP Trainer ! Also became pregnant with my second son. A great joy to me as I felt like I was really getting another chance to do better for myself and unborn child. (Trainers meeting was in Connecticut - my colleagues from Holland were amazed to hear of the barbaric birth culture here "don't most people give birth at home?" they asked)

2006 - Started off with a bang and had my son naturally on his due date at the end of January by vba2c. That's vaginal birth after two cesareans. Getting there wasn't easy, and I had to search and search for a provider to "allow" me to labor. (looking back I wish I'd done a home birth) I did find a provider - right down the hall from my office. Trainers meeting in Sun Valley, Idaho - hey these are the only vacations I get!

2007 - Had my first miscarriage that summer. Agonizing experience. Meeting was in Combrit, France. Went on a 2 week trip through Germany and France with hubby. Lots of fun! First time ever away from the kids. We missed them terribly.

2008 - Had my second miscarriage that summer. Even worse experience than the first and fell into a deep depression that I'm maybe even just now starting to recover from. Meeting was in Raleigh, NC where I met Nils Bergman - the main speaker for the conference I just recently put together.

2009 - The year of existence. My husband went on a freak out mission and did some really crappy things, which maybe someday I'll be able to write about. Planned and hosted the NIDCAP meeting in Chicago. Really enjoyed event planning, so soon after, I initiated the planning for the Skin to Skin care conference this year.

2010 - A big year of change for me. Here's a few: starting grad school in the fall, dropped my percentage at the med center (will continue on as a NIDCAP Trainer) and started working part-time at the Erikson Institute. Trainers meeting is in The Netherlands later this year! Still working on the marriage with my new motto: Love is the Only medicine.

Wednesday, July 21, 2010

ACOG announces new VBAC guidelines

Wow, I can barely believe that this press release is real. I am really grateful for the hard work and advocacy from ICAN (International Cesarean Awareness Network) and all of the wonderful women out there that have had a vbac, tried for a vbac and those that simply wanted one and were turned away. It was you who all raised your voices, believed in what birth could/might be and brought awareness and HEAT to the powers-that-be. In this case it was American College of Obstetrics and Gynecology.

I know that this won't result in some miraculous reversal of vbac bans or defacto bans, but it is a big step in the right direction. Changing the hearts and minds of those who truly believe that vbac is "dangerous" will take a generation or more. I just pray that first, women will be sparred that scar but if they should have one, that it will be the only one. I pray that the struggles I had through my primary section, cbac (cesarean birth after cesarean) and the long journey to a successful vba2c will somehow be lessened now for others.

A facebook and IRL friend posted on this Facebook today and I think it is perfect for today!

"I am only one; but still I am one. I cannot do everything, but still I can do something. I will not refuse to do the something I can do."" Author: Helen Keller

I couldn't agree more!!

Tuesday, July 20, 2010

Challenging Paradigms - Part 1

Burning questions of the day: How best to approach issues where culture, nature and science clash to create disparity and disease? Can health care and mental health professionals be both public health minded AND individualized? Can we utilize research and best practices to support parents and children to live healthfully while also preserving individual choice? When does personal need, culture or tradition trump science and public health concerns? What happens when something challenges us to examine our current paradigms? Can we adjust those paradigms to care for individuals as well as groups at large?

This past week I hosted a conference on the science behind the benefits of skin-to-skin care from birth through the first few months of life for all babies with this conference having a special emphasis on the need for skin-to-skin contact for the smallest, most premature infants. One of our main speakers, Nils Bergman ( speaks to current knowledge in neuroscience, animal studies and his own randomized control trial of 1200 - 2000 gram infants who were randomized into a control group (standard small baby care = separation) and an experimental group (no separation) with the medical care provided being exactly the same. His outcomes found that the incubator destabilized infants while 100% of the infants without separation were stable within 6 hours. His overall conclusion - Incubators cause harm. He then goes into a mini history lesson about how incubators came into fashion and how the paradigm emerged that incubators were better than the mother's own body. He is actively challenging that assumption with his work and also challenges institutions to rethink how and why they do things the way they do.
Interestingly the physicians barely blinked when presented with this provocative message. Honestly I just don't think a message like that can fully sink in when one's paradigm is still firmly in the "incubators save babies" camp.
From an allopathic perspective, I sort of "get it". If you are trained to see concerns, worries and problems as something to be "fixed", then you might have a tendency to look to your bag of tricks from technology and/or pharmacology and not move beyond that much. Health care professionals tend to assume "normal" takes care of its self and, unfortunately, "health" is the big misnomer in health care. There are exceptions of course but those tend to fall into the gone-overboard category such as lack of access to VBAC in order to reduce risk of uterine rupture, militant recommendations for "safe" sleep to prevent SIDS, and others that typically become one-size-fits-all solutions in a misguided, impossible attempt to reduce/control all risks.

I wish more researchers and scientists would challenge us to look at our assumptions. Randomized controlled trials might be the gold standard but who checks on whether the paradigm that underlies the research question is still valid? In my opinion, most studies pertaining to maternal/child care ask the wrong questions or worse, ask questions that can never be validated under the flawed paradigm. If we are to make radical changes in HEALTH outcomes for infants, then we have to be able to look beyond the barriers of our current paradigms (that's fine for third world societies that don't HAVE incubators...well, OUR families would NEVER want to stay with their baby in the hospital for that long, breastfeed on demand, etc...) and start to challenge all of our assumptions. Of course most don't have the kahunas to take on that task. Paradigms and assumptions come wrapped in emotional ribbons.

Friday, July 9, 2010

Attachment Dentistry?

I took two of my kiddos to the dentist today to have some cavities filled. Apparently they inherited their dad's cavity-prone gene. Poor kids, this is my 7 year olds 2nd cavity. Her first was about a year and a half ago. The day I took her in for the filling, she was happy and unaware that going in to take care of her "sugar bugs" was any big deal at all. She climbed into the dental chair and was really doing okay until the dentist said, "now, I don't want you to be scared.." Great. What a stupid thing to say! She immediately began to cry and reach out for me so I sat at the edge of the chair and comforted her and reassured her. The dentist immediately started to say "if you keep crying, your mommy will have to leave, you don't want to make your mommy leave do you"? That woman was so anxious about filling this child's tooth that she spilled it all out all over my daughter! I told her, the dentist, in no uncertain terms "I'm not going anywhere. She just needs to be reassured". I still kick myself that I didn't walk out of there right then but we didn't and she got through the appointment. We never went back.

Since then, I've found a really wonderful pediatric dentist who takes the time to show the children all of the equipment, lets them explore, etc... until he sees that they are okay and comfortable. He's a relationship-based practitioner rather than a distraction practitioner, which I really appreciate because that's hard to find! (He's a little bit of eye candy for momma too, so bonus) I told him and his assistant today about what had happended with the last dentist threatening her with making me leave. The dentist took extra time and was great.

Just before starting the procedure he stepped out of the room for a minute and the assistant apparently felt the need to defend her unknown colleague . "We've done that too here, the kids usually stop crying. Lots of time they just cry because their mom/dad is right there, once they leave they are fine. And this one (the dentist) doesn't like the wrap either (some sort of child straightjacket) but once another dentist found out that you have to use them because the kid moved and she cut his cheek real bad".

My exact response: Please don't ever do that again then. A cut cheek will heal but, as you can see with my daughter, fear and anxiety from being threatened with the violence of abandonment, or worse, subdued and physically held down at the moment when a child needs security the most is emotional blackmail at best and abusive. Children don't cry or cling to their parent for no reason, or worse, as a way to manipulate you. They are scared for a reason and that reason should be honored and discovered. Don't ever do that to a child again. Please.

The dentist came back in then and she buried her head in her tasks and never said a word to me. My daughter willingly and happily had her tooth filled. The dentist said "I'm so proud of you" over and over. It was beautiful. I thanked the doctor and told him I appreciated that he had respected my daughter enough to give her his time and attention. I thanked the assistant too. I don't know for sure but I think a little seed of knowing took hold in her - I doubt she'll ever threaten a child again without at least thinking twice.

As a mother I see it all too often how deeply society believes the worst of children and how quickly violence is enacted upon children as some sort of solution. It is very insidious. I'm glad that things went well for my children today and that I also had a chance to maybe make a difference for another child in the future. I'm going to write a letter thanking the dentist for his compassion, he likely needs the support and encouragement to continue on this path. I'd like to also add in some references for him to share with the staff about being mindful in their work with children. Any suggestions?

Tuesday, June 29, 2010

Can't we ask the "right" questions?

Humpf. I'll just say it. I'm frustrated. Can I get my PhD and several huge research grants, like, tomorrow? Humpf. Or better yet, yesterday.

The source of my angst? I'm just very, very tired of seeing actual scientists/researchers continuing to ask the wrong questions as it relates to the care of preterm infants, newborns and mothers. Why are we doing research that asks if doing A or B is better based on the flawed paradigms within which the ENTIRE medical community works?

Can't we find ways to look at how basic paradigms are sustained despite effective research to the contrary? Shouldn't there be some lithmus test for research proposals that sounds the "uh-huh" alarm when the scientific question is based on the failed paradigm? Yes says me. Et tu?

Sunday, June 27, 2010

I'm not just singing to the choir OR our best ain't good enough

I met 28-week Jasmine first, observed her powerful efforts to keep her tiny, one and a half pound body tucked, arms and legs folded in close for security as if trying to recreate her experience in the womb where she’d been just hours earlier. The sounds of the bright and busy intensive care nursery, the breathing apparatus, the lines and unwieldy diaper she wore, all weighed on her attempts to find a comfortable moment for rest. Her nurse that day generously responded to my suggestion to encourage Jasmine to quiet her movements by adjusting her blankets, rearranging her equipment, and quieting the room so that Jasmine could rest while being softly supported in a tucked posture. Jasmine grasped my finger tightly as her nurse gently adjusted her blankets, and then fell into a quiet, relaxed sleep. I headed down the hall to the post-partum unit to meet her parents. Tina and Jason greeted me hesitantly; their anxiety that I might bring unwelcome news of their newly born baby girl somewhat relieved as I introduced myself and congratulated them on the arrival of their amazingly strong and engaging baby. Tina, recovering from emergency surgery due to placental abruption, pre-eclampsia, and having not yet seen her baby, smiled weakly to my account of Jasmine’s behavior. As the days turned into weeks, Jasmine and her parents spent many hours together, somehow managing a bright attitude despite the lasting effects of pre-eclampsia damage to Tina’s body, the unexpected infection that put Jasmine on a breathing machine for a short time, and the difficulty of spending hours with little privacy or comfort. Along the way, I spent time with Jasmine and her family, guiding and encouraging them in their developing roles. I experienced satisfaction that Tina and Jason felt safe to share their worries, frustrations and hope during our times together. I managed effectively to advocate for a quieter room and a number of nurses invested in this family regularly cared for them. Despite these good efforts, I am left with the challenge of “was it good enough”? far too often. As typically occurs in so many instances, the earlier appreciation of the baby’s need for a supportive environment in which her abilities emerge, gives way to the hope that pushing the baby to “take a bottle” will result in an earlier transition to home. Despite what I felt had been a particularly successful process in providing this family the foundation to navigate past the typical obstacles, the forces of habit and NICU culture prevailed. Ultimately, Tina and Jason took Jasmine home healthy yet, breast-feeding abandoned. Furthermore, I know they experienced undo pain and plenty of conflicting messages as to their competency as parents along the way. The story of one family continues on long past "discharge"; the chapter of time when I get the privilege to walk along with them carries a great deal of joy yet also, the burden of always wanting and needing to do more with the little time that is given. Families who must endure the NICU deserve better. Evidence and logic demand it. While there are many who sing the same song, there is much work to be done.

*names and details have been changed to protect privacy*

Sunday, June 20, 2010

To those little lost souls

As Father's day winds down and as I sit here cruising the Internet after an ill-conceived cup of coffee at 7pm, my mind keeps turning to the memory of two little ones who spent only a few short months in my womb. Part of me hopes that by finally writing these last two birth stories that I can finally heal the sadness that shadows me every day. Maybe by writing about them I can give them new life and free myself too.

Larry was an angel - He came and left without any stressful obstetric/maternal care interventions or choices. He gave me the gift of a natural miscarriage, one I knew was coming and for which I waited, confident after my vba2c in my body's ability to manage it. It wasn't exciting or pleasant, but in a way, I birthed him and was able to bury him. The completeness of this I found out later was really important.

About 10 months later, I was again pregnant. I felt fearful that I would lose this baby, Lucy, too. I went to see some midwives that I'd hoped would help me with a home birth for the next baby. Although I'd had a successful hospital vba2c, I really wanted to have a home birth but still, apparently this isn't a real option for women where I live.

At 10 weeks I asked for an ultrasound. I knew that something was wrong. As the technician did the ultrasound I could see a darling little fetus but I knew that she had already passed. The technician sent the doctor in to tell me, but I knew. I really wished I'd brought my husband with me...I was awash with grief.

I decided to once again wait for a natural miscarriage and told the midwives that I'd seek obstetric care if necessary. I went up to visit my family in Minnesota and cried for a week and begged my mom to keep my children another week. The night my husband and I drove back home, I began to bleed and the bleeding turned into hemorrhaging pretty quickly. I felt like I was in labor.

I ended up going to the emergency room at a local woman's hospital. I was treated very poorly for choosing to wait for a miscarriage. "You should have had a d&c, this is what happens if you don't, who LET you wait"? Yeah, I make decisions about my care - no one LETS me do anything! When I asked about taking the fetal remains so that I could bury the baby the OB acted as if I were completely insane. "No one has ever asked to take it home with them! It is a surgical by-product." Thanks for completely dehumanizing me and my baby! I tried to, calmly at first, explain that I didn't need to take it home with me in a jar, but that I wanted to make arrangements for the proper disposal of her remains that would be religiously significant TO ME. I am still very upset about how I was treated. Luckily a social worker came and confirmed that, yes, people arrange for the disposal of their miscarried babies all the time. A local funeral home even donated cremation services for just such a situation.

So here I am, 2 years after losing Lucy, and I am still feeling very sad. This isn't how I wanted my reproductive years to end - with the bad taste of insensitive maternal care in my mouth and psyche. Not to mention that these two losses brought out the worst in my marriage....and we are still trying to work through that. No inspirational message there. Just life - it can be raw sometimes.

Monday, June 7, 2010

Sunshine all the Time! at

Feeling a bit nostalgic now.....

My VBA2C and yes, I claim it!

For some reason, it has taken me 4 years and 4 months to write this and my previous birth stories. I understand why I am doing it now. I am on the cusp of a new chapter and old chapters need closure before new ones can begin with full attention.....

Even after the debacle that was the cbac birth of my daughter and despite our previous experiences with infertility, I was hopeful that I would somehow find a way to birth another baby. One day I was walking through Costco and saw one of those mega packs of pregnancy tests. I looked at the package and thought "I'm pregnant". I went from there to see my hair "guy" but peed on the stick in the salon's bathroom. Yep, I was pregnant and I wasn't even late yet. Yeah! Even though I was of "advanced maternal age" at 39 at that time, I was quite certain of the outcome. I would carry the baby to term and deliver him/her vaginally and naturally. I knew this with every fiber of my being.

I began prenatal care with my OB/RE and didn't mention anything about wanting a vba2c. I knew he wouldn't go for it and it wasn't worth stressing either of us out over it. In the meantime I began to call OB offices in Chicago, found the national ICAN yahoo group (my lifesaver), and attended homebirth meetups to learn more about natural birth. None of the OBs I contacted would even consider a vba2c, neither would any of the home birth midwives or the one home birth OB in town. So many times I posted pathetic messages on the ICAN group like "All hope is gone" and "why am I being so stubborn". Thankfully my ICAN friends always brought me back to reality and reminded me that there are ALWAYs options, even when we don't think so. They helped me see that my hard labors might have been due to malposition. #1 had a compound presentation and I think #2 was anterior. I started to see a chiropractor to give myself an edge on positioning (plus I was still in pain from the dislocated sacrum from #2 labor). I exercised and was the healthiest I really had ever been. I spent hours reading birth stories, studying the research and understanding my fear of birth/pain. I ordered a hypnobirthing home study CD set and listened to it every night. I found a wonderful doula who was a vbac and hbac mom herself. I was increasingly strong, determined and unwilling to compromise. Family and friends "worried" about me but I was very clear that I was following my instinct and honoring my inner wisdom. Plus, I knew that I was growing within myself a stronger woman, a woman who "finishes what she starts". No more did I say things to myself like "I want a natural birth, but I won't be a martyr if I need an epidural or c/s". Now I told myself "no one knows YOUR body better than YOU, interventions are NOT an option. Period."

Finally, when literally all my options were exhausted, I decided to ask one of the midwives at the hospital where I work if they ever had cared for women who wanted vba2c. You can not believe how much courage this took! I work in the NICU as a developmental specialist and I'm always trying to balance what babies and families need for support against the realities of the medical team's emotional availability to be open to new concepts and paradigms so that I can gradually mold that availabilty for the benefit of babies/families. One of the most enlightening aspects of this journey for me was how relevant my road to vba2c was to my professional passions. Anyway, the midwife told me, as if this was not even a big deal, "yes, we support vba2c, in fact our chief is actively working to keep our primary and repeat c/s rates low." Wow. I was so surprised! Could I imagine giving birth just a few steps away from my office? I felt horribly vulnerable but that wasn't going to stop me. I'd found a supportive caregiver!!!

A few miscommunications later and a few VERY satisfying episodes of telling-off stupid residents by citing actual evidence, I officially switched providers at 32 weeks.

The night before my due date, I went to bed around 10pm with some early contractions. I slept for a little while but then woke up around 2 am and practiced breathing and using the relaxation techniques from the hypnobirthing CD. That worked for about an hour then I went downstairs and got out my birth ball and just rocked on it for awhile. Around 6 am I woke up my husband and told him that things were progressing. I fully expected this time that I might have the same quick, intense labor as I did before so I didn't panic when the contractions became difficult to manage. I had also arranged to have a TENS unit as an option for pain control so I stuck that on and continued to rock over the ball while my husband called our doula, Tama, and got the kids ready for school. Tama got to the house around 7:30 am and my husband took the kids to school. Tama encouraged me to squat but that made the contractions really intense. I remember thinking "you are resisting the process! just let go and let it happen!" When hubby got back we decided to try some time in the bathtub. Oh heavenly bathtub!!!! The contractions were still intense but I felt like I could stay "on top" of them while in the water. It was a sunny but bitterly cold January day and the hot water ran out early on. Hubby literally was boiling water and pouring it in the tub. I was so angry that he couldn't get the water warm enough! lol.
Tama was perfect. She simply sat next to the tub and calming interjected a few times to breathe. She somehow knew that what I really needed was her physical presence, without any undo distraction. I loved the tub and didn't ever want to get out. Oh why didn't I plan a UBA2C! I really wanted to stay at home at that point but I thought that probably wasn't fair to Tama to ask it of her. She finally coaxed me out of the tub. I remember being so afraid that my water would break if I walked across the living room to go out to the car. They finally got me in the car around 11am wearing only a sports bra and a towel wrapped around my waist. :-) Incredibly the contractions slowed and mellowed on the way to the hospital. I actually felt good, sensual and so in-control! I was totally into it, moaning and breathing, it was great. I got to the hospital and of course the ER wanted to ask me a whole bunch of stupid questions to which I gave them NOTHING. I didn't owe them anything. This birth was on my terms. In the elevator I was "vocalizing" and I heard someone say, "is that Jennifer"? Ugh, yes, giving birth at work is a bit, well, public. And there I was basically naked on an elevator full of colleagues.

One of my big fears from before was Triage. I had my husband call the unit to tell them we were coming and to make sure an actual room was available. My midwife friend (who wasn't allowed to deliver with me due to me being high-risk, puke) had everything smoothed over for me and we went right into a room. Of course right away an IV went in and they slapped a monitor on me. I was squirming around so much that it was hard to get a read on the monitor. They suggested an internal monitor to which I replied "NO"!!! Geez, the baby was going to be there any minute anyway. I did agree to let them rupture my membranes and that was a huge relief. I went from 8 cm to complete instantly. My only regret is the purple pushing position thing. But it wasn't horrible and I couldn't believe I was actually pushing! It was wonderful. I felt no pain at that time. I was doing this thing that I always knew I could do and had let so many things get in the way of. As soon as my baby was born I said, "I want to do that again"! I was on such a high. My son was placed on my chest and we started nursing. This is how a nursing relationship is supposed to start! What a difference.

I had a few stitches placed, I teared a little, at the time I thought the pinching sensation was the damn residents hands in the way. Maybe it was, I was really annoyed that she was doing anything down there.

Then I got up, went to the bathroom and walked around, holding my baby. When there was a mix up with the cord bili labs, I walked down to the nicu and greeted my coworkers so that I could support my baby during a blood draw. "you don't even look like you just gave birth" and "why are you walking around"? were typical comments. But I felt great!!! I begged the doctors to let me go home early. I was out of there 20 hours after walking through the door.

My little boy was born on his due date at 12:12 pm and so was I after a very, very long gestation.

Written with love on the 9th and 7th anniversaries of 2 c/s.

Tuesday, May 18, 2010

A mother of a birth story - love and pain

As I begin to write, I am honestly not sure if I can remember all of the details. Sad as it is to say, the memory of my daughter's birth brings a rush of emotion: grief, shame, regret...yet also love for her and gratitude that from this life-changing event, many good things have flowered from the bad.

After our son's first birthday, I cautiously considered the hope of having another child. Back during the time of our infertility, I had often stated that I really thought that if I could only get pregnant once, my body would figure out how to do it again. Was it okay to greedily wish for another child? I pondered this and whether I had the guts to get back on the fertility roller coaster. I remember making a very conscious decision one day that, yes! my desire for another child was too great to be denied. I made an appointment to get a referral for the reproductive endocrinologist immediately. I believe I was actually one day pregnant the day of that visit. Lesson #1: My intuitions should be respected and that positive decisive thought is powerful .

I continued my prenatal care with my previous OB and once again enjoyed a delightful pregnancy. Co-workers lovingly informed me that I was "soo beautiful last time, this time, no". Apparently this was their kind way of suggesting this baby would be a girl. ???? It didn't matter, I felt beautiful. I also assumed that I would try again for a natural vaginal birth. Of course. At one of my later prenatal visits my doc asked me when I wanted to schedule the c-section. Literally my jaw dropped. That was completely out of left field in my reality. I had NO IDEA that vaginal birth after cesarean (VBAC) was even an official "thing" or that some hospitals or doctors were unsupportive. How the f did that escape my radar? After all, I do work in the maternal-child healthcare industry. I had already forced my husband to go to a refresher Bradley class and now I decided to look into a doula. I interviewed a newly practicing doula who was affordable. She was nice enough. I didn't know what I should be looking for but I knew I'd gone to the hospital much too soon last time and I wanted to avoid doing that again. I knew that I was a "wimp" about pain and that for sure the hard and fast labor from before wouldn't happen again. All labors are different. This time would go according to plan. Ugh. I didn't do ANY emotional work. Also late in our relationship my doula "disclosed" that she'd had a traumatic medical experience at the hospital I was going to deliver in (the same place as #1). This turned out to be a rather important factor. Lesson #2: Pay attention to that voice inside no matter how muffled she may sound and DO the emotional work, be ready for everything.

Two years to the day of my son's birth, I went into labor, 4 days before my due date. The labor came fast and hard. I called the doula. She arrived. I didn't know what to do, neither did she. We went to the hospital right away. The sun was blinding me as sharply as the labor pains on the way there. I arrived to the same Triage space, the nurse yelled at me to stop moaning, to get out of the bathroom, to wait on that damn cot and put the monitor on. I couldn't take it. It was the same day, it was the same. The same! I begged for the epidural. The doula looked frightened. I went to a labor room. Everyone left. A young doctor stabbed my back 20 times. A nurse yelled at me to "be still". I was in transition. "Stop trying to put the needle in my back, I want to push". "Be still!!!". Epidural finally in. Doctor on call checks me. 10 cm. Yeah. I'm numb. "PUSH". I can't feel anything. The doula is silent. We have to put in an internal monitor. Baby's heart rate is dropping a bit with contractions. "You can't do it". Consent to c-section. No rush to OR. Baby is born, apgars 9 and 9. Swaddled baby flashed in my face. "she's pretty". It's a girl? tsk, tsk, so much scar tissue.

The next few hours after that are lost to me. I just remember being in the maternity ward with my baby and trying to nurse her. She couldn't latch quite right, just like her brother. At one point a nurse came to give her a bath and despite my request to do so in the room with me, she took her out for the bath. An hour later I called to find out where my baby was. "Oh she was a bit cold so we put her under the warmer". ???? Please bring me my baby, I pleaded. Another hour later I threw a temper tantrum to get my daughter back. She still couldn't nurse, who knows, but I'm sure she got a bottle while she was gone. Suddenly, I was in excruciating pain. I called for the nurse who gave me serious pain meds. The on-call doctor who did the section came by and whispered to my husband, "I hope you don't plan on having any more children...lots of scar tissue". The pain continued to worsen so around midnight I was taken to radiology and a probe was placed in my back into my right kidney and snaked through to where my ureter was supposed to be. The ureter connects the kidney to the bladder. I was watching the probe on the x-ray monitor and could see the probe and barium progress through my kidney, through the upper part of my ureter to....nothing. Empty space. The doctors had told me that they suspected there was a "stitch" in my ureter. I could clearly see there was no stitch - it had been severed. But I played along with their "stitch" game. Went down for a horrible procedure to try and "unplug" the ureter by going through my urethra and bladder. No luck. duh. So a drain was placed in my back to keep my kidney from shutting down by allowing my urine to drain and collect into a plastic bag strapped to my thigh. I was also unable to nurse my daughter for 10 hours because of the barium.

I went home with the kidney drain, a constantly leaking urine bag on my leg, the c-section wound, a dislocated tailbone (somehow I popped my tailbone out during one of the really strong contractions), a small, barely nursing baby, a two-year old and the promise of another major abdominal surgery in 6 weeks to repair my ureter.

I was determined to nurse my baby and we worked diligently at it for 4 weeks before she was able to do it very well. At six weeks, I went to a different hospital for the repair. I insisted on taking and keeping my baby with me. I had to check and double check many times to make sure that all medications given would be compatible with breast feeding. Nurses admonished me for bringing "that" baby into a dirty hospital, pain and discomfort was the norm but I was determined in a way I had never been before. For the first time in my life I didn't' give a DAMN what anyone else thought or wanted. After that surgery I had to have a catheter in my bladder (much worse than a drain in my back) for another 4 weeks. I was enormously depressed and in constant pain from my tailbone long after the other wounds healed. Through it all my daughter was the most lovely and quiet baby. It makes me cry in fear that she was like that because she couldn't afford to be all fussy and demanding. A sacrificial offering to her mommy. I told her one day a few months after I felt better, "honey you can cry and wail now if you want. Mommy feels better now". She just smiled and cooed gently. Unbelievably, I went back to work after 12 weeks of leave. I was nowhere near ready to do so physically or emotionally. Lesson #3: Be selfish, be determined, be good and kind to yourself - it's not selfish after all. You and your baby deserve a whole and healthy mommy.

Thursday, May 13, 2010

A mother of a birth story - The first cut

After the miraculous conception of my first child, which is a whole fantastic story as well, I enjoyed a fabulous pregnancy. Yes, I am that woman. No morning sickness, just the right weight gain, no problems. Besides, I LOVED being pregnant. I loved the smiles of passing strangers, the belly rubs, my changing body, everything. I could have done without the horror birth stories but I didn't pay them any mind. I was going to have a natural birth. And those nightmares of my child dying in childbirth from my fear? I was quick to suppress those thoughts whenever that came to mind.

My husband and I went to Bradley classes. This should have been a red flag at some point but I was extremely anxious about his overall interest, or lack thereof I should say. He honestly couldn't figure out what I was worried about. His mother had 8 children, himself a vaginal footling breech delivery. "What's the big deal"? Umph. Wish I had shared that sentiment back then too.

I was so...stupid. I knew nothing about birth. I loved my OB who'd been my reproductive endocrinologist as well. He was and is a very compassionate and caring man. What I didn't know is that he believes that babies should be born at 36 weeks, ideally. (cringe) The hospital I was to deliver at had an alternative birthing center which was actually a room down the hall from the labor ward with a queen size bed and a dorm-room refrigerator. When I went for the tour, I asked the nurse about the space. "Oh you won't want to go THERE. You are going to want an epidural". I chuckled at her simplistic view and said jokingly, "well you won't MAKE me have one will you"? Ha! ha! ha...

Fast forward to week 38, my OB suggested I get induced by week 40 if the baby hadn't come yet. I at least knew enough at that point that I was not willing to even talk about induction. I went into labor at 41 weeks, 3 days while shopping at Costco. Contractions were about 15 minutes apart and pretty intense but I kept shopping. My mom was coming that afternoon and I just HAD to everything ready. (shrug) I went home to my husband who was busy re-building our back porch. If you've ever seen Chicago city porches, you know this is a massive project akin to removing the entire back half of your home and rebuilding. We had to have electrical service discontinued for him to do the work and he was in a panic to get it all done before "baby" came.
I took a shower and called my doctor who told me to call when the contractions were 2 minutes a part. I called back a minute later because they were 1 minute apart and painful! On the way to the hospital my husband stopped at Wendy's and asked if I wanted "anything" as I writhed in pain on the passenger side of the car. If you've ever seen that episode of "Family Guy" where something similar happens, that was us. It really makes me laugh to remember it. "I figured this could take awhile and I'm hungry", he said. Really, he had a point.

I got to the hospital and was put into Hell. They called it "Triage". Put in a tiny cubicle, strapped up to a bunch of wires and told constantly, a laboring women with nonstop contractions, to "settle down" on the stupid cot and guess what happened? I lost it. There weren't any labor rooms available and I was only 1cm. That freaked me out. Based on my Bradley class, these contractions had to mean I was in f'ing transition!!! Of course 2 hours later, in Hell, I find out that the labor rooms weren't available not because they were in use, no, there weren't any CLEAN ones available. "I'll clean the damn room myself"! I shouted. In the meantime I let them give me a HALF dose of Stadol. That was horrible. Now I felt all of the misery but was looped out so that I couldn't bother anyone with my complaints. Finally they got me into a room but now I felt dizzy and nauseous and just wanted to go sit on the toilet. Oh no! I was dizzy and therefore "un-safe" to walk 4 feet to the bathroom with my nice husband at my side. (I am completely skipping the part where my wonderful husband was texting and ignoring me as I reached out for his help while in Triage. "You were only 1cm, I figured it was going to take awhile", thanks.)

Just for the record, I want everyone to know that it is anatomically impossible to pee on a bedpan while on your back and having serious contractions. I had to sneak to the bathroom when the nurse left the room. My good friend, Ann-Marie in the meantime had gone to pick up my mom from the airport and they arrived at about that time. Their empathetic, frightened faces were a great comfort. Really! Husband, exit stage right. ??? I don't remember seeing him again until we were in the OR.

Of course I'd begged for the epidural by this point but first we had to wait for the room, then we had to wait another 4 hours for an anesthesiologist. ??? Mean nurse and doc kicked my family out of the room to torture my into an impossible position and yelled at me to sit still. I'm sorry but constant contractions make sitting still kind of difficult. Finally the epidural was in and I was SO relieved. My OB came by right after that and told me that my cervix had swelled and that I was still at 5cm and regressing. I would "need" a cesarean. At that point I would have agreed to anything. My friend left and I was prepped for surgery. My poor mother was threatened with expulsion if she did not agree to stay off the unit as it was past visiting hours and she was not "allowed" near the surgical suite.

As we prepped for the surgery, I was calm and ready to see my baby. That changed when my OB literally sat on my chest to pull my son's head out of the birth canal. He'd wedged himself in there with one hand over his head. (For almost the whole last half of the pregnancy I kept saying I could feel his hand tickling my cervix). That scared the hell out of me and I thought for sure that he was going to die. Finally I heard him cry and instantly I knew he was okay. I didn't get to see him right away but he was somewhere close by with my husband as they closed me up.

In the recovery room I held him and tried to nurse. He wasn't interested at all and suddenly a big, anciently old nurse wisked him away to "bathe" him. I asked her to at least do it near me so I could see him. Poor little guy, what a traumatic event when you are less than an hour old!! I was so powerless to ask for anything that was important to me. I had shunned the idea of a birth plan because I figured everything would be just fine.

My son was born at 11:50pm and by the time I got into a room, it was really late. My husband took my mom home for the night. I've never felt so lonely in my whole life! Swollen from the surgery, in pain and barely able to do anything for my baby. At first he was placed in a bassinet at the foot of my bed. How was I supposed to get him from down there? Hello? I just had major surgery?! Finally I got the nurse to hand him to me and I didn't let him go the rest of the time. Nursing was really hard at first, frustrating for us both as he had a hard time latching for the first 36 hours. I pumped my colostrum and fed him with a spoon when we were both crying and exhausted; eventually we got the hang of it. The one bright spot was that the maternity ward nursing staff was very supportive of breastfeeding although one nurse the first night wanted to check his blood sugar, "just to make sure" he was okay with the few drops we'd managed.

Physically I recovered well. Honestly the surgery barely slowed me down. Coming home to a heat wave and no electricity for a week was a real bummer but we got through that and I just figured if we were lucky enough to ever have another baby, that I'd have a natural birth the next time.

Tuesday, May 11, 2010

A mother of a birth story - the prologue

At some point on Christmas Eve, 1965, my mother and father made their way to the hospital (St. Lukes in KCMO). Was it snowing and peaceful as they drove the short distance through the Plaza with the famous Christmas lights twinkling against a crisp winter sky? I don't know. All I know is that my mother and father were separated and that my father spent the evening in a smoke-filled waiting room with several other expectant fathers in various stages of panic. My mother was told that she wouldn't want to experience the birth of her first born child and she was anesthetized so that the doctors could literally pull me out of her womb. When she became conscious she had a beautiful little daughter all wrapped up in a christmas stocking. Isn't that cute? (bleck). I know my mom breast fed me for at least 3 weeks, but without any support or information, she gave up when I hit that 3-week growth spurt and needed to suckle more. She, like so many women, even today, thought that her milk supply was low or wasn't good enough and turned to the handy, high-class formula on hand. She didn't know any better and she wishes she had known. She was an excellent mother and very nurturing despite a remarkably un-nurtured childhood of her own.
The stories of my own birth impacted my eventual journey to motherhood PROFOUNDLY! "Birth must be so horrible that you have to be knocked out and your partner wouldn't even want to see such a gross thing" This was the sub-conscious message I received. That message fueled recurring dreams throughout my adolescence in which I would find out I was pregnant and the baby would die directly related to my fear of childbirth pain. !!!! Hello, anyone notice some foreshadowing???? Not me. Although I did attribute this "fear" and dream as playing a part in my struggle with infertility. Unfortunately I didn't give enough attention to that inkling of awareness well enough.

A mother of a birth story

This one is for Krista whose virtual admonitions ring in my head. "Dude, just write it". I know, I know, but I feel like I have to start at the beginning, the way-back beginning - my own birth. I guess I better make this an epic blog in parts....

Monday, May 10, 2010

I did it!

My stomach was "tied in rows" (as in one of my favorite songs, guess which one?)as I summoned up the courage to tell my colleague that I was planning my big move into a new job in addition to going to graduate school. It was a big suprise for her. I felt horrible that she was so overwhelmed and sad. It will be a difficult transition for us. On a brighter note, when I told my boss she was amazing! Very supportive and excited for me to pursue my degree. She's letting me keep a small percentage of my position so that I can still be a NIDCAP Trainer and help out on special projects as needed. This is GREAT news. One of the best aspects of my current job is when I get to share the amazing insights of how a tiny baby "speaks" to us with his/her behavior. Helping other NICU professionals use this knowledge to support families and babies in increasingly sensitive ways is a real joy!

Sunday, May 9, 2010

Before a new beginning, there has to be an end

So, tomorrow is the big day. The day my life changes. Okay, so I'm fairly dramatic. I'm like that. But seriously, tomorrow I'm giving notice to my employer. I've done amazing things there, with amazing people. Why leave? I'm starting grad school in the Fall at the wonderful Erikson Institute. Twenty-three years after graduating college, I am finally making this leap to get on the path towards a PhD. A lot has led up to this moment and I'm amazingly excited and overjoyed to start. But that's not why I'm leaving my current job. On the other hand, the job is the reason for the education. I want to be the BEST advocate and create the change I KNOW can be achieved for families who must endure the challenge of a prematurely born baby. Respectful maternal and child care is my personal and professional passion. At any rate, I am leaving my job to go to school and to work at the same Erikson Institute with the fabulous Fussy Baby Network. I'll be sharing lots about that and my journey as a "mature" graduate student along with plenty of thoughts on cesarean awareness, vaginal birth after cesarean (had my own after 2 c/s in 2006), breastfeeding, brain development, attachment theory, peaceful parenting and the ethological aspects of human attachment and development. That should keep us busy for awhile. :-)